SUTTON COLDFIELD CRICKET CLUB JUNIOR MEMBERSHIP APPLICATION

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1 Name: Date of birth: Current address: SUTTON COLDFIELD CRICKET CLUB JUNIOR MEMBERSHIP APPLICATION APPLICANT INFORMATION Name of School/College: Current Member: Yes No Nationality: Membership Fees: U9 U16 Teams: p U8/Siblings: 80.00p Ref Number: SPORTING ABILITY Has he/she played cricket before: Yes No If yes, where have they played cricket (please indicate below) Primary school Secondary school Special Educational Needs School Club Local authority coaching session/sessions County Other (please specify) CONTACT DETAILS OF PARENT/GUARDIAN Name: Address: Relationship: Mobile ALTERNATIVE EMERGENCY CONTACT DETAILS In the event of an incident or emergency situation where the parent or legal guardian named above cannot be contacted, please provide details of an alternative adult or adults who can be contacted by the club. Please make this person/these persons aware that his or her details have been provided as a contact for the club. Name: Address: Relationship: Mobile

2 AUTOMATIC NON-VOTING MEMBERSHIP STATUS Junior membership of the club also provides that the parent(s)/carer(s)/guardian(s) of the child are given nonvoting membership of the club as part of that junior membership. This does not entitle the parent(s)/carer(s) or guardian(s) to any additional privileges that would otherwise be gained by paying the appropriate adult membership fee(s). DISABILITY The Disability Discrimination Act 1995 defines a disabled person as anyone with a physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal dayto-day activities. Do you consider him/her to have a disability? Yes No Details of disabilty: MEDICAL INFORMATION Full Name of family doctor: Practice Address: Details of medical conditions or allergies: MEDICAL CONSENT I give my consent that in an emergency the Club may act in loco parentis, if the need arises for the administration of emergency first aid and / or other medical treatment, which in the opinion of a qualified medical practitioner may be necessary. I also understand that in such an occurrence all reasonable steps will be taken to contact me, or an alternative adult who I have named in Alternative Emergency Contact Details. I confirm that to the best of my knowledge my child does not suffer from any medical condition other than those detailed by me above. FIRST AID OR EMERGENCY TREATMENT Basic first aid may be given to your child should he/she sustain an injury whilst under the supervision of the Club. Should this occur, the Club will endeavour to contact a parent/guardian on the emergency number given and arrange further medical assistance if deemed necessary. I consent to my child receiving first aid or medical assistance: Yes No PHOTOGRAPHY & VIDEO CONSENT From time to time photos (digital recording) or video may be used for coaching purposes and/or promotion purposes. Sutton Coldfield Cricket Club will own the copyrights of such material. If you have any specific objection to the applicant being in these photo (digital recording) or video, please say so in writing: I have no objection: Object Reason:

3 DATA PROTECTION The Club will use the information provided on this Membership Form (together with other information it obtains about the player) to administer his/her cricketing activity at the Club and in any activities in which he/she participates through the Club and to care for and supervise activities in which he/she is involved. In some cases, this may require the Club to disclose the information to County Boards, Leagues and to the England and Wales Cricket Board. In the event of a medical issue or child protection issue arising, the Club may disclose certain information to doctors or other medical specialists and/or to police, children s social care, the Courts and/or probation officers and, potentially to legal and other advisers involved in an investigation. PARTICIPATING IN AWAY MATCHES I consent to my child participating in competitive matches at other clubs. YES NO I consent to my child travelling to and from away matches in transport provided either by officers of the Club, team managers appointed by the Club, parents of other Club Youth Section members or senior members. Parent or Guardians Signature: OVERALL CONSENT & PLAYERS AGREEMENT TO SUTTON COLDFIELD CRICKET CLUB RULES & POLICIES I agree that will abide by the clubs rules and policies as highlighted in member s information document and member s handbook. Sutton Coldfield Cricket Club is fully committed to safeguarding and promoting the wellbeing of all its members. Sutton Coldfield Cricket Club believes that it is important that members, coaches, administrators and parents, carers or guardians associated with the club should, at all times, show respect and understanding for the safety and welfare of others. Therefore, members are encouraged to be open at all times, and to share any concerns or complaints that they may have about any aspect of the club with our Club Welfare Officer: Ann Sargent, or any other Official of the Club. As a member of Sutton Coldfield Cricket Club the applicant is expected to abide by the following Junior Code of Conduct. Parent or Guardians Signature: Print Name: Payment of Fees Membership Paid Cash/Cheque. Deposit Paid Cash/Cheque 20.00p (Strike out if not applicable) (On behalf of Sutton Coldfield Cricket Club) Option to pay by Standing order: Four monthly payments of either 25.00p or 15. Bank: HSBC, Sutton Coldfield Account Name: Sutton Coldfield Cricket Club Sort Code: Account No.:

4 Sutton Coldfield Cricket Club Privacy Policy Consent Form Sutton Coldfield Cricket Club (The Club) has a Privacy Policy that is available on their website. This Privacy Policy provides guidelines on the collection, use, disclosure and security of your personal information. I have read The Club s Privacy Policy and understand the reasons for the collection of my personal information, or that of the member on whose behalf I have completed and signed an application form, and the ways in which the information may be used and disclosed. I am aware that I can access my personal information, or that of the member for whom I signed the application form, on request and, if necessary, correct information that I believe to be inaccurate. I have been provided with or have been given an opportunity to obtain a copy of The Club s privacy policy. I agree to the personal information being collected, used and disclosed in this way. Signed Date

5 Junior Members Membership Fees (i) p one off payment (ii) p Deposit followed by 4 monthly payments of Siblings and U8 members (i) p - one off payment (ii) p Deposit followed by 4 monthly payments of 15.00p Payment of Fees (a). Payment by Standing Order. After paying the Deposit of 20.00p, the monthly payments are due on the first day of each month of May June July August. You will be given a reference number when you register. Club s Bank Account HSBC, Sutton Coldfield Account Name: Sutton Coldfield Cricket Club Account No: Sort Code: (b). Payment by Cash or Cheque If paying by cash or cheque the FULL membership fee is liable to paid at the time of membership application. Cheques to be made payable to: Sutton Coldfield Cricket Club. Benefits of Membership (1). Membership to Sutton Coldfield Cricket Club (2). Insurance (3). New Junior Club Shirt (4). All fees for Monday & Friday nights (5). 16 weeks training with Level 2 coaches