Membership Form

Join Club

To become a member of this club, please fill the following form and submit. We will be in contact with you soon after receiving your membership application.

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Adult Membership

Colts Membership

Membership Type:

Section A – Player's details

First name:

Surname:

Date of Birth:

School:

Phone number:

Email:

Ethnicity:

Please state whether you consider yourself to have a disability Yes No

If you answered yes please state the nature of the disability

Section B – Parent/Guardian's details

First name:

Surname:

Address:

Postcode:

Telephone number:

Mobile:

In the case of an emergency where you cannot be contacted please provide details of an alternative adult.

First name:

Surname:

Phone number:

Relationship to player:

Section C – Medical Information

Name of doctor:

Name of surgery:

Doctor phone number:

Please state any other medical information such as allergies/conditions that you believe our staff should be aware of:

Consent:

Membership
Junior membership of the club also provides that the parent(s) / carer(s) / guardian(s) of the child are given non-voting membership of the club as part of that junior membership. This entitles the parent(s) / carer(s) / guardian (s) no additional privileges that would otherwise be gained by paying the appropriate adult membership fee(s). Any use of facilities (for example social / training / playing) may incur such charges as applicable to relevant adult membership.

Membership to the club costs £25 per year. In addition members are expected to pay £2 for each training session and match they attend. The fee is used to help pay for coaching costs, equipment and area hire.

Medical consent
I give my consent that in an emergency situation, 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 that all reasonable steps will be taken to contact me or the alternative adult whom I have named in section B of this form. I also confirm that to the best of my knowledge, my child does not suffer from any medical condition other than those detailed by me above.

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.
As the person completing this form, you must ensure that each person whose information you include in this form knows what will happen to their information and how it may be disclosed.

By returning this completed Membership Form, I agree to my child in my care taking part in the activities of Newham Cricket Club. I understand that I will be kept informed of activities at Newham Cricket Club – for example times and transport details etc. I understand in the event of injury or illness all reasonable steps will be taken to contact me / the alterative contact and to deal with that injury/illness appropriately. I understand that at certain events the player may be photographed for club purposes. I hereby DO/DO NOT give consent for this.

I understand that I am responsible for the transport of the player to and from matches unless arranged otherwise.

Section A – Player's details

First name:

Surname:

Date of Birth:

Email:

Address:

Postcode:

Phone number:

Mobile:

Ethnicity:

Please state whether you consider yourself to have a disability Yes No

If you answered yes please state the nature of the disability

Section B – In the case of an emergency please provide details of a responsible adult who can be contacted.

First name:

Surname:

Phone number:

Relationship to player:

Section C – Medical Information

Name of doctor:

Name of surgery:

Doctor phone number:

Please state any other medical information such as allergies/conditions that you believe our staff should be aware of:

Consent:

Membership
Membership to the club costs £50 per year. In addition members are expected to pay £4 for each training session and match they attend. The fee is used to help pay for coaching costs, equipment and area hire.

Medical consent
I give my consent that in an emergency situation, 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 that all reasonable steps will be taken to contact the alternative adult whom I have named in section B of this form. I also confirm that to the best of my knowledge, I do not suffer from any medical condition other than those detailed above.

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 the Club may disclose certain information to doctors or other medical specialists.
As the person completing this form, you must ensure that each person whose information you include in this form knows what will happen to their information and how it may be disclosed.

By returning this completed Membership Form, I agree to take part in the activities of Newham Cricket Club. I understand that I will be kept informed of activities at Newham Cricket Club – for example times and transport details etc. I understand in the event of injury or illness all reasonable steps will be taken to contact the alterative contact and to deal with that injury/illness appropriately. I understand that at certain events the player may be photographed for club purposes. I hereby DO/DO NOT give consent for this.

I understand that I am responsible for the transport of the player to and from matches unless arranged otherwise.

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