Junior Application Form 2017

 

                                          

 

 

  NEWDIGATE CRICKET CLUB

                                         JUNIOR MEMBERSHIP FORM

We are very pleased to welcome you to Newdigate Cricket Club. To ensure we have the correct contact details please fill out this Membership Form and return to Annette Jordan our Club Welfare Officer or John Callcut our Junior Co-Ordinator.

Section 1 – Personal Details (young people under the age of 18)

Name:……………………………………     Date of Birth: …………..  School/College:………………….

Section 2 – Personal Details (Parent/Legal Guardian)

Name:  ………………………………….       Address: ……………………………………………………..

Are you a Qualified First Aider: ……….       ………………………………………………………………..

Home Telephone Number:……………        Post Code ……………………………..

Mobile: ……………………..                        E-Mail: ……………………………………………………….

(Note. It is forbidden for the Club to e-mail or contact young people directly)

Section 3 – 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 day-to-day activities’.

Do you consider yourself to have a disability ?                          Yes                            No

If yes, what is the nature of your disability?

Section 4 – Medical Information

Name of Doctor/Surgery: ………………………………………………………..

Telephone No. of Doctor/Surgery: ………………………………………………

Please detail below any important medical information that our coaches/junior co-ordinator should be aware of (e.g. epilepsy, asthma, diabetes etc.)

…………………………………………………………………………………………………………………………..

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 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 which I have named in section 5 of this form.

…..          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.

 Please tick

Section 5 – Emergency Contact Details (alternative contact)

In the event of an incident or emergency situation, where a parent or legal guarding named above cannot be contacted, please provide details of an alternative adult who can be contacted by the Club. Please make this person aware that his or her details have been provided as a contact for the Club:

Name: …………………………………..  Relations to the person (ie, Aunt, neighbour etc.) ……………………

Address: ……………………………………………………………………………. Post Code:…………………

Home telephone number: …………………………  Work telephone number: …………………………………..

Mobile: ……………………………..

Section 6 – 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 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.

Section 7 – 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 this 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 Newdigate Cricket Club.

I understand in the event of injury or illness all reasonable steps will be taken to contact me/the alternative contact and to deal with that injury/illness appropriately.

By signing this I confirm that I have read the Club’s Code of Conduct which can be found on the notice board, fixture cards and the website.

Signed (Young Person) …………………………………  Print ………………………………………..

Signed (Parent/Legal Guardian …………………………  Print ………………………………………..

Date: ……………………………….

Subscription:   £60.00 and £35 for additional members of the same family

£25.00 for under 7s and £35.00 for girls ………………………. Cheque enclosed

I wish to become a social member of Newdigate Cricket Club ……………….. Cheque for £10 enclosed

It is the Club’s policy that all juniors will wear helmets as per the guidelines issued by the ECB.

**Why not join the Centurion Club and raise money for the club? The cost is just £5.00 per month.

Please send me details                                   YES                       NO

 

 PHOTOGRAPHY, TRANSPORT AND CHANGING ROOMS POLICY

 Permission for the use of photographs and recorded images

Please note that this part of the form needs to be signed by the young player (if aged between 12 and 18) as well as the parent or legal guardian of the young player.

Newdigate Cricket Club (the club) recognizes the need to ensure the welfare and safety of all young people in cricket. As part of this commitment we will not permit photographs, video images or other images of young people to be taken or used without the consent of the parent/guardian and the young player. The club will follow the guidance issued by the England and Wales Cricket Board (ECB) on the use of images of young people which is available on http://www.ecb.co.uk. The club will take steps to ensure that these images are used solely for the purpose they are intended, which is the promotion and celebration of the club’s cricketing activities. If you become aware that these images are being used inappropriately you should inform the Club Welfare Officer immediately.

If photographs e.g. team or action shots, are submitted to the press or published on the club website individuals will not be identified. In circumstances where there is a need to identify an individual player in the press parental permission will be sought beforehand.

Please note: The club understands that there are circumstances under which a parent would not wish their child to be photographed. Whilst the club will do all that it can to ensure the safety  of children during games and practice, it is the responsibility of the parent concerned to ensure that if necessary their child is not videoed or photographed. The club is not always able to supervise children at all times during cricket activities or competitions.

To be completed by the parent/guardian and the player if aged between 12 and 18

 I/we consent to Newdigate Cricket Club photographing or videoing my or my child’s involvement in cricket under the above terms and conditions,

Signature of Parent/Guardian……………………………………………….Signature of Player…………………………………….

 Transport to matches and practice sessions

 Newdigate Cricket Club policy is that parents or other responsible adults are responsible for transporting players to and from all matches and practice sessions and therefore the club will not be registering private vehicles for the transportation of individuals in connection with any fixtures or practice sessions arranged by the club. The implementation of this policy is not intended to exclude any player from participation and parents or guardians should contact the Club Welfare Officer if they have any problems with the transportation of players to matches or practice sessions.

Club changing policy

All parents must be aware that there are circumstances under which players under the age of 16 years may find themselves changing in the presence of older persons. The club has therefore adopted the following policy in accordance with the ECB’s ‘Safe Hands – Welfare of Young People in Cricket Policy’:

  1. Adults should not change or shower at the same time using the same facility as young people.
  2. Adults should try to change at separate times from young people
  3. If adults and young people need to share a changing facility, the club must have consent from the parent/guardian that their child/children can share a changing room with adults in the club.
  4. If young people need to share changing facilities with adults, their parents will be allowed to supervise them whilst they are changing.

Note: If young people are uncomfortable changing or showering with adults, no pressure should be placed on them to do so. Encourage them to do this at home.

Consent by parent / legal guardian

 I confirm that I have legal responsibility for  …………………………………………….. (name) and I understand and accept the above conditions.

Signed ………………………………………..    Print …………………………………………………………   Date …………………………………….

 

 

 

 

 

 

 

 

 

 

Affiliated to the Surrey County Cricket Board – Member of the East Surrey Colts League,

Surrey Downs League and the Fuller’s Brewery Surrey County League

 

www.newdigatecricketclub.co.uk