ORMSKIRK CRICKET CLUB
Welcome to Ormskirk Cricket Club. This Junior Membership Form should be completed by the parent or legal guardian of any player under the age of 18 and should also be signed by the player. Please complete this form and return it to either the manager of your age group team on registration night on Friday 13th April 2018 or Bill Rankin (Junior Chairman) at any other time.
We will also use this information to ensure that you are kept informed about events and information concerning Ormskirk Cricket Club.
Section 1 – Personal Details of the child applying for Junior Membership
Section 2 – Contact Details of Parent / Legal Guardian
Section 3 – Emergency Contact Details (Alternative Contact)
In the event of an incident or emergency situation where a parent, or legal guardian 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:
Section 4 - Sporting Information
Has the child played Cricket before?
If yes, where?
Other. Please state.
Section 5 – Information about any Impairment
Please provide information about any impairment your child may have so that we can determine what reasonable adjustments may be required to support your child’s full participation in club activities.
Please tick if you consider your child / the child in your care to have an impairment?
If yes, what is the nature of the impairment?
Other (please specify):
If you have ticked yes in the box above please provide us with any additional information that will assist us to ensure your child is fully supported whilst at the club.
Section 6 – Medical Information
Please detail below any important medical information that our coaches/junior coordinator should be aware of (e.g. epilepsy, asthma, diabetes, current medication, injuries etc.)
I give my consent that in an emergency situation, the club may act in my place, (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 as the relevant parent/legal guardian, or the alternative adult I have named in section 3 of this form.
I confirm that to the best of my knowledge, my child/the child in my care does not suffer from any medical condition other than those detailed above.
Section 7 - Automatic Non- Voting Membership Status
Junior membership of the club also provides that the parent(s) / legal guardian(s) of the child are given non-voting membership of the club as part of that junior membership. This does not entitle the parent(s) / guardian(s) to any additional privileges that would otherwise be gained by paying the appropriate adult membership fee(s). Any use of facilities by parents or legal guardians (for example social / training / playing) may incur such charges as applicable to relevant adult membership.
Section 8 – Photographs & Recorded Images
The Club may wish to use photographs or video footage of your child on its website, Twitter feed or for other publicity purposes – such as in local press. Video is also a useful coaching tool. If you DO NOT wish for your child’s photograph to be used or for him/her to be filmed for any reason please tick the box below.
I do NOT give consent for my child’s image to be used on the club website or Twitter feed or for other purposes or for any recorded images of my child to be taken.
Section 9 – 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. It will also use the information to keep you aware of activities/events at the club.
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 Junior Membership Form, I agree to my child / the child in my care taking part in the activities of Ormskirk Cricket Club.
I confirm that I have legal responsibility for the child named in section 1 above, and that I am entitled to give this consent.
I understand that I will be kept informed of activities at Ormskirk Cricket Club – for example details of times and transport etc.
I understand that 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.
I confirm that to the best of my knowledge all information provided in this form is accurate and I will inform the club of any changes to this information in a timely manner.
By checking this box I am confirming that all the above is true and that I agree to all the terms and conditions contained in this form.