Cricket Club Colts Membership Application & Parental Consent ...

United Services (Portsmouth) Cricket Club
Colts Membership Application & Parental Consent
2012 Season Subscriptions
U11 £10
U13 £15
U15 £20
Plus £2 per training session, net session or match
Note: Signing on subscription must be paid by beginning of April.
Please complete the attached forms and return with the subscription
payment to the appropriate team manager
For Colts Contacts: See website at
http://www.usportsmouthcc.com/colts
Club Welfare Officer : Martin Leonard M: 07747 012652
E: uscc@live.co.uk

United Services (Portsmouth) Cricket Club
Application for Colts Membership & Parental Consent
Players Name: ...............................
To ensure that we have the correct contact details for you please insert the information requested on the following two pages, then
sign, detach and return this form with full payment to the appropriate team manager. If you are under 16 please ask your parents or
guardian to sign this form before it is returned. Should you require any assistance when completing this form please contact the
appropriate team manager or club welfare officer. We will also use this information to ensure that you are kept informed about club
events.
Data Protection - The Club advises that all data and personal information requested is held by the club and stored securely,
confidentially and is only used for the direct purpose of providing safe secure cricket for young people.
PART 1
PLAYERS DETAILS;
Name:
………………………………………………………………………………………………………..
Address:
………………………………………………………………………………………………………..
………………………………………………………………………………………………………..
……………………………………………...Postcode:……………………………………………..
Home Tel:
…………………………………… ………..Players Mobile Tel;…………………………………………...
E-mail:Players:………………………………………………………Parent/Guardian:………………………………………......
DOB: …………………Age;……………………………… School Year:………….……….
Gender: (Please circle) Male Female
Emergency
Contact Name ………………………………………………………………………………………………………..
Emergency
Tel No;
………………………………………………………………………………………………………..
Medical information..
Please detail below any important medical information that the club should be aware of;
(e.g. epilepsy, asthma, diabetes, allergies, etc.)

Players Name: ...............................
PART 2
In order to help the club monitor its membership which may also assist with future funding
applications can you please complete the following information where appropriate;
Ethnicity; (Eg; White, Irish, Mixed (White/Black Caribbean), Indian, Pakistani, Caribbean, African, Chinese or any other ethnic group please
indicate below as appropriate)
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? (Please circle) Yes No
If yes, what is the nature of your disability? (Please indicate below as appropriate)
Sporting information
Have you played Cricket before? (Please circle) Yes No
If yes, where have you played the sport: (please indicate below)
By returning this completed form:
I agree to my son/daughter/child in my care, taking part in the activities of the club and confirm
that my child will comply with the Junior Club Rules
I confirm that I understand the spirit of the Parent/Spectators Code of Conduct
I understand that I will be kept informed of cricket activities at the club, eg; Timing and
transportation details for away matches when my child is involved
I understand that in the event of any injury or illness, all reasonable steps will be taken to
contact me and deal with that injury/illness appropriately
I am aware of and have access to all principle Club Welfare Policy procedures
(published on club website and displayed on club noticeboard)
I confirm I have read copies of the relevant codes of conduct on the noticeboard/website
I enclose my subscription as a cash for £ .
Name of Parent/Guardian (Block Capitals);
Signature of
Parent/Guardian;…………………..…………………………………………Date;…………………………
Please also complete and sign following page

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 by
the Parent or Legal Guardian of the Young Player.
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 that 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 may
occasionally be identified.
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, it is the responsibility of
the parent concerned to ensure that if necessary their child is not videoed or photographed. The club is unable to
supervise individual children in this respect during cricket activities or competitions.
To be completed by the Young Player (if 12 years or older) – please strike out the words that
you do not agree to.
I,. …………………………………………… consent / do not consent to United Services (Portsmouth) Cricket Club
photographing or videoing my involvement in cricket under the above terms and conditions.
Transport to matches and practice sessions
United Services (Portsmouth) Cricket Club’s 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 or seeking CRB clearance specifically for drivers 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 or Team Manager 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 clothes in the presence of persons over 18 years. The club requests that all parents/guardians
understand that:
As a principle, young players playing in Colts teams do not share dressing rooms with adults
Young players who do not wish to change or shower with adults are under no obligation to do so and are advised to
change and shower at home
Young players when playing in adult teams will share dressing rooms with adults. It is the responsibility of the parent
concerned to ensure that their child does not enter changing facilities at any time if consent is not given
Consent by Parent/Legal Guardian - Please strike out the words which you do
not agree
………………………………………………………….. (name of young person). I confirm that I have
legal responsibility for this young person and am entitled to give this consent. I also confirm that I
understand and accept the Club’s policies on transportation and the use of photography and
recorded images. If this young player participates in adult cricket he/she will change at home /
he/she can change at the club
Signed: ……………………… Print Name: ……………
… Date: ……………….