Edmonton Cricket Club – Junior Member Registration Form
This form is designed to be completed by the Parent or Legal Guardian of any player under the age of
18. It should also be signed by the player themselves. Please return this form either at the registration
evening or to Tim O’Brien, 20 Chatsworth Drive, Enfield, EN11EX.
Name
Address
Postcode
Gender
Male
Female
Date of Birth
School
Home Telephone Number
Work/ Mobile Telephone Number for Parent/ Guardian
Email Address
Emergency Contact Name/ Relationship
Emergency Telephone Number
Medical information
Please detail below any important medical information that our coaches need to know (e.g. allergies, medical
conditions, current medication, special dietary requirements, injuries):
Doctor’s Name and Contact Number:
Medical Consent
I give my consent that in an emergency situation, the Club may act in my place (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 which I have named on this form.
I confirm to the best of my knowledge, my child/the child in my care does not suffer from any medical condition
other than those detailed in this form.
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 this child to have a disability?
Yes
No
If yes, what is the nature of your disability?
Visual impairment
Hearing impairment
Multiple disability
Physical disability
Learning disability
Other (please specify):
Consent to participate:
I agree to the child named above taking part in the activities of the club. (This consent only relates to
JUNIOR cricket. Please see the open age cricket policy for more information on juniors playing in open
age group cricket)
I also confirm I have been given comprehensive details of the home and away fixtures in which my child
may participate
Transport Policy
Under ECB Safeguarding Children guidelines in relation to tours/away fixtures, clubs must gain permission for
your child to be driven to an away ground by a volunteer if you are unable to take them yourself. By signing
below I consent to my child taking part in the activities indicated for the entire season. I acknowledge that the
Club will be liable in the event of any accident only if they have failed to take reasonable steps in their duty of
care for my child during the away fixture.
Signed – Parent/ Legal guardian:
Photography/ video policy
Under ECB Safeguarding Children guidelines in relation to the use of photography and filming. The club
requires permission of parents/Carers for the use of all photographs and films. Please indicate below whether
you consent for pictures of your child to be used in promotional material. Names of the players will never be
provided.
Signed – Parent/ Legal guardian:
I consent/do not consent
Consent from child in connection with club photography/video policy
(For players aged 12 – 18) Please indicate if you DO or DO NOT agree with the statement below:
I consent to the club photographing or videoing my involvement in cricket under the terms and conditions in the
club photography/video policy. [NOTE: LEAVE THIS BOX UNTICKED IF YOU DO NOT AGREE]
Legal authority to provide consent:
I confirm that I have legal responsibility for …………………………………………..and am entitled to give
this consent.
I confirm that to the best of my knowledge, all information provided on this form is accurate, and that I will
undertake to advise the club of any changes to this information.
Signed (Parent/ Legal Guardian):
Date of signing:
Printed name of Parent/ Legal Guardian who has completed this form:
Name of Child applying for Junior Membership:
Signed:
Date:
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.
Data protection
The club will use the information provided on this form, as well as, other information it obtains about the player (together “Information”)
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 ECB. In the event of a medical or child safeguarding 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 each person whose information you include in this form knows what will
happen to their information and how it may be disclosed.