RUPERTSWOOD CRICKET CLUB Inc. (Reg. No: A0030022X)
P.O Box 336 Sunbury 3429
NIOR PLAYER REGISTRATION AND MEDICAL INFORMATION
Junior Player Registration and Medical Information Season 2015-16
(To be completed by Parent / Guardian)
Note: Details on this form will be provided on a confidential basis to Cricket Australia (Via MyCricket, Coach
and Team Manager of the team your child plays in.
* Denotes a mandatory field
*Player Full Name: …………………………………………………… *Date of Birth…………………………………
Parent / Guardian Names: …………………………………………………………………………………………….
*Address: …………………………………………………………………………………………………………………
Telephone: AH …………………………. BH ……………………..…. *Mobile …………………………………..
Team for 2015/2016 season (circle one): U12
U14
U16 (as at 1/9/2015)
*Email address:…………………………………………………………………………………………….
Parent Occupation/s …………………………………………………………………………………………………..
Medicare No. : ………………………. Ambulance Subscription No. : …………………………………………..
*Does your child suffer from ASTHMA of any form?
Yes
No
(circle one)
*List any details of CURRENT / ONGOING health problems
…………………………………………………………………………………………………………………………………..
*Details of any ANKLE / KNEE / JOINT problems
………………………………………………………………………………………………………………………
*Details of any KNOWN ALLERGIES which your child has experienced
…………………………………………………………………………………………………………………………………..
*Details of any SPECIAL DIETARY CONSIDERATIONS
…………………………………………………………………………………………………………………………………..
*Details of any OTHER CONDITIONS (eg heart)
…………………………………………………………………………………………………………………………………..
The date (year) of your child’s last TETANUS INJECTION was ……………………………………………………...
I declare that the above information is complete and correct and I authorise the Club representative who accompanies my child to
consent, where it is impractical to communicate with me, to him/her receiving such medical / surgical treatment as may be deemed
necessary. I also understand that as a part of Registration with the club there is an expectation that I will provide assistance with team
support activities during the season and will adhere to the club’s ethos at all time (see reverse of this form).
Signed: ……………………………………………….
Date: ……………………………
Name: ..…………………………………………….
Registration Fees:U12, U14 & U16 Teams
Single player
Additional junior player -1st
FEES PAYABLE NO LATER THAN 31st October 2015
2nd
3rd
$ 140.00
$ 95.00
$ 65.00
$ 55.00
A $10 discount for single player & $5 for each other player will apply if paid by 31st October 2015
http://rupertswoodcc.org.au or email rupocc@optusnet.com.au
UNPAID
PAID- CASH-CHEQUE-MONEY ORDER-CREDIT CARD
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Club Code of Ethics
Coaches, officials and parents, by example of behaviour, hold an enormous influence over the
youth of the community. The good conduct of all adult participants and teams is considered
mandatory for the privilege of participation. The club seeks to implant in the youth of the
community, ideas of good sportsmanship, honesty, loyalty and courage, so that they may be finer,
stronger and happier youths who will grow to be good healthy adults. This objective will be
pursued by providing fully supervised cricket matches upon the basis that the attainment of
exceptional skill or the winning of matches is secondary in the moulding of future citizens.
Parents Code
Do not force an unwilling child to participate in sports. Remember children are involved in organised
sport for their enjoyment, not yours. Encourage your child always to play by the rules. Teach your
child that honest effort is as important as victory so that the result of each game is accepted without
disappointment.
Turn defeat into victory by helping your child work towards skill improvement and good
sportsmanship. Never ridicule or yell at your child for making a mistake or losing a competition.
Remember that children learn best by example.
Applaud good play by members of both teams playing. Do not publicly question the officials
judgement and honesty. Support all efforts to remove verbal and physical abuse from children’s
sporting activities. Recognise the value and importance of volunteer coaches, they give their time
and resources to provide recreational activities for your child.
Spectators Code
Be on your best behaviour. Do not use profane language or harass players, coaches or officials.
Applaud good plays by your team and the visiting team. Show respect for your team’s opponents.
Without them there would be no match. Never ridicule or scold a child for making a mistake
during a competition. Condemn the use of violence in all forms. Respect the officials’ decisions.
Encourage players to always play according to the rules. Remember that children play organised
sport for their own fun. They are not there to entertain you and they are NOT miniature proathletes.
Insurance
Rupertswood Cricket Club Senior and Junior sides are covered by Cricket Australia’s Australian
Cricket National Club Risk Protection Programme (http://www.jltsport.com.au/cricketaustralia/) for
Personal Accident Insurance. Coverage is for players on official match days and training sessions
by club appointed coaches only.
Privacy Policy and Photos/Images on Club Website
Rupertswood Cricket Club has adopted the same privacy guidelines as Salesian College. Personal
player information will only be used in the club newsletter, score & performance notification to the
local media and to the GDCA for district representation purposes. This policy is available from
Salesian College or from the website: www.scr.vic.edu.au.
I have read the above information re Rupertswood Cricket Club’s privacy policy and agree for my
child’s personal details to be used only for the stated purposes.
Photo/Images/Videos (please circle which one is applicable)
6
Yes
I agree to the publication of photos/images/videos on the Club Website of my child
No
I do not agree to the publication of photos/images/videos on the Club Website of my child
Signed: ___________________________________________
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Date: _______________________