Section 1: Information about the young player
Subscription £45 per junior for the season (£40 per additional junior)
Junior member name *
Your answer
Gender *
Date of birth *
MM
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DD
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Team
Address *
Your answer
Parent/Guardian names *
Your answer
Home telephone number
Your answer
Mobile telephone number *
Your answer
Email contact (1) *
Your answer
Email contact (2)
Your answer
Medical information (Please detail below any important medical information that our coaches/volunteers/officials should be aware of (e.g. epilepsy, asthma, diabetes) *
Your answer
Emergency contact details. Please insert the information below to indicate the person(s) who should be contacted in case of an incident/accident: *
Your answer
By returning this completed form, I agree to my son/daughter/child in my care taking part in the activities of Leeds and Broomfield Cricket Club Juniors (LBJ), or Leeds and Broomfield Cricket Club (LBCC). I understand that I will be kept informed of these activities – for example timing and location. I understand that in the event of any injury or illness all reasonable steps will be taken to contact me and to deal with that injury/illness appropriately.
Name of parent/guardian: *
Your answer
Date *
MM
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DD
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YYYY
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