LCC Junior Coaching Membership Form

Please complete all sections of this form as to join as a Junior Member at Lapworth Cricket Club.

Annual cost for 1 child is £80. Sibling discounts available as follows:

2 children - £140
3 children - £180


Payment can be made electronically to:

Name: Lapworth CC
Sort Code: 77-27-20
Account No: 33665860

By completing this form you consent to act in accordance with the rules and requirements of the following policies:








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Child's First Name *
Child's Surname *
Email
(Parent/Carer/Guardian email address)
 *
Are you (Parent/Carer/Guardian) currently a Lapworth CC Player? *
Street Address *
Postcode *
Child's Date of Birth *
MM
/
DD
/
YYYY
Gender *
Mobile Phone Number (Parent/Carer/Guardian) *
Emergency contact

(To be completed by parent/guardian/carer.  Please state the full name of the first person who should be contacted in case of an emergency/accident etc.)
 *
Medical information

(Please detail below any important medical information that our Coaches, Team Managers and Head of Junior Cricket  should be aware of (e.g. epilepsy, asthma, diabetes, etc.)
 *
School *
School Year *
Ethnicity

(In order to help the club monitor its membership can you please tick one of the following boxes to identify ethnic group/origin.)

 *
Required
Disability Info

Do you consider your child to have a disability?
 *
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