Child's Forename *

Child's Surname *

Alternative Email Address

Date Of Birth *

Membership Type *

Post Code *

Address *

Primary Carer Contact *

Primary Carer Phone Details *

Primary Carer Alternative Phone Details

Primary Carer Relationship *

Secondary Carer Name

Secondary Carer Phone Details *

Secondary Carer Relationsip

Age group ( as at Sep 20) *

School Year ( as at Sep 20) *

School

School phone number

Doctor's surgery *

Surgery Contact Details *

Medial IssMedic *

Please provide details of issue , together with any medication requirements such as Epi pen

Membership Fee

Membership Fees Paid *

How paid *

New Members, how did you find us ?

I agree to the child named above taking part in the activities of the club *

I understand that my child will have to wear a helmet with a faceguard or grille when batting or when standing up to the wicket when wicket keeping, both in adult cricket and junior cricket played with a hard ball. *

I consent to my child using the shared adult changing facilities ( For Players Aged 13 - 18) *

I consent to my child being contacted by text message / email with details of fixtures and meeting times from their manager/coach ( For Players Aged 16 and over) *

I understand and agree to the responsibilities, which my child and I have in connection with these policies. *

I understand that is my responsibility for the safe delivery and collection of my child/children from matches and training. *

I acknowledge that neither HHCC nor its officers have any responsibility for my child outside of the period of the coaching session, game or function, whether my child is at the club premises or otherwise. *

MEDICAL CONSENT: I give my consent that in an emergency situation; the club may act in loco parentis, if their need arises for the administration of emergency 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(s) whom I have named above. *

I confirm that to the best of my knowledge, my child does not suffer from any medical condition other than those detailed by me in section 5 of this form. *

PHOTOGRAPHY / VIDEO POLICY (FOR PLAYERS AGED 5-18) I consent to the Club photographing or videoing my involvement in cricket under the terms and conditions in the Club photography/video policy. *

Data Protection. The Club will only use the information provided on this form (together with 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 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 England and Wales Cricket Board. In the event of a medical issue or child protection 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 advisors involved in an investigation. The club will not pass on personal data to third parties for marketing purposes. *

I confirm I have read (available on www.hamptonhill.play-cricket.com or in hard copy at the HHCC clubhouse), or been made aware of, the club’s Code of Conduct and policies concerning:• Changing / Showering• Transport• Anti bullying• Managing Children away from the club • Missing Children• Playing in Adult Matches• Photography / Video *

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