West Essex Cricket Club: Junior Membership Application 2025
To be filled out by Parent of applicant
Sign in to Google to save your progress. Learn more
1. Contact Information
Full Name (as per Passport) *
Parent Email *
Parent Mobile Number *
Home Address *
Post Code *
Date of Birth *
MM
/
DD
/
YYYY
Country of Birth (If not UK) *
Date of Arrival in the UK
Please only fill out if Country of Birth is NOT UK
MM
/
DD
/
YYYY
2. Emergency Contact Details
Full Name *
Contact Number *
Relationship with you *
3. Disability
Do you have any physical or mental health conditions or illnesses that have lasted or are expected to last 12 months or more *
4. Medical Information
Please detail any important medical information that club volunteers need to know and which could be affected by your participation in cricket activities. Such as: allergies, medical conditions e.g  asthma, current medication, special dietary requirements, or injuries.  *
Medical Consent *
Required
5. Club Photography / Video Consent
I consent to the club photographing, videoing or live streaming my involvement in cricket in line with club policy.  *
6. Privacy Statement
West Essex Cricket Club take the protection of the data that we hold about you as a member seriously and will ensure that the data you provide is processed in accordance with data protection legislation.

Please read the full privacy notice on our website www.westessexcc.co.uk 
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms