ࡱ> XZW%` Jbjbjٕ 9R""""rrr<J>$D@""""V,1#######$&h(v#Qr"#""""k#eee"8"r"#e#eeM!Zr!" p)_Qq4e!%"\$0>$m!,`)d`)!`)r!IheCT III##UIII>$ jj"""""" Edmonton Cricket Club Junior Member Registration Form This form is designed to be completed by the Parent or Legal Guardian of any player under the age of 18. It should also be signed by the player themselves. Please return this form either at the registration evening or to Roger Sans, 54 Chatsworth Drive, Enfield, EN11EY. NameAddress PostcodeGenderMale c Female cDate of BirthSchoolHome Telephone NumberWork/ Mobile Telephone Number for Parent/ GuardianEmail AddressEmergency Contact Name/ RelationshipEmergency Telephone NumberMedical information. Please detail below any important medical information that our Coaches need to know (e.g. allergies, medical conditions, current medication, special dietary requirements, injuries) Doctors Name and Contact Number:.  FORMCHECKBOX  I give my consent that in an emergency situation, the Club may act in loco parentis, if the need arises for the administration of emergency first 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 which I have named on this form.Disability The Disability Discrimination Act 1995 defines a disabled person as anyone with a physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities. Do you consider this child to have a disability? c Yes c No If yes, what is the nature of your disability? c Visual impairment c Hearing impairment c Physical disability c Learning disability c Multiple disability c Other (please specify): Transport Policy. Under the new ECB Welfare of Young People guidelines in relation to tours/away fixtures, clubs must gain permission for your child to be driven to an away ground by a volunteer if you are unable to take them yourself. By signing below I consent to my child taking part in the activities indicated for the entire season. I acknowledge that the Club will be liable in the event of any accident only if they have failed to take reasonable steps in their duty of care for my child during the away fixture. Signed Parent/Carer:..Photography. Under the new ECB Welfare of Young People guidelines in relation to the use of photography and filming. The club requires permission of parents/Carers for the use of all photographs and films. Please indicate below whether you consent for pictures of your child to be used in promotional material. Names of the players will never be provided. (Parent/Carer full name) consents /does not consent Data protection. The Club will 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, childrens social care, the Courts and/or probation officers and, potentially to legal and other advisers involved in an investigation. As the person completing this form, you must ensure that each person whose information you include in this form knows what will happen to their information and how it may be disclosed. Consent to participate:  FORMCHECKBOX  89> C F H I J f m  .  j n ȷsfUfUfKfKfKfKfKfhTcOJQJ^J hhTcOJQJ^JmH sH hhTcOJQJ^J hNh~0CJOJQJ^JaJ hzht?CJOJQJ^JaJ hzh~0CJOJQJ^JaJ hzh'CJOJQJ^JaJ hzhzCJOJQJ^JaJ(hzhzCJOJQJ^JaJnH tH hh~0OJQJ^J*hh~00J5>*CJOJPJQJ^J89I J K P Q  TTTTP@@@@@@d$If^ TTTTP@@@@@@d$If]^gd dgd' 7$8$H$gdz$a$JJQ R Z [ d e jjjQ TTTTP@@@@@@d$If^ TTTTP@@@@@@d$If]^xkd$$Ifl0+d'9064 laytTce f m 2 iM TTTTP@@@@@@d$If^gdZ, TTTTP@@@@@@d$If]^gdZ,vkd$$Ifl0+d'9064 laytTc2 4 P R lS TTTTP@@@@@@d$If^ TTTTP@@@@@@d$If]^vkdD$$Ifl0+d'9064 laytTcR T b d lS TTTTP@@@@@@d$If^ TTTTP@@@@@@d$If]^vkd$$Ifl0+d'9064 laytTcd f lS TTTTP@@@@@@d$If^ TTTTP@@@@@@d$If]^vkd$$Ifl0+d'9064 laytTc lS TTTTP@@@@@@d$If^ TTTTP@@@@@@d$If]^vkd$$$Ifl0+d'9064 laytTc   lS TTTTP@@@@@@d$If^ TTTTP@@@@@@d$If]^vkd$$Ifl0+d'9064 laytTc j l lS TTTTP@@@@@@d$If^ TTTTP@@@@@@d$If]^vkdd$$Ifl0+d'9064 laytTcl n lS TTTTP@@@@@@d$If^ TTTTP@@@@@@d$If]^vkd$$Ifl0+d'9064 laytTc jh$7$8$H$If^h`gdv $IfgdTcvkd$$Ifl0+d'9064 laytTc ɺhT;.hhTcOJQJ^J1hvhvB*CJOJQJ^JaJnH ph333tH 'hZ,B*CJOJQJ^JnH ph333tH <jDhvhvB*CJOJQJU^JnH ph333tH -hvhvB*CJOJQJ^JnH ph333tH 6jhvhvB*CJOJQJU^JnH ph333tH hvhvCJOJQJ^JhvhTcCJOJQJ^J-hvhTcB*CJOJQJ^JnH ph333tH h hTc5CJOJQJ^J *<m```PPP Z@@$IfgdTc  @$IfgdTc$ T@@d$Ifa$gdTc$ TTTTP@@@@@@d$Ifa$gdTcbkd$$Ifld'&064 la <%&3¸±¤yl]B2hho5CJOJQJ^J5hhoB*CJOJQJ^JmH nH ph# sH tH hhoCJOJQJ^Jho5CJOJQJ^JhTcCJOJQJ^JhFhTcCJOJQJ^JhhTc5CJOJQJ^JhhTcOJQJ^J hTchTchTcOJQJ^JhTchTcOJQJ^J)hTchTcB*OJQJ^JnH ph333tH hzhTcOJQJ^Jh6khTc5OJQJ^J% $IfgdFbkdB$$Ifld'&064 la%&3 $Ifgdobkd$$Ifld'&064 lax$7$8$H$IfgdZ,  Z@@gduAybkdR$$Ifld'&064 lalwʹʹmR74jhZ,B*CJOJQJU^JaJnH ph333tH 4hhhZ,5B*CJOJQJ^JaJnH ph333tH 1hwohwoB*CJOJQJ^JaJnH ph333tH (hwohwoCJOJQJ^JaJnH tH 0hwohwo56CJOJQJ\]^JnH tH 0hwohwo6B*CJOJQJ^JnH ph333tH 6hwohwo56B*CJOJQJ\^JnH ph333tH hzOJQJ^JhhoOJQJ^J LHMHHHHvIwIzrrree\\ 7$8$H$gdo xx7$8$H$gdo$a$gdZ, xx7$8$H$gdZ,  Z@@gduAylkd$$Ifl F'& t0644 laytZ, HKHMHNH\H]H^H`HHHHHHHȭ髒c钄K04hhho5B*CJOJQJ^JaJnH ph333tH .hZ,5B*CJOJQJ^JaJnH ph333tH @j hhhZ,B*CJOJQJU^JaJnH ph333tH hZ,CJOJQJ^JaJ1h\hZ,B*CJOJQJ^JaJnH ph333tH U4jhZ,B*CJOJQJU^JaJnH ph333tH @j2 hhhZ,B*CJOJQJU^JaJnH ph333tH +hZ,B*CJOJQJ^JaJnH ph333tH I agree to the child named above taking part in the activities of the club.  FORMCHECKBOX  I also confirm I have been given comprehensive details of the home and away fixtures in which my child may participate Legal authority to provide consent:  FORMCHECKBOX  I confirm that I have legal responsibility for ..and am entitled to give this consent.  FORMCHECKBOX  I confirm that to the best of my knowledge, all information provided on this form is accurate, and that I will undertake to advise the club of any changes to this information. Signed (Parent / Legal Guardian): Printed name of Parent / Legal Guardian who has completed this form: Date of signing: Signed (Child if 12 years or older): Date of signing:  HH I I II>IPIuIvIwIxIIIIIII9J:JϮϕfEϕϕ@j hc2hoB*CJOJQJU^JaJnH ph333tH 1h|jhoB*CJOJQJ^JaJnH ph333tH *ho5B*CJOJQJ^JnH ph333tH 1h\hoB*CJOJQJ^JaJnH ph333tH @j hc2hoB*CJOJQJU^JaJnH ph333tH +hoB*CJOJQJ^JaJnH ph333tH 4jhoB*CJOJQJU^JaJnH ph333tH wI:J;J^J_JJJJJJJJJJJJJJJJ Z@d^gdZ, TTTTP@@@@@@dgdzxgdv$a$gdo:J;J]J_JJJJJJJJJJJJJJӲӜqcRKGCKh~0hRq hZ,h!w jhh~0UmHnHuhvCJOJQJ^JaJ(hvhvCJOJQJ^JaJmH sH +hvhv5CJOJQJ^JaJmH sH +hvhz5CJOJQJ^JaJmH sH hvhz5OJQJ^J%hv5CJOJQJ^JaJnH tH +hvhv5CJOJQJ^JaJnH tH +hvB*CJOJQJ^JaJnH ph333tH 7;0?PAPBP. 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