Youth Membership

This form is designed to be completed by the parent, carer or guardian of any player under the age of 18.

Section 1 - Child's Personal Details

Child's Name

Gender

Date of Birth

Address

Name of School / College

School Year

Section 2 – Contact Details of Parent(s) / Carer(s) / Legal Guardian(s)

Parent(s) / Carer(s) / Legal Guardian(s) Name(s)

Relationship to Child

Parent(s) / Carer(s) / Legal Guardian(s) Address(es)

Parent(s) / Carer(s) / Legal Guardian(s) Mobile Telephone Number(s)

Any Parent(s) / Carer(s) / Legal Guardian(s) Alternative Telephone Number (s)

Parent(s) / Carer(s) / Legal Guardian(s) Email (s)

Section 3 – Emergency Contact Details (Alternative Contact)

Can we use the above details as a contact in an emergency? If possible please provide the contact details of an alternative adult below. As the person completing this form, you must ensure each person whose information you include in this form knows what will happen to their information and how it may be disclosed.

Alternative adult to be contacted in an emergency

Alternative adult's contact number

Relationship with the child

Section 4 - Sporting Information

Has your child played cricket before?

If yes, where has this been played?

Section 5 – Information about any disability

We will use this information for statistical purposes as well as to establish if there are any additional needs / support / adjustments that your child may require, please discuss this with us.

The Equality Act 2010 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’.

Does the child have any physical or mental health conditions or illnesses that have lasted or are expected to last 12 months or more?

Does this disability or illness affect them in any of the following areas? Vision impairment, Hearing impairment, Mobility impairment, Dexterity impairment, Learning impairment, Memory impairment, Mental Health impairment, Stamina, Breathing or Fatigue impairment, Developmental impairment? If so, please provide us with any additional information so we can ensure your child is fully supported

Section 6 – Medical Information

Please indicate if you would like to discuss this privately with us. Not providing consent will not affect the child's membership of the club. However, giving us consent to share this information will help our coaches and volunteers to know how to respond effictively in case of any medical emergency.

Name of Doctor / Surgery

Doctor / Surgery Telephone Number

Please provide any important medical information that our coaches/volunteers should be aware of (e.g. epilepsy, asthma, diabetes, current medication, injuries etc.) for the delivery of the child’s safe participation in the club's activity

I consent to the child's medical and disability information being shared in accordance with the Club Privacy Notice

Medical treatment consent.

In the event of injury, illness or other emergency all reasonable steps will be taken to contact you / the alternative contact, and to deal with that situation appropriately. In the event contact cannot be made please consider giving your consent to medical treatment set out below.

I give my consent that for the above-named child, in an emergency situation, the club may act in my place (in loco parentis) if the need arises to administer first aid and / or other medical treatment which in the opinion of a qualified medical practitioner may be necessary. I confirm that to the best of my knowledge, the above-named child does not suffer from any medical condition other than those detailed above.

Yes

Section 7 - Automatic Non- Voting Membership Status and Supporting the Club

Youth Membership of the Club provides all family members of fee paying Youth Members automatic ‘family members’ status of ‘the Club’. This does not entitle the parent(s) / carer(s) / guardian(s) to any additional privileges that would otherwise be gained by paying the appropriate adult membership fee(s). Any use of facilities by parents,carers or legal guardians (for example social / training / playing) may incur such charges as applicable to relevant adult membership.

As the club develops and grows through the next few years, there may be projects that we undertake that require help. If you feel that you may be of assistance in the future, please could you help us by answering the following questions (this is of course optional). Thank you.

Please list family members names below so that an accurate list of Family Members can be maintained.

Would you be interested in helping the club?

Would you be interested in helping with the organisation of one of the youth teams?

Parent(s)/carer(s) profession:

Would you or your company consider sponsoring the club in some way?

Section 8 – Data Privacy

The Club will use the information provided on this Membership Form together with other information it obtains about the player (together “Information”) to administer their cricketing activity at the Club and in any activities in which they participate through the Club and to care for and supervise activities in which they are 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 or child safeguarding 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 advisers involved in an investigation.

Full details are provided in the club Privacy Notice, which is available on the club website, at the club house or on request. 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.

Section 9 – Membership Fees

Payment for membership fees will be via direct Bank Transfer. Details are below:

7yo – 15yo Annual Membership is £45 (excluding All Stars & Dynamos. A family limit of £135 will apply if 2 or more U16's join with 1 adult member.)

Age group is based on school year i.e. age at 1st September of the prior year.

16yo – 18yo Annual Membership Fee of £60 is payable upon joining annually.

If a more flexible payment arrangement is required, please contact your Team Manager or John Gray, Club Secretary on 07847 336237.

Once you've submitted this form, please send the appropriate Membership Fee by Direct Bank Transfer into the following account:

Account Number: 80432512

Sort Code: 20-19-95

Name: Galleywood Cricket Club

Please quote reference with your surname in format: Mship-surname

Add membership amount due here (please just type number without £)

Section 10 Consent to Participate

By returning this completed Youth Membership Form, I agree to my child / the child in my care taking part in the activities of Galleywood Cricket Club

I understand that I will be kept informed of activities at Galleywood Cricket Club – for example details of fixtures, times and transport etc.

I also agree that, in accordance with Club policy, my son/daughter wears a protective helmet when batting or standing up to the stumps when keeping wicket.

Parents/carers are responsible for transporting players to and from all matches and practice sessions. In circumstances where parents/carers cannot provide such transport, then there is an obligation on them to liaise with either the youth manager (or in the case of a senior game) the captain of that side to ascertain and approve of all transport arrangements to and from that fixture.

I consent to the club photographing or videoing/streaming the above-named child’s involvement in cricket in line with the Club Privacy Notice:

By returning this completed form, I confirm that I have read and understood the permission statements and consents on this membership form and the club Privacy Notice.

I confirm that I have legal responsibility for the child named in section 1 above, and that I am entitled to give this consent.

I confirm both I and the child have read, or been made aware of the relevant Club and ECB policies and agree to abide by the Club Code of Conduct Young Players.

I confirm that to the best of my knowledge all information provided in this form is accurate and I will inform the club of any changes to this information in a timely manner.

Consented Name

Date completed