2024 Summer Registration – The Northern Club

SECTION 1: PERSONAL DETAILS OF YOUNG PLAYER

Young Players Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

D.O.B *

School Year *

Gender *

Is your child interested in playing for a team? (Under 9, & Under 11). *

If you answer ‘yes’, should you be selected by the Club to play us in a League requiring player registration, relevant information from this Section 1 (including month and year of birth) will be provided to that League to enable them to check your eligibility to play in that League.

SECTION 2: PERSONAL DETAILS FOR PARENT/LEGAL GUARDIANS OF YOUNG PLAYER

Parent/Guardian Name *

First

Last

IMPORTANT IF SURNAME IS DIFFERENT TO THE CHILDS.

Address (if Different)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Parent/Guardian Email *

Home Phone *

Mobile Phone *

If the young person is under 16 and is selected to attend a County Board or League run event (such as trials, nets or representative fixtures), the Club may provide your name and contact details to the relevant League / County Board to enable them to notify you of arrangements.

SECTION 4: EMERGENCY CONTACT DETAILS

Please provide the contact details of an additional adult below.

Name *

First

Last

Name of an alternative adult who can be contacted in an emergency

Contact Number: *

Phone number for alternative named adult

Relationship: *

Relationship which this person has to the child (for example, aunt, neighbour, family friend and so on)

SECTION 5: SPORTING EXPERIENCE INFORMATION

Has your child played cricket before? *

Please select... *

Primary School
Secondary School
Special Educational Needs School
Club
County
Local Authority Coaching Session(s)
Other

SECTION 6: MEDICAL INFORMATION

Please detail below any important medical information that our coaches/junior co-ordinator need to know, and which would be affected by your child’s participation in cricket activities. Such as: allergies; medical conditions (for example - epilepsy, asthma, and so on); current medication; special dietary requirements, any additional needs, and/or any injuries. Please indicate if you would like to discuss this privately with us.

Medical Conditions *

Please indicate if none.

Name of Doctor *

Surgery Name *

Medical Consent: *

I consent to my child’s medical details to be shared with coaches/leaders for the purposes of the delivery of my child’s safe participation in the cricket club activity. Not providing consent will not affect your child’s membership to the Club, however giving us consent to share this information will help club volunteers to know how to respond effectively in the case of any medical emergency.

SECTION 7: PARENT/LEGAL GUARDIAN PARTICIPATION AGREEMENT

Consent *

I agree to the child named above taking part in the activities of the club
I confirm I have been made aware of the club’s policies which can be found at https://northernclub.uk/home/policies concerning Safeguarding & Anti-Bullying
I understand and agree to the responsibilities which I and my child have regarding these policies
I confirm that the Northern Club cannot be held responsible for any injury caused by my child misusing equipment.
I confirm that my child will not climb on Northern Club property such as Sight-Screens & Pitch Covers - A result in which would see them and yourself as a guardian being asked to leave the premises. The Northern Club have the right to cancel your child's Cricket SMASH place without refund should this occur.

Should you have any concerns about a young person at the club please contact our Child Welfare Officer via juniorcricket@northernclub.uk

2024 Northern Junior Cricket Summer Registration

SECTION 1: PERSONAL DETAILS OF YOUNG PLAYER

SECTION 2: PERSONAL DETAILS FOR PARENT/LEGAL GUARDIANS OF YOUNG PLAYER

SECTION 4: EMERGENCY CONTACT DETAILS

SECTION 5: SPORTING EXPERIENCE INFORMATION

SECTION 6: MEDICAL INFORMATION

SECTION 7: PARENT/LEGAL GUARDIAN PARTICIPATION AGREEMENT

Thank You To Our Partners!

Copyright 2016 Nexgen Web Design & SEO