Junior Cricket Membership Form - The Northern Club

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The Club
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Sports
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- Online Membership Form
Policies
Contact

NORTHERN CRICKET CLUB JUNIOR MEMBERSHIP APPLICATION FORM 2021

(for players under the age of 18)

We are very pleased to welcome you to Northern Cricket Club for the 2021 season. This form is designed to be completed by the parent, or legal guardian of any player under the age of 18. As the person completing or receiving this form, you must ensure each person whose information you include knows what will happen to their information and to whom it may be disclosed. Details are set out in Section 8.

- Step 1 of 5

SECTION 1: PERSONAL DETAILS OF YOUNG PLAYER

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, under 13 or under 15). *

Yes
No

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

Name *

First

Last

Address (if Different)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

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 3: MEMBERSHIP

All children must be registered and have paid their 2021 subscription to the club. Otherwise he/she is not covered by club insurance for training and matches and cannot be selected to play for Northern Cricket Club.

2021 subscription rates – subject to change if season shortened

I confirm my child wishes to become a member of the Northern Club (allowing access to hockey, squash and bowls facilities). Free membership applies ages 5 to 13.

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? *

Yes
No

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

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

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

Thank You To Our Partners!

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If you or your business are interested in supporting us, please get in touch via one of the below options.

General Enquiry
Cricket Partnerships

Moor Park,
Elm Avenue
Crosby
Liverpool
L23 2SX

0151 924 1594

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