Wollaston Cricket Club

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Membership Form

Woll

 

We are very pleased to welcome you to Wollaston Cricket Club  To ensure we have the correct contact details for you, please fill out this Membership Form and return it to the Head Coach – Neal Perry. 

If you are under the age of 16 please also ask your parents / carer or guardian to sign the Membership Form before it is returned. We will also use this information to ensure that you are kept informed about events and information from Wollaston Cricket Club.

 Section 1 – Personal Details. 

Name:

Address:

Postcode:

Home telephone number:

   

Mobile:

     

Email:

 

Date of birth:

Name of School / College

     

     

 Whilst it is not compulsory that the following section is completed, the footnote at the end of this Membership Form explains why this section is important.

 Section 2 – Ethnicity 

A

White

 

British

Irish

Any other white background (please specify): 

     

       

 

B

Mixed  

 

White & Black Caribbean

 

White & Asian

 

White & Black African

 

Any other mixed background (please specify):

     

       

 

C

Asian or Asian British

Pakistani        

Indian

Bangladesh

Any other Asian background (please specify):

     

           

 

D

Black or Black British

Caribbean

    

African

Any other Black background (please specify):

     

       

 

E

Chinese or other ethnic group

Chinese

 

Any other (please specify):

     

 Section 3 – 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 yourself to have a disability?

Yes

No

If yes, what is the nature of your disability?

Visual impairment

Hearing impairment   

Physical disability

 

Learning disability

 

Multiple disability

 

Other (please specify):

     

       

 Section 4 - Sporting Information 

Have you played Cricket before?

Yes

No

If yes, where have you played Cricket: (please indicate below)

Primary school                       

 

Secondary school

 

Local authority coaching session(s)

 

Club

 

County

 

Other (please specify):

     

         

 

Section 5 – Medical Information

 Please detail below any important medical information that our coaches/junior coordinator should be aware of (e.g. epilepsy, asthma, diabetes etc.) 

Text Box:  

 

 

 

 

 

 

 Section 6 – Emergency Contact Details 

This section is to be completed by the parent / carer or guardian: 

Please insert the information below to indicate the persons who should contacted in the event of an incident / accident: 

Emergency Contact Person 1:                                   Emergency Contact Person 2:

Name:                                                                         Name:

Relationship to individual:                                           Relationship to Individual:

Home Tel:                                                                   Home Tel:

Work Tel:                                                                    Work Tel:

Mobile Tel:                                                                   Mobile Tel:

 

 

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

I understand that I will be kept informed of activities at Wollaston Cricket Club– for example times and transport details etc… 

I understand in the event of injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately. 

Name of parent/carer/guardian: 

Signature of parent/carer/guardian:                           

 

Date:

 

In reference to Section 2 on this Membership Form:

Sport can and does play a major role in promoting inclusion of all groups in society. However, inequalities have traditionally existed within sport, particularly in relation to gender, race and disability. The England and Wales Cricket Board and Sport England are committed to promoting and developing sports equity, which is about fairness in sport, equality of access, recognizing inequalities and taking steps to address them. By monitoring the profile of young people in sports clubs, national governing bodies of sport and Sport England can identify any issues relating to under-representation of different groups and can together develop strategies to ensure all young people have an opportunity in the future development and progress in sport.

____________________________________________________________

Code of Conduct for Cricket Club Members and Guests  click here
Code of Conduct Set of Rules for Young People  click here
ECB Cricket Equity Policy  click here
Membership Form  click here

 

 

 

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