Phone Number *

1* Junior (age >7 and age<15) (£150)

2* Juniors (age >7 and age < 15) (£125) [ You will get discount on 2nd Junior Registration ]

Juniors winter nets (£90)

Adults (£100)

Students Membership ( Age >16) (£50)

Minishins (£100)

Minishins winter nets (£60)

Girls (£25)

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

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

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 whom I have named in emergency contact section of this form.

Yes No

Automatic Non- Voting Membership Status Junior membership of the club also provides that the parent(s) / carer(s) / guardian(s) of the child are given non-voting membership of the club as part of that junior membership. This entitles the parent(s) / carer(s) / guardian(s) no additional privileges that would otherwise be gained by paying the appropriate adult membership fee(s). Any use of facilities (for example social / training / playing) may incur such charges as applicable to relevant adult membership.Data Protection: The Club will use the information provided on this Membership Form (together with other information it obtains about the player) to administer his/her cricketing activity at the Club and in any activities in which he/she 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, children's 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.By returning this completed Membership Form, I agree to my child in my care taking part in the activities of Shinfield Cricket Club.I understand that I will be kept informed of activities at Shinfield 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 / the alternative contact and to deal with that injury/illness appropriately.I agree to abide by Shinfield Cricket Clubs code of conduct for junior players, parents and carers available to view on our website http://shinfieldcc.play-cricket.com/ We also encourage you to sign up to our website http://shinfieldcc.play-cricket.com/ Where you can find more information, view policies, shop and help raise funds for the club. *

Digital Signature *( Please Enter Name - For Juniors, it should be sign by their Guardian / Parent/ Carer)