Junior Membership Form

Child's Name *

First

Last

School Year *

Date of Birth (dd/mm/yyyy) *

Address

Parent / Guardian's Name *

Primary Email Address *

Contact Number 1 *

Secondary Contact

Secondary Email Address *

Contact Number 2

DISABILITY INFORMATION - For statistical purposes and also to ensure that we are able to support your child appropriately we need the following information on disability. The Disability Discrimination Act 1995 defines a disabled person as anyone with a physical of mental impairment, which has a substantial and long term adverse effect on his or her ability to carry out normal everyday activities.

MEDICAL INFORMATION - It is important that the club has information about medical conditions that may affect your child’s ability to play cricket. Please provide any details regarding medical conditions, allergies or any other relevant medical information below. This information will be held confidentially and will only be shared with those members of the club who have direct contact with your child.

JUNIOR MEMBERSHIP FEES - 1st Child £37:00; 2nd Child £30:00; 3rd Child £25:00 *

I wish to pay by bank transfer (details will provided upon submitting this form)
I wish to pay by debit / credit card
I wish to pay by cheque
I have already paid

Attending Training Unaccompanied (The Club would prefer that all juniors arrive with and are collected by their parent / guardian. Understandably, some of our older juniors prefer to make their own way to and from training. Please indicate your preference below).

I consent to my child attending and leaving training by themselves
I or another adult will accompany my child to training and collect them at the end

Please read carefully the statements below, and tick the boxes to indicate that you understand and agree with them *