Membership Form 2013
THE WOODFORD WELLS CRICKET CLUB – JUNIOR CRICKET SECTION.
We are very pleased to welcome you to The Woodford Wells Cricket Club To ensure we have the correct contact details for you, please fill out this Membership Form and return it to your coach asap or on your first day at the club for the 2012 Season.
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 The Woodford Wells Cricket Club.
Section 1 – Personal Details.
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Name: |
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Address: |
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Postcode: |
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Home telephone number: |
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Mobile: |
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Email: |
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Date of birth: |
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Name of School / College |
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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
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A |
White |
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British |
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Irish |
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Any other white background (please specify): |
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B |
Mixed |
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White & Black Caribbean |
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White & Asian |
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White & Black African |
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Any other mixed background (please specify): |
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C |
Asian or Asian British |
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Pakistani |
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Indian |
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Bangladesh |
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Any other Asian background (please specify): |
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D |
Black or Black British |
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Caribbean |
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African |
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Any other Black background (please specify): |
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E |
Chinese or other ethnic group |
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Chinese |
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Any other (please specify): |
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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’.
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Do you consider yourself to have a disability? |
Yes |
No |
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If yes, what is the nature of your disability? |
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Visual impairment |
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Hearing impairment |
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Physical disability |
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Learning disability |
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Multiple disability |
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Other (please specify): |
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Section 4 - Sporting Information
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Have you played Cricket before? |
Yes |
No |
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If yes, where have you played Cricket: (please indicate below) |
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Primary school |
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Secondary school |
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Local authority coaching session(s) |
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Club |
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County |
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Other (please specify): |
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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.)
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 The Woodford Wells Cricket Club
I understand that I will be kept informed of activities at The Woodford Wells 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:
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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 and the Woodford Wells Cricket Club are committed to promoting and developing sports equity, which is about fairness in sport, equality of access, recognising 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.
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