PERSONAL DETAILS OF PLAYER/OFFICIAL (MANDATORY):

All information in this Section 1 will be used by Mistley Cricket Club and provided to the ECB and will be used and protected as described in the Privacy Notice below.

Your Name (required)

Home Address (required)

Post code (required)

Date of Birth (required)

Email address (required)

Mobile Telephone Number (required)

Home Telephone Number

Are you interested in playing League Cricket? (required)
YesNo

If you answer 'yes', should you be selected by Mistley Cricket Club to play for 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.

If you are or become an official of Mistley Cricket Club, the Club may provide the information in this Section 1 to County Boards or Leagues that the Club is a member of or affiliated to; to enable them to contact you about cricket matters.

If you are a player and 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 and/or County Board to enable them to notify you of arrangements.

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PLAYER PARTICIPATION AGREEMENT (MANDATORY):

I agree to taking part in the activities of the Club.

I confirm I have read, or have been made aware of, the Club’s policies concerning:
Changing / showering: Anti bullying and the code of conduct: Transporting children: Photography / video: Social media, text andhttp://mistleycricketclub.org.uk/wp-admin/edit.php?post_type=page email

I understand and agree to the responsibilities which I have regarding these policies

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EMERGENCY CONTACT DETAILS (MANDATORY):

Name of an adult who can be contacted in an emergency

Phone number of named adult

Relationship which this person has with you

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SPORTING EXPERIENCE INFORMATION (OPTIONAL):

Have you played cricket before?
YesNo

If yes, where has this been played? (e.g. Club, School University, Local Authority Coaching Sessions)

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DISABILITY (OPTIONAL):
By providing the information in this Section 4, you are giving your explicit consent to the Club using this information (and any additional disability information provided by or for you) for statistical purposes as well as to establish if there are any additional needs / support / adjustments that you may requires.

The Equality Act 2010 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 have any physical or mental health conditions or illnesses that have lasted or are expected to last 12 months or more?
YesNo

Does this disability or illness affect you in any of the following areas?
Vision impairmentHearing impairmentMobility impairmentDexterity impairmentLearning impairmentMemory impairmentMental health impairmentStamina, breathing or fatigue impairmentDevelopmental impairment Has other type of impairment, please provide more details:

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MEDICAL INFORMATION (OPTIONAL):

By providing the information in this Section 5, you are giving your explicit consent to the Club using this information (and any additional medical information provided by or for you) to help you when you participate in cricket activities.

Please detail below any important medical information that our club volunteers need to know and which would be affected by your 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.

Name of doctor/surgery name

Doctor’s telephone number

Medical consent:

I consent to my medical details to be shared with coaches/leaders for the purposes of the delivery of my safe participation in Club activity.

If you do not give your consent, this will not affect your membership of the Club. However, giving us consent to share this information will help Club coaches and leaders to know how to respond effectively in the case of any medical emergency.

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CLUB PHOTOGRAPHY/VIDEO CONSENT (OPTIONAL):

I consent to the Club photographing or videoing my involvement in cricket in line with the Club photography/video policy.

If you do not give your consent, this will not affect your membership of the Club. If you choose not to give consent, please contact us to discuss how we can manage any potential photography.

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PRIVACY STATEMENT:

Mistley Cricket Club takes the protection of the data that we hold about you as a member seriously and will ensure that the data you provide is processed in accordance with data protection legislation.

Please read the Club’s Privacy Notice (linked above) carefully to see how the Club will use and protect your personal data, who it may be disclosed to and why and your rights in respect of your personal data.

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PLAYER DECLARATION (MANDATORY):

By submitting this completed form, I confirm that I have read and understood the permission statements on this membership form and the Privacy Notice below.

Would you like to sign up to the Mistley Cricket Club Newsletter and stay up to date with club events, news and offers?
YesNo