Adult Membership

Personal Details of Member

Name*

Date of Birth*

Contact Telephone Number*

Email Address*

Home Address*

Emergency Contact Details

As the person completing this form, you must ensure each person whose information you include in this form knows what will happen to their information and how it may be disclosed.

Emergecy Contact Name*

Emergecy Contact Phone Number*

Your Relationship to this Person*

Medical Information

Please detail below any important medical information that our Club volunteers need to know and which may be relevant to 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*

Doctors Telephone Number*

I consent to my medical details being shared with Team Captains/Club volunteers for the purposes of the delivery of my safe participation in the Club's activities.

Not providing consent will not affect your membership of the Club, however giving us consent to share this information will help Club volunteers to know how to respond effectively in the case of any medical emergency.

Member Participation Agreement

Please note that you have the right to cancel your membership of the Club at any time.

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

I agree to comply fully with the Club's governing constitution and policies as notified to me or as posted on the Club's website from time to time.

Club Photography and Video Consent

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

I consent to the Club photographing or videoing my involvement in cricket.

Member Agreement

By returning this completed form, I confirm that I have read and understood the permission statements on this membership form and the privacy notice provided with this form. I also undertake to abide by the Club's governing documents and policies.