SHENFIELD CRICKET CLUB

22A Chelmsford Road, Shenfield, Essex CM15 8RQ

Tel. 01277 210108

Website: Twitter: E-mail:

COLTS Registration Form 2018

First Name: / Surname: / D.O.B: / School Year:
Known Medical Condition/Allergies:
Please tick ONE box - A separate form must be submitted FOR EACH Child - One form for each application
CURRENT SCHOOL YEAR / COST / SELECT
YEAR ONE - born between 1st Sept 2011 and 31st Aug 2012 / £80.00
YEAR TWO - born between 1st Sept 2010 and 31st Aug 2011 / £80.00
U9 (SY-3) - born between 1st Sept 2009 and 31st Aug 2010 / £80.00
U9 (SY-4) -born between 1st Sept 2008 and 31st Aug 2009 / £80.00
U11 (SY-5 & 6) - born between 1st Sept 2006 and 31st Aug 2008 / £80.00
U13 (SY-7 & 8) - born between 1st Sept 2004 and 31st Aug 2006 / £80.00
U15 (SY-9 & 10) - born between 1st Sept 2002 and 31st Aug 2004 / £80.00
U16 (SY-11) - born between 1st Sept 2001 and 31st Aug 2002 / £40.00

IF CONTACT DETAILS ARE UNCHANGED FROM 2017 – MARK AS SUCH HERE.

ADDRESS: / POST CODE:
CONTACT EMAIL ADDRESS 1:
CONTACT EMAIL ADDRESS 2:
Tel. No (H): / Mob (1): / Mob (2):
Emergency Contact (1) Name: / Tel No: / Relationship:
Emergency Contact (2) Name: / Tel No: / Relationship:

Data Protection

The information you provide in this form will be used solely for dealing with you as a member of Shenfield Cricket Club.

The club has a Data privacy Policy which can be found on the website of the club. Your data will be stored and used in accordance with this policy.

The club may arrange for photographs or videos to be taken of club activities and published on our website or social media channels to promote the club.

  • If you consent to your image being used by the club in this way, please tick here
  • If you consent to the use of your child’s image being used for the purposes as above, please tick here

Agreement to club policies.

I confirm I have read, consent to and agree withall the clubs policies (available on the SCC website), including Parental Responsibility, Medical Consent Policy, Colts Code of Behaviour, Data Privacy Policy, Safe Guarding Policy and Safeguarding Reporting.

Signed (parent/legal guardian): Date of signing:
Printed name of parent /legal guardian who has completed the form
Signed (child if 12 years or older):

Please take extra care with E MAIL addresses, and send the completed form and payment (cheques made payable to “Shenfield Cricket Club”) to the Club’s Colts Membership Secretary as below, by 31st March 2018. Only use A5 envelopes for standard postage rates. Forms should NOT be delivered to the clubhouse pavilion.

Vanessa Ekers, Little Corston, Thoby Lane, Mountnessing, Brentwood, Essex CM15 0TA

Bertie Joel Champions 1996 & 2010 ● Essex League Cup Winners 1999 & 2011 ● Shepherd Neame Div One Champions 2003

NTAC:4UC-11