CHALLOW & CHILDREY CRICKETCLUB

YOUTH REGISTRATION FORM 2018SEASON

(FORSCHOOL YEARS 4 TO 13)

Please complete the details below and return the form together with yourpayment. Please note we can only accept cheques via postal registration – we cannot accept cash. Should you wish to pay cash, you will need to attend the registration eveningin person. Postal registrations and cheque payments only should be sent to Challow & Childrey Cricket Club, Vicarage Hill, East Challow, Wantage, Oxon, OX12 9RR.

This year we have introduced a one for all YouthMembership fee of £45 (per youth) this includes youthmembership forONEplayer plus social membership for twonon-playingadults.

Please add a Gift Aid Donation to my membership fee to supportCCCC of £………………

We believe that our youth membership fees represent good value for money (£3.21 per training session) so we would be delighted if you could consider making a donation. By doing this we can claim back 25p of tax on every £1 that you give. Please complete the attached form. Thank you.

YOUTH PLAYERDETAILS – Please complete in capital letters

Name:………………………………………………………………… Male Female

Address:……………………………………………………………………………………………………………….

…………………………………………...……………………………………..Post Code:.……………..………….

Home TelephoneNo:…………………………………………… Date of Birth:.………………………………..

Email:……………………………………………………………………………………………………….…......

Current School: …………………………………………………….. Current SchoolYear: ………….…….

EMERGENCY CONTACTDETAILS

Please complete the information below to indicate the person who should be contacted in caseofanemergency.

Contact Name: ………………………………………Emergency Contact Number: ………………………………

Contact Name: ………………………………………Emergency Contact Number: ………………………………

MEDICALINFORMATION

Please detail below any important medical information that our coaches/administrators shouldbeaware of (e.g. epilepsy, asthma, diabetesetc).

………………………………………………………………………………………………………………………....……

………………………………………………………………………………………………………………………………

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MEDICAL CONSENT

Please tick if you DO NOT give your consent that in an emergency situation, the club may act in your place if the need arises for the administration of emergency first aid and/or other medical treatment which, in the opinion of a qualified medical practitioner, may be necessary. That you also understand, in such an occurrence, all reasonable steps will be taken to contact you or the alternative adult which has been named on page one of this form.

DISABILITY

The DisabilityDiscrimination Act 1995 defines a disabled person as anyone with a "physicalormental impairment which has a substantial and long term adverse effect on his or her abilitytocarry out normal day to dayactivities".

Do youconsideryour child to have adisability:Yes No

If so, please indicate the type ofdisability:

Visual Impairment HearingImpairment

Physical Impairment LearningDisability

Multiple Disability Other (pleasespecify)

…………………………………………………………………………………………………………………………….

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DATAPROTECTION

Alldetailssuppliedwillbestoredelectronicallyforclubuseonly.Noinformationwillbepassedto Third Parties. Please tick the box if you DO NOTgive consent for your details to bestored.

Photographs and/or video may be taken at matches/trainingfor publicity andcoachingpurposes
and may be published on the club website and in the local press. Please tickthebox if you

DO NOTgive consent for this.

CODE OFCONDUCT

  • Players will not be able to participate in club activities until a signed registration formandpayment has beenreceived.
  • All players must register at the start and end of each session and must not leavetheground until they have been signed out.
  • The cut off point for membership is the 1stJune.

CONSENT

I agree for my son/daughter to take part in the activities of the club and agree to follow theCodes of Conduct detailed in the Youth Handbook (attached and also on the website). I also agree to be boundbythe Rules & Constitution of the club. I understand that in the event of any injury or illnessallreasonablesteps will be taken to contact me and to deal with that injury/illnessappropriately.

Name ofParent/Carer:…………………………………………………………………………………………………

Parent/CarerSignature: …………………………….………………………….……..Date:………………………..

For Club UseOnly

AgeGroup/Girls
Amount Paid
Cash/Chq/Card
On Memb DB

Community Amateur Sports Club (CASC) Gift Aid Declaration – single donation

In order to Gift Aid your donation you must tick the box below:
I want to Gift Aid my donation of £______to:

Name of CASCChallow & Childrey Cricket Club
I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the
current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to
pay any difference.

My Details
Title ______First name or initial(s) ______
Surname ______
Full Home address ______
______
______
Postcode ______Date ______
Please notify the CASC if you:

  • want to cancel this declaration
  • change your name or home address
  • no longer pay sufficient tax on your income and/or capital gains

If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief
due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or askHM Revenue and Customs to adjust your tax code.