SUNSHINE COAST CRICKET

SENIOR

REGISTRATION FORM 2015/16

Address Correspondence to selected club –

This form to be retained by the Club and all details entered onto My Cricket.

Please tick which club you wish to register with.

Caboolture Sports Cricket Club

Player’s surname / Given names
Address / Town Postcode
Email Address
Phone Nos / Home: / Mobile: / Work:
Date of Birth / / / / Occupation:
Available for Rep Cricket / YES NO
Played Last Year / YES NO / Last Club: Grade:
NB. If you have played for a different Club in Queensland a clearance is required Th. This clearance is the responsibility of the registered player and must be in the hands of the Administrator SCCA

NB. If you have played for a previous Club in Queensland a clearance is required from that Club. It is your responsibility to gain this clearance and it must be in the hands of the Administrator SCCA Inc. prior to you taking the field in an SCCA sanctioned match or activity.

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING

Indemnity Release

I, ______(Applicant) in consideration of being allowed to participate in cricket matches, training and associated events (“Activities”) organized and / or supervised by the club and associations (Queensland Cricket, Sunshine Coast Cricket Association Inc. and affiliated Clubs)., acknowledge, agree and confirm the following:

(a)That there are inherent risks associated with the activities which may result in personal injury (even of a serious nature) to participants.

I fully accept and agree to bear those risks.

(b)To the full extent permitted by law I absolve, indemnify, release and discharge QC ,SCCA Inc and Affiliated Clubs and its officers, employees, representatives and agents (the indemnities) from any and all liability for any injury, loss, cost, charge, expense or damage suffered by me however caused, arising from or incurred directly or indirectly as a result of my participation in the activities, including without limitation, where caused by an act, omission, default or negligence by the indemnities.

Privacy Act

In addition, I hereby agree and consent to the provision of the personal information relating to me as set out in this form to the Sunshine Coast Cricket Association and Queensland Cricket Association Limited for use by them as they see fit in the course of their administration of cricket in Queensland. Queensland Cricket’s {and therefore SCCA’s} Privacy Policy is available at

I agree on signing this registration form to abide by the Rules and By-Laws of the SCCA Inc. I understand also that I am automatically included in the QC compulsory insurance scheme upon paying my fees and being registered by the club on the QC Player Data base My Cricket.

I have read, understood, acknowledge and agree to all the matters referred to in this statement, including the warning, indemnity release and Privacy Act..

Signed: ______Date: ______

Fees do apply and are at the discretion of each individual club