Membership Form

Eastbourne Cricket Club

Membership Form

EASTBOURNE CRICKET CLUB

We are very pleased to welcome you to Eastbourne Cricket Club. To ensure we have the correct contact details for you, please fill out this Membership Form and return it to Eastbourne Cricket Club, Eastbourne Saffrons Sports Club, Compton Place Road, Eastbourne, East Sussex, BN21 1EA.

If you are under the age of 16 please also ask your parents / carer or guardian to sign the Membership Form before it is returned. We will also use this information to ensure that you are kept informed about events and information from Eastbourne Cricket Club.

Section 1 – Personal Details.

Name:
Address:
Postcode:
Home telephone number:
Mobile:
Email:
Date of birth:
Name of School / College

Whilst it is not compulsory that the following section is completed, the footnote at the end of this Membership Form explains why this section is important.

Section 2 – Ethnicity

A	White
	British
	Irish
	Any other white background (please specify):

B	Mixed
	White & Black Caribbean
	White & Asian
	White & Black African
	Any other mixed background (please specify):

C	Asian or Asian British	Pakistani
	Indian	Bangladesh
	Any other Asian background (please specify):

D	Black or Black British
	Caribbean
	African
	Any other Black background (please specify):

E	Chinese or other ethnic group
	Chinese
	Any other (please specify):

Section 3 – Disability

The Disability Discrimination Act 1995 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 consider yourself to have a disability?	Yes	No
If yes, what is the nature of your disability?
Visual impairment
Hearing impairment
Physical disability
Learning disability
Multiple disability
Other (please specify):

Section 4 - Sporting Information

Have you played Cricket before?	Yes	No
If yes, where have you played Cricket: (please indicate below)
Primary school
Secondary school
Local authority coaching session(s)
Club
County
Other (please specify):

Section 5 – Medical Information

Please detail below any important medical information that our coaches/junior coordinator should be aware of (e.g. epilepsy, asthma, diabetes etc.)

Text Box:

Section 6 – Emergency Contact Details

This section is to be completed by the parent / carer or guardian:

Please insert the information below to indicate the persons who should contacted in the event of an incident / accident:

Emergency Contact Person 1: Emergency Contact Person 2:

Name: ______________________________ Name: _________________________________

Relationship to individual: _______________ Relationship to Individual: _________________

Home Tel: ____________________________ Home Tel: ______________________________

Work Tel: ____________________________ Work Tel: ______________________________

Mobile Tel: ____________________________ Mobile Tel: _____________________________

By returning this completed Membership Form, I agree to my child in my care taking part in the activities of Eastbourne Cricket Club.

I understand that I will be kept informed of activities at Eastbourne Cricket Club – for example times and transport details etc…

I understand in the event of injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately.

Name of parent/carer/guardian:

Signature of parent/carer/guardian:

Date:

In reference to Section 2 on this Membership Form:

Sport can and does play a major role in promoting inclusion of all groups in society. However, inequalities have traditionally existed within sport, particularly in relation to gender, race and disability. The England and Wales Cricket Board and Sport England are committed to promoting and developing sports equity, which is about fairness in sport, equality of access, recognising inequalities and taking steps to address them. By monitoring the profile of young people in sports clubs, national governing bodies of sport and Sport England can identify any issues relating to under-representation of different groups and can together develop strategies to ensure all young people have an opportunity in the future development and progress in sport.