Junior Social Membership Application Form (training only)

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Pontblyddyn CC

Home
About
Membership
Club Policies and Safeguarding
Sponsors
Contact
Club Management Committee

info@pontblyddyncc.org.uk

Tel: 01352 748460

Pontblyddyn Cricket Club

Junior Social Membership Application - Under 18s - non -playing - £10

NOTE: This form is only to be used for any junior members who wish to participate in club training sessions, but do not want to participate in club matches. Please speak to one of the coaches if you have any queries

Junior Social Membership Application Form

First Name:

Surname

Street Address

Town

County

Post Code

Email: (if over 16 only)

Phone: (if over 16 only)

Date of birth

Gender

Parent / Guardian First Name

Parent / Guardian Surname

Parent / Guardian Address if different

Parent / Guardian email address:

Parent / Guardian Mobile No

Parent / Guardian Home Tel.

Does the junior applicant suffer from any of the following?

Epilepsy

Heart Trouble

Asthma / Breathing dificulties

Allergies (details below please)

Other condition (details below)

None

Please enter any additional details of medical conditions or any other medical or medication information that you feel is relevant in the space below

I confirm that all the medical information that I feel is relevant in relation to the participation of activities at Pontblyddyn Cricket Club has been provided

Yes

No

Emergency Contact Name if Different to Parent / Guardian

Emergency Mobile No. (if different to Parent /Guardian

Emergency Work No.

Emergency Home No

Is the junior applicant considered to have a disability?

Yes

No

If Yes, what is the nature of the disability?

Visual Impairment

Hearing impairment

Mobility Impairment

Learning Impairment

Other (please provide details)

Please enter any additional details of disability that are considered relevant in the space below

CLUB PHOTOGRAPHY / VIDEO CONSENT. As parent or guardian do you consent to the club photographing or videoing the junior member when involved in cricket / club activities in line with the club photography/video policy.

Yes

No

Acceptance of Terms of Selection for match teams

This membership allows junior members to participate in club traing sessions. It does not allow selection to play in a junior team to represent the club in inter - club matches. If the junior member is selected and would like to play in any such matches a match fee of £5 per match is payable or this membership can be upgraded to full junior membership for a further payment of £40. All match fees must be paid before the match and proof of payment shown to the team coach. Payments can be made on-line via the club website.

Acceptance of the club terms of membership

By accepting the terms of membership, you are providing consent that you have read and understand the club policies and privacy statement and accept them as part of your membership. Any breach of the club rules and or policies will result in disciplinary action being taken, which may result in your membership of the club being revoked.

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Contact info:

01352 748 460

info@pontblyddyncc.org.uk

Alder Meadow,

Wrexham Road,

Pontblyddyn,

Flintshire.

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