Junior Membership Form (renewals)

Ruislip Cricket Club

Junior Renewal form

 

This Junior Renewal Membership Form should be completed by the parent or legal guardian of any player under the age of 18.

 

Section 1 – Personal Details of the child re-applying for Junior Membership

Name:

Address:

Date of Birth:

School Year:

 

Section 2- Parent/Legal Guardian Contact details

Name:

Relationship to child:

Address if different:

Contact telephone number:

Email:

 

Section 3-Emergency Contact details (Alternative Contact)

Name:                                                  Relationship to child:

Contact telephone number:

 

Section 4-Medical History –

Please give details of any physical, mental impairment or medical issues that we should be aware of.

 

Doctor /Surgery details: _____________________________________________________________________________

 

__ I give my consent that in an emergency situation the club may act in my place, (in loco parentis), 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. Please tick                                                                                                                                                                                    

 

__ I confirm that I have legal responsibility for the child named above 

 

__ I confirm that I have received a copy of the club’s codes of conduct and appropriate policies and agree to abide by them

 

Payment

Membership subs for £60 for first child, £40 for siblings.

 

BY POST (Print and return form with payment to Jill Hooley, 70 Seaford Close, Ruislip HA4 7HN)

 

I enclose a cheque for £              payable to ‘Ruislip Cricket Club’

 

OR ONLINE (Return completed form once payment has been transferred to ruislipcolts@outlook.com)

 

I have transferred the sum of £                to the following account  

 

Barclays Bank, Account name Ruislip CC.

Account number 70781509  Sort code 20 73 53

 

Please use your child’s name + Colts as the reference eg. ‘Fred Smith Colts’

 

 

Signed ……………………………………………………………………

 

Name ……………………………………………………………………..

 

Date ………………………………………