Women’s Softball Membership Please enable JavaScript in your browser to complete this form.SECTION 1 (MANDATORY): PERSONAL DETAILS OF PLAYER This form is designed to be completed by a player over the age of 18. If you are under 18, please use the Club’s Junior or Student Membership Application Form instead. As the person completing or receiving this form, you must ensure each person whose information you include in this form knows what will happen to their information and to whom it may be disclosed. Details are set out in the Privacy Notice. The Club uses the ECB’s Play-Cricket system to store data. Data from this form may, therefore, be entered onto that system. Name *FirstLastDate of Birth *Home Address *Postcode *Phone *Email *Are you interested in playing League Cricket?YESNONOT SUREIf you answer ‘yes’, should you be selected by the Club to play in a League requiring player registration, relevant information from this Section 1 (including month and year of birth) will be provided to that League to enable them to check your eligibility to play in that League. SECTION 2 (OPTIONAL): EMERGENCY CONTACT DETAILS Name of an adult who can be contacted in an emergency Phone number of named adult Relationship which this person has with you SECTION 3 (OPTIONAL): SPORTING EXPERIENCE INFORMATION Have you played cricket before: YESNOIf yes, where has this been played?ClubSchoolLocal authority coaching session(s)UniversityOther (please specify)DetailsSECTION 4 (OPTIONAL): DISABILITYBy providing the information in this section, you are giving your explicit consent to the Club using this information (and any additional disability information provided by or for you) for statistical purposes as well as to establish if there are any additional needs / support / adjustments that you may requires. The Equality Act 2010 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 have any physical or mental health conditions or illnesses that have lasted or are expected to last 12 months or more? YESNODoes this disability or illness affect you in any of the following areas?VisionHearingMobilityDexterityLearningMemoryMental HealthStamina, breathing or fatigueDevelopmentalOther, please provide more details:More details if required:SECTION 5 (OPTIONAL): MEDICAL INFORMATION By providing the information in this Section 5, you are giving your explicit consent to the Club using this information (and any additional medical information provided by or for you) to help you when you participate in cricket activities.Please detail below any important medical information that our club volunteers need to know and which would be affected by your participation in cricket activities. Such as: allergies; medical conditions (for example- epilepsy, asthma, and so on); current medication; special dietary requirements, any additional needs, and/or any injuries. Please indicate if you would like to discuss this privately with us.Name of doctor/surgery nameDoctor’s telephone numberMedical consent:I consent to my medical details to be shared with coaches/leaders for the purposes of the delivery of my safe participation in Club activity.If you do not give your consent, this will not affect your membership of the Club. However, giving us consent to share this information will help Club coaches and leaders to know how to respond effectively in the case of any medical emergency. SECTION 6 (MANDATORY): PLAYER PARTICIPATION AGREEMENT: I agree to taking part in the activities of the Club • I confirm I have read, or have been made aware of, the below ECB/Club’s policies: • Anti-Bullying • Changing Rooms and Showering Facilities • Club Safeguarding Policy Statement • Code(s) of Conduct • Creating a Safe, Welcoming and Inclusive Environment • Junior Players Playing in Open Age Cricket • Managing Children Away from the Club • Photo, Video and Live Streaming • Responding to, Recording, and Reporting Concerns • Social Media • Transport to and from Matches and Training. I understand and agree to the responsibilities which I have regarding these policies *YESNOSECTION 7 (OPTIONAL): CLUB PHOTOGRAPHY/VIDEO/LIVESTREAMING CONSENT I consent to the Club photographing, videoing or livestreaming my involvement in cricket in line with the Club photography/video policy. YESNOIf you do not give your consent, this will not affect your membership of the Club. If you choose not to give consent, please contact us to discuss how we can manage any potential photography. SECTION 8: PRIVACY STATEMENT: The club take the protection of the data we hold about you seriously and will ensure the data you provide is processed in accordance with data protection legislation. Please carefully read the full privacy notice in the 'Safeguarding' page of St Asaph Cricket Club website, to see how the club will treat the personal information you provide to us. PLAYER DECLARATIONI confirm that I have read and understand the permission statements on this membership form and the privacy noticeConfirmedWomen's Softball membership PaymentPrice: £50.00Stripe Credit Card *Single Line TextSubmit Payment
