RADCLIFFE ON TRENT CRICKET CLUBRADCLIFFE ON TRENT CRICKET CLUB

MEMBERSHIP FORM – SEASON 2010

passed to

1. Player Details (Senior & Junior)

SurnameFirstNameAddressPost Code

Phone-Home Phone -Mobile

e-mail

– if you wish to receiveinformation by this media (please print clearly)

Type of Membership

(Annual Subscription)

Indicate typerequired

Senior (£50)

The annual subscription increases to

£70

if not paid by 30 June 2010.5 x monthly direct debits available –ask the Secretary for more details

Intermediate (£25)

For 18 – 21 years age or in full time education

Midweek (£25)

For senior players who only play midweek games

Social Membership (£25)

Non playing membership

Junior (£20)

Up to and including those in school year 13. This rate is for thefirst child in a family; for other children from the same immediate family therate is

£10

per child.

Pages 2-3 of this form should also be completed for all junior members

I enclose the fee of £…………………. Signed: Date:Please return this form with remittance (

cheques should be made out to Radcliffe on Trent CC

) to:-David Ward, 26 Park Road, Radcliffe On Trent, Nottingham NG12 1AS (0115 9118784)

All members are reminded that membership of Radcliffe on Trent CC is subject tocompliance with the Club Constitution. This is displayed in the pavilion or is availablefrom the Secretary on request.

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RADCLIFFE ON TRENT CRICKET CLUBRADCLIFFE ON TRENT CRICKET CLUB

The following sections should be fully completed for all junior members.2. Junior Player Additional Details

SchoolDate of BirthSchool Year

Medical Information

Please give details of any medical conditions, treatments or allergies about which your coach/ team manager ought to beaware

Doctor /Surgery

Phone

3. Parent /Carer Details

Name/sAddress

HomePhoneWork

PhoneMobile

4. Emergency Contact

Name/s

Relation to junior

Address

HomePhoneWork PhoneMobile

5. Disability

The Disability Discrimination Act ‘95 defines a disabled person as anyone with a physical or mentalimpairment, which has a substantial & long term adverse effect on his/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 yourdisability?Visual impairment Hearing impairment Multiple disabilityPhysical disability Learning disability Other(please specify):

By returning this completed form, I agree to my son/daughter/the child in my care taking part in the activitiesof the club. I understand that I will be kept informed of these activities – for example timing and transportdetails.I acknowledge that as parent/carer/guardian of the Junior Player I am given automatic non-votingmembership status of the Club as part of that junior membershipI confirm that to the best of my knowledge my son/daughter/the child in my care does not suffer from anymedical condition other than those detailed above

Signed ………………………………………….. …………………….. Parent/Guardian/CarerDate………………………………………….Name (please print) …………………………………………………………………………………………………….

PLEASE ALSO ENSURE THAT YOU COMPLETE THE ATTACHED CONSENT FORM AND RETURNWITH THIS FORM.

PLEASE NOTE:

Transport to matches and practice sessions

ROTCC policy is that parents / carers are responsible for transporting junior players to and from all matches and practicesessions and therefore the Club will not be registering private vehicles for the transportation of individuals in connectionwith any fixtures or practice sessions arranged by the Club. The implementation of this policy is not intended to exclude

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