HARYANA CRICKET ASSOCIATION Haryana 5, astoK ROAD, VAY NAGAR, BHIAAN, HARYANA. 127021181) 1654-25511 | Chasey Bary cam Cricket a ee een E 1ON FORM (2018-19) (Tobe filed in and executed by Parent/Guardian of players under the age of 18) + Manaetory Fits (TORE ALLED IN CAPTALS SECTIONA * Gonder Male Female * Dato of Birth Paste your Under 14 [Under 16 Under 18 Under 23. [] Senior | Junior Under 23 Senior ‘SECTION A : PARTICULARS OF PLAYER Player Name + First vame + Last Name Display Name (432 appears nthe scorecard) » Parent/Guardian Name + Rolation with player * Player's Contact Number * Player's Contact Number 2 (ParetfGuarian number Under 18) (ParontKGuarcian number # Under 18) vitape 1 Gly or District + Sate Page 1014Haryana yy Cricket Permanent Addross: This walbe your communication address + Acces Line sony ‘* State + County Email Facebook Titer Instagram Birth Registration Certificate Enter your bth registration ceniteate number + Aadhar numbor Pan Card number aay Dote of expiry (8mm ney) Date of issue (damm yr) Represented Districts Enclosed photocepy of passport YES NO. [] District | I | I I ] Representation State District uw 16 vig zs ‘Senior Page 2.0f 4Haryana Cricket + Proficiency (Seiect any one option) Z batsman [7] Bower [] atrounder —[] wicketkeeper Batsman * Batting * Bowler Select any ore option ‘Select any one option ‘Select any one option Select anyone option Right Har “Top Oder Right arm Fast Fast Negium cohen Mite Order Leta onsrin Leg Spin Lower Order Orthodox Chinaman * Photo Identity Proof (vane of te Photo kent Proo attached ex: Aadharcars) Enter certicate number Date ofisue (4d) mm * Signature of the Player «District Association Secretary, Signature and Seal ‘Please sign inside the box Given beiow Please sin inside the box aven below Page 3of4Haryana Cricket ‘SECTION B : UNDERTAKING 8/0 dl, 0 hereby undertake: {That have read the Haryana Cricket Association Registration Rules, understood them and undertake that Iwi able by them and understand hat in case 1 ‘donot abide by any ofthese res or her res framed by the Haryana C:cket Association cx the BCCI rom tine to time, I shal ot be lable for selection to Ct cnn of any camp or eam af the Haryana Cricket Association. ts assocites or afiaes or successors by whatever name called 2. Thattne attached attested poo! of my date of birth ae bonatde, genuine, rue and correct and | undersiand Pat they are found o be malaise, untrue or incorrect. | shal rot be Hable fr selecfon to or cning of any camp or team ofthe Haryana Cricket Association, is associates or afliates or successors by ‘whatever name called and may be able for dscipinary ard legal acton. 3. That! undertake to ensure that | shal always abide by l the laws ofthe game of Cricket and the laws, res and code of conduct for players in efed at any ‘ven time, incuding the Ani Doping ard Ans Conpiion rules and laws fang which, understand thet ry registration shal stand cancoled and! shall rot be considered for selecion fr any team either ef the Haryana Cricket Asseciaion ors assocates and afiales or successor by whatever name called and ‘ray intr aia be Late for aiscipurary and legal action. 44. Tatl undertake that! shal rot play any match in any tournament oc any league which 's not approved by te Haryana Cricket Assocation ore BCC, faltng which, | understand that my repisraion shall be deemed tobe cancelled foruith and! shal not be elie for selection for any team or camp either of the Haryana Cricket Association orits associates and aflites or suctestot by whatever name called, in future ard shall not be alowed to be associated with the 2am ‘5.1 understand that | shall be subject to medical examinations and tests conducted by registered medical practitioners, chosen by the Haryana Cricket ‘Association ots afiites! associates forthe purpose and wituily corsent forthe samme. | also understand thatthe fests shallincude but nct be ime toa bone density test xray. physical examination tet of samples of body fds ec. and ther tests as prescibed by te ECCI or may be preseibed by BCCI rom lune to ne, to determine te age of he player, medical conciuon ofthe player and fe eligi of te payer to take part a Cricket Wate of ne partcuar ‘age group. My joing of and continuation ina eam. a team. Lam so selected and my patcpaion in any match or program or event ofthe age group Contucted by the BCCI, the Haryana Cricket Assocation or ay of ts associa ard afates, shall be subject othe resus and facings ofthe regisored mecca practitioners besed onthe aforestid medical exarrinations ard teats conducted by hinfher. Further. understand thet such dsquatfcation ofan payer ‘based onthe aforerrentoned mecical fngng shall resut inthe cancetaton ofthe player registration forthe gven year or that parkour age group andor upto fur years fr any ofve age group. | undertake to subject myse wlingy to such medical examination and tests and further undertake to abi by the fining ofthe medical practioner and understand hatin ease of 3 negative fring regarting my age or oer parameters (ncluting tut not ite tothe proserce of banned substances), shall not be Hable fo playin the given ge gioup end the sd finding shal be nal. Further, Lam consenting to such medical examination ‘angtests and tne shanng of he resus thereof bythe Haryana Cricket Assocation wi all such organtzatons and inwiuals as ney deem ft 6. understand tal the ageftone age so determined does net mean thet tis my actual dwonalogcal age 7-Luncerstand thatthe decision ofthe selection commitioes ofthe Haryana Cricket Assocation os Afilates cx Associates regarting the selecfon ofary eam, ‘group, camp and the selection ofthe payers and the ining and venue of announcement af ts decisions shale nal are | undertake to abide by thei cecsion. 42.1 understand that | am being considered for registration by the Haryana Cickat Associaton fer paticinaing inthe ter disc! teuramant ot the possible ‘selection o any camp rand further til and being alowed to take part nthe sald iounaments camps etc, soley on the bass Of my present undertaking and ry undertaking to abide by the Haryana Cricket Association Registration rs. 9. Lamtegaty competent and fully autrorzed te sign and execute the preset undertaking VERIFICATION ‘Verfed thatthe contents ofthe section ofthe form filed by me are true tothe best of my knowledge and bebef ard noting mater has teen concealed \teretrom and that my underiaking in section B of he formas been execited of my own free wil and wiheut ary duress © reseue. Page 4014