Fulham Cricket Club Registration and Consent Form 2018/19

Confidentiality: Details on this form will be held securely and will only be shared with coaches or others who need this information in order to meet the specific needs of your child whilst engaged with Fulham Cricket Club.

Name of child/young person:

Address:

Date of Birth:

Gender:

Ethnicity:

School:

School year:

Name of parent / carer:

Day time Tel No parent/carer:

Mobile Tel No parent/carer:

Email address parent/carer:

Emergency contact information:

Name of alternative adult who can be contacted in an emergency:

Relationship to child/young person:

Day time Tel No alternative adult:

Mobile Tel No alternative adult:

Medical information:

Any specific medical conditions requiring medical treatment?

Yes No
If Yes please give details

Details of medication required (pain/flu/inhaler):

Yes No
If Yes please give details

Any specific medical condition or disability?

Yes No
If Yes please give details

Any allergies?

Yes No
If Yes please give details

Details of any dietary requirements (vegan/vegetarian):

Yes No
If Yes please give details

Consent information: please tick the boxes below

I give consent for my child to take part in Fulham Cricket Club Programmes.

I give my consent that if an emergency medical situation arises, Fulham Crickett may act as ‘in loco parentis’. If the need arises for administration of first aid and/or other medical treatment which in the opinion of a qualified medical practitioner may be necessary. I also understand that in such circumstances that all reasonable steps are made.

I confirm that I have read, or been made aware of, the organisation’s policies concerning:

Safeguarding

Codes for conduct for parents, coaches, & young people

Transport policy

Changing room policy

Photography, imagery, videoing, texting and use of social media policies

I can confirm that my child is aware of Fulham Cricket’s code of conduct for young people and anti-bullying policy.

I understand that my child must wear a suitable helmet when batting, standing up to the stumps when keeping wicket or fielding in certain positions, along with other required safety protection relevant to the role.

Date:

Print name parent / carer:

Subscriptions:

Course name:

Amount:

Fulham CC Account Number: Barclays Bank 63579239

Fulham CC Sort Code: 20-45-45

If paying by cheque, please make cheques payable to Fulham Sports Club Ltd. Please note a 50% sibling discount applies for all siblings.