JUNIOR MEMBERSHIP FORM – 2014 SEASON
LONG DITTON CRICKET CLUB
Welcome to Long Ditton Cricket Club. To ensure that we have the correct details for you, please insert the information
requested below and return this to Frances Rogers, Juniors Secretary. If you are under 16, please also ask your parents or
guardians to sign the form before it is returned. We will also use this information to ensure that you are kept informed about
club events.
PERSONAL DETAILS
Age at 31st August 2013.………Date of Birth…………….
NAME OF JUNIOR MEMBER………..………………………………...................................................................................................
NAME OF PARENT/GUARDIAN/CARER……………………………………………………………………………………………
ADDRESS………………………………...................................................................................................................................................
POST CODE………………………………......................
HOME TELEPHONE NUMBER OF PARENT/GUARDIAN/CARER……………………………….................................................
MOBILE PHONE NUMBER of PARENT/GUARIAN/CARER……………………………………………………………………….
e-mail parent/guardian/carer/……………………………….................................................................................................................
(Please be very clear with your e-mail address)
Please state how you would like correspondence to be addressed to you, e.g. Mr Smith, Mr/Mrs Smith/ S. Smith, Ms Smith
etc…….
Name of School/College etc attended by junior member………………………………......................................................
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In order to help the club monitor its membership, can you please tick one of the following boxes to identify your ethnic group:
White
Mixed
Asian or Asian British
Black or Black British
Chinese





Other ethnic group (please state)…………………………….......................................................................................................
SPORTING INFORMATION
Has the young player played cricket before? Yes  No 
If yes, where have they played the sport: (please indicate below)
Primary school

Secondary school  Local authority coaching session(s) 
Club 
County 
Other  (Please
specify)……………………………............................................................................................................................................
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Page 3 of 8
Information about any Impairment
Please provide information about any impairment your child may have so that we can determine what reasonable adjustments may be
required to support your child’s full participation in club activities.
Do you consider your child / the child in your
Yes
No
care to have an impairment?
If yes, what is the nature of the impairment?
Visual impairment
Hearing impairment
Physical impairment
Learning difficulty
Multiple impairments
Other (please specify):
If you have ticked yes in any box above please provide us with any additional information that will assist us to ensure your child is fully supported
whilst at the club.
........................................................................................................................................................................................................................
MEDICAL INFORMATION
Please detail any important medical information that our coaches/junior club co-ordinator should be aware of (e.g. epilepsy,
asthma, diabetes, allergies etc)
………………………………........................................................................................................................................................................
........................................................................................................................................................................................................................
Name of Doctor / Surgery:
Doctor / Surgery telephone number:
□
Medical consent:
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. I also understand that in such an occurrence all reasonable steps will be taken to contact me as the relevant parent / legal
guardian, or the alternative adult I have named on page 5 of this membership form.
□
I confirm that to the best of my knowledge, my child / the child in my care does not suffer from any medical condition other than
those detailed above.
(Please tick the boxes on the left if you agree to the above)
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ALTERNATIVE EMERGENCY CONTACT DETAILS - TO BE COMPLETED BY PARENT/GUARDIAN
Please insert the information below to indicate the person (s) who should be contacted in case of an incident / accident if
person(s) named on Page 1 cannot be contacted
Contact name :…………………………...........................................................................................................
Emergency contact number………………………………...................................................................................................................
Relationship to young member (e.g aunt, grandparent, neighbour etc)....................................................................................................
YOUR SKILLS / KNOWLEDGE:
Do you have any skills / knowledge which you think could assist the club? If so, please state here:
Would you be willing to be a coach, umpire/scorer/kitchen helper etc on a rota basis? Yes / No (Delete as approrpriate)
If yes, please state what role(s) you would prefer............................................................................................................................
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LONG DITTON CRICKET CLUB: (Page 6 also needs to be completed)
Permission for the use of photographs and recorded images
Long Ditton Cricket Club recognises the need to ensure the welfare and safety of all Young People in Cricket. As part of this
commitment we will take all reasonable steps to ensure photographs, video images or other images of Young People are not taken or
used without the consent of the Parent/Guardian and the Young Player. Long Ditton Cricket Club follows the guidance issued in
‘Safe Hands – Welfare of Young People in Cricket’ on the use of images of Young People which is available at:
http://www.ecb.co.uk/safehands. Long Ditton Cricket Club will take steps to ensure that these images are used solely for the
purpose they are intended, which is the promotion and celebration of cricketing activities.
If photographs e.g. team or action shots, are submitted to the Press or published on the ECB’s Fuller’s League website, our website or
in our handbook individuals will not ordinarily be identified. Where a child or young person is identified it will only be with the
explicit consent of parents.
Please note: Long Ditton Cricket Club understands that there are circumstances under which a parent would not wish their child to
be photographed. Whilst Long Ditton Cricket Club will do all that it can to ensure the safety of children during photographed
events, it is the responsibility of the parent concerned to ensure that if their child is not to be photographed and partakes in an activity
and is by the nature of the activity inadvertently photographed or filmed, Long Ditton Cricket Club cannot be held responsible.
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Transport to matches and practice sessions
Long Ditton Cricket Club’s policy is that parents or other responsible adults are responsible for transporting players to and from all
matches and practice sessions and therefore the Club will not be registering Private Vehicles for the transportation of individuals in
connection with any fixtures or practice sessions arranged by the Club. The implementation of this policy is not intended to exclude
any player from participation and parents or guardians should contact the Club Welfare Officer if they have any problems with the
transportation of players to matches or practice sessions.
Club Changing Policy
For players under the age of 16 playing in adult teams the following policy applies:
 Young players uncomfortable with changing or showering with adults are under no obligation to do so and are advised to change
and shower at home
 Parental consent must be given if Young Players are to share changing facilities with adults
 If Young Players are sharing changing facilities with adults, parents have the option to supervise them whilst they are changing.
The Club will make reasonable efforts to arrange this.
Data Protection
The Club will use the information provided on this Membership Form (together with other information it obtains about the player) to
administer his/her cricketing activity at the Club and in any activities in which he/she participates through the Club and to care for and
supervise activities in which he/she is involved.
In some cases this may require the Club to disclose the information to County Boards, Leagues and to the England and Wales Cricket
Board. In the event of a medical issue or child protection issue arising, the Club may disclose certain information to doctors or other
medical specialists and/or to police, children’s social care, the Courts and/or probation officers and, potentially to legal and other
advisers involved in an investigation.
As the person completing this form, you must ensure that each person whose information you include in this form knows what
will happen to their information and how it may be disclosed.
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By returning this completed Junior Membership Form, I agree to my child / the child in my care taking part in the activities of Long
Ditton Cricket Club. Parents / guardians of the young player automatically become members of Long Ditton CC and are entitled to
attend and vote at Annual/Extraordinary General Meetings
I confirm that I have legal responsibility for the child named in section 1 above, and that I am entitled to give this consent.
I understand that I will be kept informed of activities at Long Ditton Cricket Club – for example details of times and transport etc.
I understand that in the event of injury or illness all reasonable steps will be taken to contact me / the alternative contact, and to deal
with that injury/illness appropriately.
I confirm that to the best of my knowledge all information provided in this form is accurate and I will inform the club of any changes
to this information in a timely manner.
Name of parent / legal
guardian:
Signed:
Date:
Page 8 of 8
Forms to be returned to: Frances Rogers, Juniors Secretary, to: 151 Warren Drive South, Tolworth, Surrey
KT5 9QH. Cheques of £85 to be paid to Long Ditton Cricket Club
YOUNG PERSON’S CODE OF CONDUCT: LONG DITTON CRICKET CLUB
LONG DITTON CRICKET CLUB is fully committed to safeguarding and promoting the well being of all its members.
The club believes that it is important that members, coaches, administrators and parents associated with the club should, at all times, show respect, encouraged to
be open at all times and to share any concerns or complaints that they may have about any aspect of the club with Colin Knight, Welfare Officer.
As a member of LONG DITTON CRICKET CLUB you are expected to abide by the following junior club rules:
All members must play within the rules and respect officials and their decisions.
All members must respect opponents, with no inappropriate behaviour.
Members should keep to agreed timings for training and competitions or inform their coach or team manager if they are going to be late.
Members must wear suitable kit, sports shirt, shorts/tracksuit, cricket whites etc and protectors for training and match sessions, as agreed with the coach/team
manager. Helmets must be used for wicketkeepers and batsmen if parental consent has not been given for a junior member to play/practice without one.
Members must pay any fees for training or events promptly.
Junior members are not allowed to smoke on club premises or whilst representing the club at competitions.
Junior members are not allowed to consume alcohol or drugs of any kind on the club premises or whilst representing the club.
Code of Conduct for Parents/Carers/Supporters: Long Ditton Cricket Club
1. Encourage your child to learn the rules and play within them.
2. Discourage unfair play and arguing with officials.
3. Help your child to recognise good performance, not just results.
4. Never force your child to take part in sport.
5. Set a good example by recognising fair play and applauding the good
performances of all
6. Never punish or belittle a child for losing or making mistakes.
7. Publicly accept officials’ judgements.
8. Support your child’s involvement and help them to enjoy their sport.
9. Use correct and proper language at all times.
CODE OF CONDUCT GIVEN TO
OFFICIALS AND VOLUNTEERS AT LONG DITTON CRICKET CLUB
The essence of good ethical conduct and practice is summarised below. ALL officials and volunteers MUST:
 Consider the well-being and safety of participants before the development of performance.
 Develop an appropriate working relationship with performers, based on mutual trust and respect.
 Make sure all activities are appropriate to the age, ability and experience of those taking part.
 Promote the positive aspects of the sport (e.g. fair pla).
 Display consistently high standards of behaviour and appearance.
 Follow all guidelines laid down by the national governing body and the club.
 Hold the appropriate, valid qualifications and insurance cover.
 Never exert undue influence over performers to obtain personal benefit or reward.
 Never condone rule violations, rough play or the use of prohibitive substances.