Welcome to Fox Lodge CC Youth Registration Portal
This form is to be filled by the parent or guardian of the below named child/children
Player Name 1
*
D.O.B.
*
Player Sibling 2
D.O.B.
Player Sibling 3
D.O.B.
Player Sibling 4
D.O.B.
Address
*
Post Code
*
School
*
Parent/Guardian Contact Name
*
Parent Contact Number 1
*
Parent Contact Number 2
E-mail
*
Doctors Name
*
Number
Address
*
Any specific conditions or alergies requiring medical treatment, medication or special attention
Yes
No
If yes; please provide details
Declaration
*
I agree to adhere to the Code of Conduct for members, parents & players that is expected by Fox Lodge CC
I am aware that Fox Lodge implements a child protection policy & know how to contact the club welfare officer if required (Details on Club Notice Board)
I acknowledge that this form is for registration purposes of Fox Lodge CC & will information will only be stored while membership is valid
Consent
I have been made aware of Fox Lodge cricket club's policy on photographing or videoing, and agree to have my child photographed/videoed for publicity purposes in line with this policy.
I give permission for the coaches present to give the immediate necessary first aid & and take appropriate steps to ensure minimum delay if a medical emergency arises.
Form Completed by
*
Date
*
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Month
-
Day
Year
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