Lords Taverners - Super 1s

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Super 1s Sign Up form
This form is to register for Cornwall Super 1s Cricket Sessions.

Please enter information below correctly. 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 your specific needs.

By completing the details you agree to all the T & Cs and code of conduct which can be found at https://cornwallcricket.co.uk/about-us/policies/code-of-conduct.html

Participant's Full Name *

Participant's Gender *

Male

Female

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Participant Ethnicity *

White/White British

Black/Black British

Asian/Asian British

Mixed

Other

Unknown

Participants Date of Birth *

YYYY

Participant Address (including postcode) *

Participants Contact Phone Number *

Option 1

Option 2

Other:

Participant/Parent/Guardian/Carer's Contact Email Address *

Emergency Contact Name *

Emergency Contact Number *

Emergency Contact Relationship to Participant *

Yes

Option 1

Required

Option 1

Option 2

Do you have a Disability (please select) *

Hearing impaired

Visually Impaired

Learning Disability

Physical Disability

Autistic Spectrum Disorder

Other:

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Medical information - Please details any medical conditions that we should be aware of (allergies, medications to be administrated, long term injuries etc) *

Option 1

Required

Yes

Option 1

By consenting to share the information you have provided on this form, you agree to personal information being held on a secure database by the Cornwall Cricket Board. The Cornwall Cricket Board will only use this data to send information regarding the Cornwall Cricket Programme. If requested to do so we will pass your information onto the NHS Track and Trace. By typing your name below, you agree to your Data being held by us the Cornwall Cricket Board. You can withdraw your consent by emailing ddo@cornwallcricket.co.uk at any time and stating that you withdraw your consent. All your data will then be removed from the Cornwall Cricket Board database. Information held by the Cornwall Cricket Board includes the personal information as stated above. By typing your name above, you are electronically certifying you give your consent to the Cornwall Cricket Board holding your data as stated above, you agree to all the T & Cs and all information provided is correct. *

I consent to my data being used for the purposes laid out above

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