ELPMCC Juniors - About your child

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This form is designed to be completed by the parent, or legal guardian of any player under
the age of 18.

Data protection. The club will use the information provided on this form, as well as, other information it obtains about the player (together “Information”) 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 ECB. In the event of a medical or child safeguarding 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 each person whose information you include in this form knows what will happen to their information and how it may be disclosed.

Child's Name *

Child's Date of Birth *

YYYY

Child's School Year *

Year 1

Year 2

Year 3

Year 4

Year 5

Does your child have any additional needs / disabilities we need to be aware of? *

Yes

If you answered Yes to the previous question, please indicate the nature of their disability

Visual Impairment

Learning disability

Hearing Impairment

Multiple disability

Physical disability

Other:

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Please detail below, any important medical information that our coaches need to know. Such as: allergies; medical conditions (for example - epilepsy, asthma, and so on); current medication; special dietary requirements, any additional needs, and/or any injuries. Please let us know if you would like to discuss this with us. If none - please write "none" *

Do you wish to register a sibling *

Yes

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