Junior Membership – Abergavenny Cricket Club

Junior Membership

Details of Parent or Guardian

First Name of Parent or Guardian

Last Name of Parent or Guardian

Address

Address Line 1

Address Line 2

City

Post Code

Contact Phone Number

Contact Email

Secondary Contact

First Name

Last Name

Contact Phone Number

Details of Junior Member/s

Dropdown member number

First Name

Last Name of Junior Member

DOB

Dropdown school Year

First Name of 2nd Junior Member

Last Name of 2nd Junior Member

DOB 2nd

Dropdown School Year 2nd

First Name of 3rd Junior Member

Last Name of 3rd Junior Member

DOB 3rd

Dropdown School Year 2nd

First Name of 4th Junior Member

Last Name of 4th Junior Member

DOB 4th

Dropdown School Year 4th

Medical Declaration

Are there any medical conditions we should be aware of?

Yes

Please provide details

medications

Membership Category

Membership Category – Please pay by Bank Transfer using the following details (please include the players name as a reference) Bank Transfer details – Abergavenny Cricket Club – Sort Code 30-90-02 – Acct No. 00558045

Junior = £30

Student = £40

Family = £50

Consent Delaration

Video Analysis – I am happy for video analysis to be used for training purposes. Members will always be notified if they are being video and this will only ever be in a group training environment. All video will be deleted at the end of the training session.

Yes

I hereby consent to the above taking part in training sessions and matches for Abergavenny Cricket Club. I understand that any participation is entirely at own risk. I hereby consent to the above having photographs taken and images published in the Club House, in the Club media and in the local press in association with promoting the aims of the Cricket Club. Should an accident arise I hereby authorise the Club coaches or organisers to make direct contact with the medical services, especially if parents cannot be contacted. I take full responsibility for taking and collecting my child, or making the necessary arrangements for my child to be taken or collected to each training session or match. I agree that I and my children will abide by the Junior codes of conduct.

I Agree