Please complete the Player Profile Form below in as much detail as possible.

SECTION 1: Personal Details of Player

Squad

Player's Full Name

Player's Date of Birth DD/MM/YYYY

Player Address

Postcode

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SECTION 2: Details of Parent / Guardian and Emergency Contact

Name of Legal Parent/Guardian

Parent/Guardian Address

Postcode

Email

Mobile Number

Home Number

Alternate Emergency Contact

Name

Relationship

Mobile Number

Home Number

Work Number

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SECTION 3: Disability

The Equality Act 2010 (replacing the Disability Discrimination Act 1995) defines a disabled person as anyone with “a physical impairment which has a substantial and long-term adverse effect on his or her ability to carry out normal day- to-day activities”

Does this child have a disability as defined under the Act?

YES/NO
YesNo

If YES, what is the nature of the Disability (choose from the dropdown options and please provide details below).

Details of Disability

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SECTION 4: Activities

I agree to the young person named above taking part in the activities of the LCCB

YesNo

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SECTION 5: Medical Information

Please provide details of any important medical information that LCCB needs to be aware of (e.g. allergies, medical conditions etc.)

Does your child currently take any medication, if so, please specify
YesNo

If YES, please specify

Does your child self-administer the medication?
YesNo

Doctor's Name

Surgery Name

Surgery Address

Surgery Number

I consent to my child receiving medical treatment which, in the opinion of a Qualified Practitioner, may be necessary or emergency first aid.
YesNo

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SECTION 6: Policies

I consent to the LCCB photographing or videoing my child’s involvement in cricket under the terms and conditions in the LCCB photography / video policy.
YesNo

I consent to any LCCB photography or video of my child’s involvement to be used for promotional and marketing purposes for LCCB only.
YesNo

I understand that LCCB coaches/team managers are not to transport players to and from cricketing events.
YesNo

I recognise the importance of adhering to collection times so that coaches/team managers are not left on their own to care for players awaiting collection.
YesNo

I confirm I have read, or been made aware of the LCCB policies concerning (most of which are under Child Welfare policy):
Changing / Showering
YesNo

Photography / Video
YesNo

Anti-bullying
YesNo

Missing Children
YesNo

E-Safety Guidelines
YesNo

Code of Conduct
YesNo

Playing in Adult Matches
YesNo

Transport
YesNo

Managing Children Away from Home
YesNo

Parent / Guardian has read the Code of Conduct forms below

PARENT CODE OF CONDUCT

PLAYER CODE OF CONDUCT

 

FULL POLICIES CAN BE FOUND HERE

Data protection. The LCCB will use the information provided on this form (together with 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 participates through the LCCB and to care for and supervise activities in which he/she is involved. In some cases this may require the LCCB 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 LCCB 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 information.

Form updated 2012