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

SECTION 1: Personal Details of Player

Player's First Name

Player's Surname

Squad

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 below of any important medical information Lincolnshire Cricket need to know and which may be affected by your child's participation in cricket activities. Such as; allergies; medical conditions (for example; epilepsy, asthma and so on); current medication; special dietary requirements; any additional needs, and/or any current/previous injuries

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

I consent to my Childs medical details being shared with Lincolnshire Cricket and any 3rd party Lincolnshire Cricket deem necessary.
YesNo

Not providing consent will not affect your child's participation, however giving us consent to share this information will help Lincolnshire Cricket to know how to respond effectively in the case of any medical emergency.

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SECTION 6: Policies

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

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

I understand that Lincolnshire Cricket 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 Lincolnshire Cricket welfare policies concerning:
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

Sun Protection Policy
YesNo

Managing Children Away from Home
YesNo

I understand and agree to the responsibilities which I and my child have regarding both the Parent/Player code of conduct

We expect parent/guardian or a responsible adult to always collect their child from each venue after training sessions and matches unless they are in year 7 or above where we will accept permission by ticking the consent box below allowing them to leave unaccompanied.

I give permission for my child to leave the building/ground unaccompanied. (Please note this option is only available for children in school year 7 and above.  Primary School children must always be collected by an adult).

YesNo

By completing this online form I confirm that I have the legal responsibility and that I have read and understand the permission statements on this form and the privacy notice below.
YesNo

Parent/Guardian Full Name

Signed (Parent/Guardian/Player over 18)

Signed

PARENT CODE OF CONDUCT

PLAYER CODE OF CONDUCT

 

FULL POLICIES CAN BE FOUND HERE

Privacy Notice. Lincolnshire Cricket will use the information provided on this form (together with other information it obtains about the player) (together “Information”) to administer his/ her cricketing activities in which he/she participates through Lincolnshire Cricket. To care for and supervise activities in which he/she is involved. In some cases, this may require Lincolnshire Cricket 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, Lincolnshire Cricket may disclose certain information to doctors or other medical specialists. To the 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 in this form knows what will happen to their information. For our full privacy policy click here

Form updated 2018.