Bottisham & Lode Cricket Club Membership Form
Bottisham & Lode Cricket Club Membership Form We are very pleased to welcome you to Bottisham & Lode Cricket Club. To ensure that we have the correct contact details for you, please insert the information requested below and return this form to your team manager. If you are under 16 please also ask your parents or guardian to sign the form before it is returned. We will also use this information to ensure that you are kept informed about club events.
Section 1 – Personal Details. Name Address: Postcode: Home Telephone Number: Mobile: Email: Date of Birth:
Section 2 – Ethnicity. In order to help the club monitor its membership can you please tick one of the following boxes to identify your ethnic group – this section is not compulsory. White Other
Mixed
Asian or Asian British
Black or Black British
Section 3 – Disability. The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial and long term adverse effect on his or her ability to carry out normal day-to-day activities’.
Do you consider yourself to have a disability?
Yes
No
If yes, what is the nature of your disability?
Section 4 – Medical Information. Please detail below any important medical information that our coaches should be aware of (e.g.epilepsy, asthma, diabetes, etc.)
Section 5 – Sporting Information. Have you played Cricket before?
Yes
No
If yes, where have you played Cricket: (please indicate below) Primary School Club If Other, please specify:
Secondary School County
Local authority Coaching session(s) Other
Section 6 – Emergency Contact Details. (For Juniors, this section is to be completed by the parent / carer or guardian) Please insert the information below to indicate the persons who should contacted in the event of an incident / accident: Emergency Contact Person Name Contact Number
Relationship to Individual Alternative Contact Number
Section 7 – Transport and Welfare. Transport Private cars are used to transport to away matches and rely on the support of parents & volunteers. The club acknowledge they will be liable in the event of any accident if they have failed to take reasonable steps in their duty of care for your child during transportation to an away fixture. Welfare The clubs welfare of young people in cricket policy ensures we provide a safe, friendly and enjoyable experience for the children taking part. If you have any concerns of any nature, please contact directly the Club Welfare Officer – Claire Westbrook (01223) 811507.
Section 8 – Consent & Signatures. Please be aware that official photographers may be in attendance during games/coaching sessions. They will be easily identifiable. If for any reason you do not wish your child/children to be photographed, please indicate this by ticking the box. If my child plays adult cricket (for the club senior teams) then they should attend matches already changed and ready to play. I hereby authorize the club to retain the data provided here, for the sole use of the club and relevant cricket authorities. The club agrees not to pass this information on to any other organisation I understand that I will be kept informed of activities at Bottisham & Lode CC – for example times and transport details etc… I understand in the event of injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately. By returning this completed Membership form I agree that I/ my child will abide by the rules and policies of Bottisham & Lode Cricket Club For Junior Players, (to be completed by Parent or Carer) For Adult Members By returning this completed Membership Form, I agree to my child in my care taking part in the activities of Bottisham & Lode Cricket Club. Name of parent / carer:
Name of Player: Signature of Player: Date:
Signature of parent / carer: Date:
Section 9 – Gift Aid. The club can also recover Gift Aid on any donations, if you are a tax payer please complete this gift aid section. Name of Charity of Community Amateur Sports Club (CASC) – Bottisham and Lode Cricket Club Please treat as Gift Aid donations all qualifying gifts of money made: today
in the past 4 years
in the future
Please tick all boxes you wish to apply. I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or CASCs that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 28p of tax on every £1 that I gave up to 5 April 2008 and will reclaim 25p of tax on every £1 that I give on or after 6 April 2008. Donor Details First Name: Address:
Surname:
Postcode:
Signature:
Date: Please notify the charity or CASC if you:
Want to cancel this declaration Change your name or home address No longer pay sufficient tax on your income and/or capital gains.
If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self Assessment tax return or ask HM Revenue and Customs to adjust your tax code.
Section 1 – Personal Details. Name Address: Postcode: Home Telephone Number: Mobile: Email: Date of Birth:
Section 2 – Ethnicity. In order to help the club monitor its membership can you please tick one of the following boxes to identify your ethnic group – this section is not compulsory. White Other
Mixed
Asian or Asian British
Black or Black British
Section 3 – Disability. The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial and long term adverse effect on his or her ability to carry out normal day-to-day activities’.
Do you consider yourself to have a disability?
Yes
No
If yes, what is the nature of your disability?
Section 4 – Medical Information. Please detail below any important medical information that our coaches should be aware of (e.g.epilepsy, asthma, diabetes, etc.)
Section 5 – Sporting Information. Have you played Cricket before?
Yes
No
If yes, where have you played Cricket: (please indicate below) Primary School Club If Other, please specify:
Secondary School County
Local authority Coaching session(s) Other
Section 6 – Emergency Contact Details. (For Juniors, this section is to be completed by the parent / carer or guardian) Please insert the information below to indicate the persons who should contacted in the event of an incident / accident: Emergency Contact Person Name Contact Number
Relationship to Individual Alternative Contact Number
Section 7 – Transport and Welfare. Transport Private cars are used to transport to away matches and rely on the support of parents & volunteers. The club acknowledge they will be liable in the event of any accident if they have failed to take reasonable steps in their duty of care for your child during transportation to an away fixture. Welfare The clubs welfare of young people in cricket policy ensures we provide a safe, friendly and enjoyable experience for the children taking part. If you have any concerns of any nature, please contact directly the Club Welfare Officer – Claire Westbrook (01223) 811507.
Section 8 – Consent & Signatures. Please be aware that official photographers may be in attendance during games/coaching sessions. They will be easily identifiable. If for any reason you do not wish your child/children to be photographed, please indicate this by ticking the box. If my child plays adult cricket (for the club senior teams) then they should attend matches already changed and ready to play. I hereby authorize the club to retain the data provided here, for the sole use of the club and relevant cricket authorities. The club agrees not to pass this information on to any other organisation I understand that I will be kept informed of activities at Bottisham & Lode CC – for example times and transport details etc… I understand in the event of injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately. By returning this completed Membership form I agree that I/ my child will abide by the rules and policies of Bottisham & Lode Cricket Club For Junior Players, (to be completed by Parent or Carer) For Adult Members By returning this completed Membership Form, I agree to my child in my care taking part in the activities of Bottisham & Lode Cricket Club. Name of parent / carer:
Name of Player: Signature of Player: Date:
Signature of parent / carer: Date:
Section 9 – Gift Aid. The club can also recover Gift Aid on any donations, if you are a tax payer please complete this gift aid section. Name of Charity of Community Amateur Sports Club (CASC) – Bottisham and Lode Cricket Club Please treat as Gift Aid donations all qualifying gifts of money made: today
in the past 4 years
in the future
Please tick all boxes you wish to apply. I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or CASCs that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 28p of tax on every £1 that I gave up to 5 April 2008 and will reclaim 25p of tax on every £1 that I give on or after 6 April 2008. Donor Details First Name: Address:
Surname:
Postcode:
Signature:
Date: Please notify the charity or CASC if you:
Want to cancel this declaration Change your name or home address No longer pay sufficient tax on your income and/or capital gains.
If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self Assessment tax return or ask HM Revenue and Customs to adjust your tax code.
