Weald Coaching application form vFINAL

Weald Coaching developing young people in cricket
REGISTRATION FORM
Name *

CHILD FIRST NAME CHILD SURNAME
DATE OF BIRTH *

Day Month Year
Date
GENDER *
NATIONALITY *
HOW WOULD YOU DESCRIBE ETHNIC ORIGIN*? *
*We are required to collect data on ethnic origin as part of our commitment to Sport England Clubmark
YOUR ADDRESS (IN FULL) *
POSTCODE *
PARENTS/CARERS NAME(S) *
TELEPHONE

Code Number
MOBILE

Code Number
EMAIL *
example@example.com
ALTERNATIVE EMERGENCY CONTACT (name, mobile and telephone number) *
DETAILS OF ANY RELEVANT MEDICAL CONDITIONS *
I will pay:

in one annual payment of £40.00 in 12 monthly instalments of £4.00
- I consent to my child's membership of Staplehurst Cricket and Tennis Club and for the information in this form to be given to the Club for membership purposes
- I acknowledge that both Weald Coaching Limited and Staplehurst Cricket & Tennis Club have a Data Privacy Policy and the information on this form will be processed in accordance with those policies to enable my child to fully participate in the Weald Coaching's programmes
- I agree that Weald Coaching Limited and Staplehurst Cricket & Tennis Club do not accept responsibility or liability for any personal accident or injuries incurred during any practice session
- I have read Weald Coaching Limited's Code of Conduct and agree to abide by it
- I consent to photography of my child in games and training and appropriate use of photographs in Weald Coaching Limited's and Staplehurst Cricket & Tennis Club's publications and website
SIGNED

Clear
PARENT/CARER
DATE

Day Month Year
Date
PLEASE SET UP A DIRECT DEBIT INSTRUCTION BY GOING TO OUR WEBSITE https://wealdcoaching.com/book

I HAVE/WISH TO TAKE OUT FAMILY MEMBERSHIP OF STAPLEHURST CRICKET & TENNIS CLUB (tick box)
Should be Empty:

Weald Coaching developing young people in cricket

REGISTRATION FORM

PARENT/CARER