GMCC 2022 Membership Form
This form will enable you to register adult and junior members from the same household. Please complete the form fully and have your payment card ready to make a payment at the end. If you have any problems completing the form please email gmccmembership@outlook.com. If you wish to register your child for All Stars or Dynamos please follow the link provided on our website.
Name of person completing the form
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Email for confirmation of form submission
*
example@example.com
Address for all persons on this form
*
Street Address
Street Address Line 2
City
County
Postcode
Emergency Contact Details
Please provide a second contact name and number for all persons on this form
Emergency contact name
*
First Name
Last Name
Emergency contact Number
*
Please enter a valid phone number.
Please tick all of the following that apply
*
I confirm that each person I am registering on this form wishes to take part in the activities of the club (either as a player or a social member)
I confirm that I have permission to complete this form on behalf of others (if applicable)
I confirm that I am the legally responsible parent/guardian for any children I am registering on this form (if applicable)
Are you using this form to register...
*
Playing Members only or Playing and Social Members?
Social Members only?
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PLAYER 1
1. Name
First Name
Last Name
1. Date of birth
-
Day
-
Month
Year
Date
1. School (if applicable)
1. School Year (if applicable)
Please Select
2
3
4
5
6
7
8
9
10
11
12
13
1. Gender
Male
Female
Prefer not to say
1. Email if over 18
example@example.com
1. Mobile Number if over 18
Please enter a valid phone number.
1. Playing shirt size
Please Select
Mens XXS
Mens XS
Mens S
Mens M
Mens L
Mens XL
Mens XXL
Mens 3XL
Mens 4XL
Mens 5XL
Junior XSB (6yrs)
Junior SB (7yrs)
Junior MB (8/9yrs)
Junior LB (10/11yrs)
Junior XLB (12/13yrs)
1. Long or short-sleeved playing shirt
Please Select
Short-sleeved
Long-sleeved
For those playing senior cricket
1. Medical Information (if applicable)
Please detail any important medical information that our club volunteers need to know and which would be affected by your 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 injuries. By completing this part of the form you agree to your details being shared with coaches/leaders for the purposes of the delivery, and your safe participation in, club activities. If you would prefer to discuss this privately please indicate in the box.
Do you wish to register another player?
Yes
No
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PLAYER 2
2. Name
First Name
Last Name
2. Date of birth
-
Day
-
Month
Year
Date
2. School (if applicable)
2. School Year (if applicable)
Please Select
2
3
4
5
6
7
8
9
10
11
12
13
2. Gender
Male
Female
Prefer not to say
2. Email if over 18
example@example.com
2. Mobile Number if over 18
Please enter a valid phone number.
2. Playing shirt size
Please Select
Mens XXS
Mens XS
Mens S
Mens M
Mens L
Mens XL
Mens XXL
Mens 3XL
Mens 4XL
Mens 5XL
Junior XSB (6yrs)
Junior SB (7yrs)
Junior MB (8/9yrs)
Junior LB (10/11yrs)
Junior XLB (12/13yrs)
2. Long or short-sleeved playing shirt
Please Select
Short-sleeved
Long-sleeved
2. Medical Information (if applicable)
Please detail any important medical information that our club volunteers need to know and which would be affected by your 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 injuries. By completing this part of the form you agree to your details being shared with coaches/leaders for the purposes of the delivery, and your safe participation in, club activities. If you would prefer to discuss this privately please indicate in the box.
Do you wish to register another player?
Yes
No
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Next
PLAYER 3
3. Name
First Name
Last Name
3. Date of birth
-
Day
-
Month
Year
Date
3. School (if applicable)
3. School Year (if applicable)
Please Select
2
3
4
5
6
7
8
9
10
11
12
13
3. Gender
Male
Female
Prefer not to say
3. Email if over 18
example@example.com
3. Mobile Number if over 18
Please enter a valid phone number.
3. Playing shirt size
Please Select
Mens XXS
Mens XS
Mens S
Mens M
Mens L
Mens XL
Mens XXL
Mens 3XL
Mens 4XL
Mens 5XL
Junior XSB (6yrs)
Junior SB (7yrs)
Junior MB (8/9yrs)
Junior LB (10/11yrs)
Junior XLB (12/13yrs)
3. Long or short-sleeved playing shirt
Please Select
Short-sleeved
Long-sleeved
3. Medical Information (if applicable)
Please detail any important medical information that our club volunteers need to know and which would be affected by your 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 injuries. By completing this part of the form you agree to your details being shared with coaches/leaders for the purposes of the delivery, and your safe participation in, club activities. If you would prefer to discuss this privately please indicate in the box.
Do you wish to register another player?
Yes
No
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PLAYER 4
4. Name
First Name
Last Name
4. Date of birth
-
Day
-
Month
Year
Date
4. School (if applicable)
4. School Year (if applicable)
Please Select
2
3
4
5
6
7
8
9
10
11
12
13
4. Gender
Male
Female
Prefer not to say
4. Email if over 18
example@example.com
4. Mobile Number if over 18
Please enter a valid phone number.
4. Playing shirt size
Please Select
Mens XXS
Mens XS
Mens S
Mens M
Mens L
Mens XL
Mens XXL
Mens 3XL
Mens 4XL
Mens 5XL
Junior XSB (6yrs)
Junior SB (7yrs)
Junior MB (8/9yrs)
Junior LB (10/11yrs)
Junior XLB (12/13yrs)
4. Long or short-sleeved playing shirt
Please Select
Short-sleeved
Long-sleeved
4. Medical Information (if applicable)
Please detail any important medical information that our club volunteers need to know and which would be affected by your 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 injuries. By completing this part of the form you agree to your details being shared with coaches/leaders for the purposes of the delivery, and your safe participation in, club activities. If you would prefer to discuss this privately please indicate in the box.
Do you wish to register another player?
Yes
No
Back
Next
PLAYER 5
5. Name
First Name
Last Name
5. Date of birth
-
Day
-
Month
Year
Date
5. School (if applicable)
5. School Year (if applicable)
Please Select
2
3
4
5
6
7
8
9
10
11
12
13
5. Gender
Male
Female
Prefer not to say
5. Email if over 18
example@example.com
5. Mobile Number if over 18
Please enter a valid phone number.
5. Playing shirt size
Please Select
Mens XXS
Mens XS
Mens S
Mens M
Mens L
Mens XL
Mens XXL
Mens 3XL
Mens 4XL
Mens 5XL
Junior XSB (6yrs)
Junior SB (7yrs)
Junior MB (8/9yrs)
Junior LB (10/11yrs)
Junior XLB (12/13yrs)
5. Long or short-sleeved playing shirt
Please Select
Short-sleeved
Long-sleeved
5. Medical Information (if applicable)
Please detail any important medical information that our club volunteers need to know and which would be affected by your 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 injuries. By completing this part of the form you agree to your details being shared with coaches/leaders for the purposes of the delivery, and your safe participation in, club activities. If you would prefer to discuss this privately please indicate in the box.
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4. Social members
People who wish to use the facilities at Melton Park but who are not playing members (or a guest of playing members) should register as social members. The fee for a social member is £10. Parents of junior members automatically become social members and therefore do not need to complete this section.
Do you wish to add any social members?
Yes
No
Social member 1
S1. Name
First Name
Last Name
S1. Phone Number
Please enter a valid phone number.
S1. Email
example@example.com
Do you wish to register another social member?
Yes
No
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Next
Social member 2
S2. Name
First Name
Last Name
S2. Phone Number
Please enter a valid phone number.
S2. Email
example@example.com
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Terms and Conditions and Payment Page
Here is a summary of your selected options. Please check they are correct and tick the relevant boxes before proceeding to the payment.
I give permission for photographs of the players named on this form to be used in club publications or displays on the club’s website, on Great Melton C.C.’s social media sites or in the local press
*
Yes
No
I give my consent for the administration of emergency first aid and/or other medical treatment which in the opinion of a qualified medical practitioner may be necessary. I also understand that in such an occurrence all reasonable steps will be taken to contact the parent or emergency contact
*
Yes - I confirm that to the best of my knowledge, the players registered on this form do not suffer from any medical condition other than those that I have detailed
No
My Products - select the number of each category of membership you require and then complete the payment details.
*
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( X )
Half season Membership
This is for those players over the age of 18 in full-time employment.
Shirt
Quantity
Price
Shirt with Kukri swap
0
1
2
3
4
5
£
16.00
Shirt without Kurki swap
0
1
2
3
4
5
£
22.00
No playing shirt needed (Ladies or those not planning to play senior cricket this year)
0
1
2
3
4
5
£
10.00
Item subtotal:
£
0.00
Half season U17/U19/Student/Unemployed membership
For those players in Years 11 and above, in full-time further education or unemployed.
Shirt
Quantity
Price
Shirt with Kukri swap
0
1
2
3
4
5
£
11.00
Shirt without Kukri swap
0
1
2
3
4
5
£
17.00
No playing shirt needed (Ladies or those not planning to play club cricket this year)
0
1
2
3
4
5
£
5.00
Item subtotal:
£
0.00
Summer U9/U11/U13/U15 membership + coaching fees
For those members in school years 10 and below
Shirt
Quantity
Price
Shirt with Kukri swap
0
1
2
3
4
5
£
16.00
Shirt without Kukri swap
0
1
2
3
4
5
£
22.00
No playing shirt needed (for those who do not wish to play in any club matches this year - can always be purchased at a later date))
0
1
2
3
4
5
£
10.00
Item subtotal:
£
0.00
Half season Social Membership
£
5.00
Quantity
0
1
2
3
4
5
Item subtotal:
£
0.00
Credit/Debit Card Details (Secure payments taken by Stripe - GMCC will not receive your card details)
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: