• Sporting Memories

    The information given below will be keptconfidential and only seen by the facilitators of the club and staff within Sporting Memories and Somerset CricketFoundation. The information provided will be used to help Somerset Cricket Foundationin the case of an emergency should you become unwell.  The details alsogive us the opportunity to find out about your interests and hobbies, so that we can make the sessions as interesting as possible for you. It will alsoprovide a baseline of information as part of the funded projects evaluation.Permission has been granted and authorised forthe club facilitator to call the named personnel or the emergency serviceswhere required, and appropriate in relation to the wellbeing of theparticipant. (See Emergency Contact details).

  • Your contact information

  • Date of birth
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Which session would you like ot attend?*

  • Medical information

  • Do you have any of the following:*

  • Emergency contacts

  • Being part of sporting memories

  • I am/Feel Happy*
  • How often do you feel you lack companionship?*
  • How often do you feel left out?*
  • How often do you feel isolated from others?*
  • How often do you feel lonley?*
  • How often do you feel left out?*
  • ON HOW MANY DAYS DO YOU DO ANYPHYSICAL ACTIVITY? (THIS CAN INCLUDE WALKING, GOING TO THE GYM OR ANYTHING THATGETS YOU MOVING) (PLEASECIRCLE ONE ANSWER)
  • ON THE DAYS YOU ARE ACTIVE, FOR HOWMANY MINUTES DO YOU USUALLY PARTICIPATE IN PHYSICAL ACTIVITY?
  • COMPARED TO OTHER PEOPLEYOUR OWN AGE, DO YOU THINK YOU ARE:

  • Photographic consent

  • PHOTOGRAPHIC, VIDEO IMAGES AND AUDIO CONSENT: BOTHPARTNERS PRODUCE A WIDE RANGE OF MATERIALS TO INFORM PEOPLE ABOUT OUR WORK SUCHAS PRINTED PUBLICATIONS, ADVERTS, AUDIOVISUAL AND ELECTRONIC MATERIALS, MEDIAWORK, DISPLAY AND ANY OTHER MEDIA THAT WE MAY USE IN THE FUTURE. THE COPYRIGHTOF ANY MATERIAL WHICH IS GENERATED AS A RESULT SHALL BE ASSIGNED AND SHALL BETHE PROPERTY OF REMINISCENCE LEARNING AND SOMERSET CRICKET FOUNDATION. DO YOU GIVEPERMISSION FOR PHOTOGRAPHIC, VIDEO IMAGES AND AUDIO CONSENT
  • Would you like to receive the Foundation's friendly newsletter?*

  • Featuring club updates, latest news and events, including ways for you to get involved in – and support – cricket in your local community. You can unsubscribe at any time. For full details on how we collect, use and store your personal information; please see our Privacy Policy.

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