JUNIOR REGISTRATION FORM
Name and date of Cricket Camp or 121 Session wishing to attend
*
Name of Cricket Camp or Name of 121 Coach
Date of Cricket Camp or 121 Session (or todays date)
Name and date of Cricket Camp or 121 Session wishing to attend
*
Name of Cricket Camp or Name of 121 Coach
Date of Cricket Camp or 121 Session (or todays date)
PLAYER PERSONAL DETAILS
Players Name
*
First Name
Last Name
Player Date of Birth
*
Player School Year
*
PLAYER MEDICAL INFORMATION
Players Medical Information ie Allergies, Medication - If None please Indicate
*
Name
*
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number for parent/legal guardian
-
Area Code
Phone Number
Mobile Phone Number for parent/legal guardian
*
-
Area Code
Phone Number
EMERGENCY CONTACT DETAILS
Please provide the contact details of two adults below. As the person completing this form, you must ensure each person whose information you include in this form knows what will happen to their information and how it may be disclosed.
Name of an adult who can be contacted in an emergency - Contact One
*
Full Name - Contact One
Emergency Phone Number - Contact One
Name of an adult who can be contacted in an emergency - Contact Two
Full Name - Contact Two
Emergency Phone Number - Contact Two
Email for parent/legal guardian
*
example@example.com
Photography/Video Consent
*
I consent to Skillz Cricket Academy Ltd photographing or videoing my child and his/her involvement in cricket in line with Skillz Cricket Academies photography/video policy.
Does your child play Hardball Cricket?
*
Yes
No
What School does your child attend
*
Has your child attended a previous Skillz Camp?
Yes
No
PARENT/GUARDIAN AGREEMENT
By returning this completed form, I confirm that I have legal responsibility of (name of child) and that I have read and understood the permission statements on this membership form and the privacy notice below.
Signature
*
Date
*
-
Month
-
Day
Year
Date Picker Icon
Submit
Should be Empty: