Coalpit Heath Cricket Club
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Member Registration Form
Cricket Youth Registration Form
Youth Player Registration Form
Instructions
All fields marked with an asterisk * are mandatory. If you have previously registered only complete details that have changed since you last registered. If you are registering a new player please complete all fields. Once complete click "Submit". A confirmation email will be sent to your email address.
Person registering the youth player
Your name
*
Your home telephone number
Your mobile telephone number
Your work phone number
Will only be used in emergencies
Your email address
*
(A confirmation email will be sent to this address)
Your address
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Your occupation
Do you have specific skills or expertise that might be of use to the cricket club? For example, are you a builder or a plumber?
Your relationship to youth player
For example are you their parent, guardian, carer etc
Do you wish to register as a social member?
*
This will entitle you to use the cricket club facilities
Yes
No
Junior playing member's details
Junior player - name
*
Junior player - date of birth (displayed in US format mm/dd/yyyy)
Junior player - gender
Male
Female
Junior playing member contact preferences
*
Do you give permission for team managers or captains to contact your child directly for playing matters such as availability for matches?
Yes - captains or managers may contact my child directly about playing cricket
No - please only contact me or the other parent
Junior player - home phone number
If different to your details
Junior player - mobile phone number
Junior player - email address
Junior player - educational establishment
Which school or college does your child attend?
Junior player - medical conditions
Please provide details of any pre-existing medical conditions, allergies etc
Junior player acknowledgement - helmets
*
In compliance with ECB guidelines it is Coalpit Heath Cricket Club policy that all U18 players MUST wear a cricket helmet when batting, wicket keeping or fielding within approximately 8m of the batsmen. The club will make available helmets to all U18 players
Acknowledged
Junior player acknowledgement - photos and videos
*
I consent to Coalpit Heath Cricket Club, members of the press or other parents photographing or videoing my child playing cricket or celebrating Coalpit Heath Cricket
Agreed
Junior player acknowledgement - transport
*
It is Coalpit Heath Cricket Club's policy that parents, relatives or guardians or their authorised represenative is responsible for transporting their child to and from matches. Parents should contact the team manager if they have problems with transportation.
Agreed
Second parent's details
Instructions:
Please provide contact details for a second parent / guardian, if required. Only complete details where these are different to your own.
Second parent - name
Second Parent - address
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Second parent - home phone
Only provide if the second parent resides at a separate address
Second parent - mobile phone
Second parent - work phone
This number will be used only in emergencies
Second parent - email
Second parent - occupation
Do you have specific skills or expertise that might be of use to the cricket club? For example, are you a builder or a plumber?
Second parent - sign up to become a social member
*
Would you like to register the second parent as a social member? (Annual fee applies)
Yes - please register the second parent as a social member
No - do not register the second parent as a social member
Gift Aid declaration
Declaration
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 Community Amateur Sports Clubs (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 Coalpit Heath Cricket Club will reclaim 28p of tax on every £1 that I donated up to 5 April 2008 and will reclaim 25p of tax on every £1 that I donated on or after 6 April 2008.
Gift Aid options
*
Do you want the cricket club to claim GiftAid on donations made?
Yes - I want the Cricket Club to claim GiftAid on all donations made
No - I do not want the Cricket Club to claim GiftAid on all donations made
Important
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.
Your Name
*
Today's date
*
(NB displayed in US format mm/dd/yyyy)
Verification
Please enter any two digits with no spaces (Example: 12)
*
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