Junior Indoor Training Registration Form

Gidea Park & Romford Cricket Club

2019 Indoor Nets Registration
Junior's Name *

First Name Last Name
Please register here for GPRCC's 2019 junior indoor coaching sessions. Sessions are strictly limited to 30 children for each session and will be allocated on a first come first served basis.

Location:

The Campion School, Hornchurch RM11 3BX

Coaching Dates:

Friday 1st November
Friday 8th November
Friday 15th November
Friday 22nd November

Coaching Sessions:

Session 1: 6.30pm - 7.30pm: Years 1 - 4 Closed, session full
Session 2: 7.40pm - 8.40pm: Years 5 - 8 Closed, session full
Session 3: 8.40pm - 9.40pm: Years 9 and above

Coaching Rates:

1st child: £20
2nd and subsequent children: £15
Email *
example@example.com
School Year *
Enter current school year
This session is full
Did you register for 2018 indoor nets? *

Yes No

Any Changes?
Have any of your contact details or medical details changed? *

No Yes

Junior's Details
Gender

Male Female
Birth Date: *

Day Month Year
School
Allergies / Medical Conditions
Contact Details
Parent / Guardian Name *

First Name Last Name
Mobile Phone Number: *

Area Code Phone Number
Home Phone Number:

Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Emergency Contact Number *

Area Code Phone Number

Please Read Before Submitting
By submitting this form you are confirming that:
1. I agree with the Gidea Park & Romford Cricket Club terms and conditions as laid down in the club's constitution, its codes of conduct including the England and Wales Cricket Board (ECB) “Safe Hands” Child Protection Policy and any notices that may be displayed within club premises from time to time.
2. I understand that it is my responsibility to arrange personal accident insurance if required and agree that the club and/or its agents cannot be held liable for any loss or damage howsoever caused.
3. I agree and accept that the contact details on this form may be transmitted, either manually or electronically, between club officers for normal club administration purposes and I give consent for these details to be given to the organisations to which the club has affiliated, where reasonable and appropriate.
4. I understand that in the event of any injury or illness to the above named, all reasonable steps will be made to contact me and to deal with that injury or illness appropriately.
5. I also give consent to the above named being included in any normal press releases and/or video and/or television and/or team and individual photographs that may be included in any pages on the club’s website and accept that it is my responsibility to notify the club secretary in writing should I wish to withdraw this consent (secretary's contact details can be found on www.gprcc.co.uk).

I wish to pay for: *

A first child £ 20.00 GBP

Subsequent child £ 15.00 GBP

Total £ 0.00 GBP

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

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