Adult Membership Form

Application for Adult Membership

Full Name*
Street*
Town*
Post Code*
Email Address*
Home Telephone*
Mobile*
Home Telephone*
Date of Birth*
Emergency Contact Name*
Emergency Contact Telephone*

Please complete and sign this form, and signify your acceptance of the statements below by ticking the boxes

I confirm that I will comply with the Club Members' Code of Conduct.

Yes No

The Disability Discrimination Act 1995 defines a disabled person as anyone with “a physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities”.

Do you have a disability?

Yes No

If yes, what is the nature of the disability?

MEDICAL INFORMATION

1. Do you experience any conditions requiring medical treatment and/or medication?

Yes No

If yes, please give details

2. Do you have any allergies?

Yes No

If yes, please give details

3. Do you have any specific dietary requirements?

Yes No

If yes, please give details

4. Please provide any further information you feel is necessary

I consent to receiving medical treatment which, in the opinion of a qualified medical practitioner, may be necessary.

5. Is there anything that you are required by law to declare before taking up membership of this club ?

Yes No*

If yes, please give details

Date :

 

 

 

Ulverston Cricket Club take the protection of the data we hold about you as a member seriously and are committed to respecting your privacy. This notice is to explain how we may use personal information we collect and how we comply with the law on data protection, what your rights are.

Our full data privacy can be viewed here :

Data Privacy Notice

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