Junior Membership Form Membership is open to all applicants regardless of age, ability, disability, gender, race, ethnicity, sexuality, nationality, religious belief or social/economic status. All details will be kept in a secure database with access restricted to authorised Club officers only. In line with GDPR new regulations (2018) by signing and completing this application form you agree to your personal data being stored on our database. Should your membership lapse, your data will be stored for a period of 12 months and then deleted.Applicant's Name(Required) DrMissMrMrsMsProf.Rev. Prefix First Last Applicant's PhoneDate of Birth(Required) DD slash MM slash YYYY School(Required)School Year(Required)Name of Parent / Carer(Required) First Last Parent / Carer Contact Number(Required)Address(Required) Street Address Address Line 2 City County Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Name of Emergency Contact(Required) First Last Emergency Contact Phone(Required)Email(Required) Enter Email Confirm Email Medical Conditions(Required)If your son / daughter has any medical conditions of which we should be aware please give details below. If not, please write 'NONE'.Please indicate to which ethnic group you belong(Required)White (British, Irish any other White background)Mixed (White & Black Caribbean, White & Black African, White & Asian, any other mixed background)Asian or Asian British (Indian, Pakistani, Bangladeshi, any other Asian background)Black or British Black (Caribbean, African, any other Black background)ChineseOtherRather not sayPlease select Membership type(Required)Junior under 12 (£50)Junior 12-18 (£60)To be completed by Playing Members onlyDeclarationI consider my child to be physically fit and capable of full participation and agree to notify the club of any changes to the medical information provided. Furthermore, if my child is injured, I give my permission for the team managers/coaches to obtain emergency medical treatment on my behalf for my child. I also consent to my child travelling to venues for matches and training by transport provided by the club which may include travelling in other players’ private cars. Yes Please indicate your main sport(Required)CricketSquashTennisBowlsRugbyLacrosseOnce you submit this form, it will be processed in the Club Office, including the seeking of proposal and seconding required under the Club's Articles of Association. We will contact you shortly to discuss collecting your payment.Photo Consent The Liverpool Cricket Club Ltd recognises the need to ensure the welfare and safety of all young people in sport. As part of our commitment to ensure the safety of young people we will not permit photographs or video images of young people to be taken or used without the consent of both the Legal Guardian and the young person. All sections will follow the guidance for the use of images of young people as detailed by their own national governing bodies. The Liverpool Cricket Club Ltd will take steps to ensure these images are used solely for the purposes for which they are intended, which is the promotion and celebration of activities of the young players along with their use as a training/coaching tool. If you become aware that these images are being used inappropriately, you should inform the section’s welfare officer immediately. If at any time a legal guardian or young person wishes the data to be removed from the website, seven days’ notice must be given to the section after which the data will be removed.Parental Consent(Required)I give consent for my child to be photographed/videoed by his/her Sport Section Leader under the rules and conditions stated. I confirm that I have legal parental responsibility for this child and am entitled to give this consent and that that there are no restrictions related to taking photographs. I understand that if I do not permit my child to be photographed or videoed then it is my responsibility to ensure that this is complied with. Yes No Child Consent(Required)I consent to being photographed or videoed by the Sports Section Leader showing my involvement in the Sporting activity under the stated rules and conditions. Yes No CommentsThis field is for validation purposes and should be left unchanged.
