Family Life Membership

This includes two adults and two children.

This Family (Life) Membership Form should be completed by the parent or legal guardian of any player under the age of 18 and must also be signed by the player. You can register up to two adults and three children on this form.

Each week there will be a free prize draw for family members.

We will use this information to ensure that you are kept informed about events and information concerning Honley Cricket Club.

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Firstly, please tell us a little bit about the first child on the membership
Name Name First Last
Please provide your name
Date of Birth Date of Birth / DD / MM YYYY

Please provide your date of birth
School

Please tell us the school the applicant attends
School Year

Please tell us which school year the applicant is in at, as at the start of the current season
Gender

Please tell us the applicant's gender
Medical Conditions

Please tell us any medical conditions the first child has
Please tell us about the second child...
Name Name First Last
Please provide your name
Date of Birth Date of Birth / DD / MM YYYY

Please provide your date of birth
School

Please tell us the school the applicant attends
School Year

Please tell us which school year the applicant is in at, as at the start of the current season
Gender

Please tell us the applicant's gender
Medical Conditions

Please tell us any medical conditions the first child has
Next, please tell us how to get in touch with the applicant and their parent/ carer...
Parent/ Carer Name Parent/ Carer Name First Last
Please tell us the name of the applicant's parent/ carer
Home Telephone

Please provide the applicant's home phone number

Please note that you should provide both area code and telephone number, separated by a space
Parent/ Carer Mobile

Please provide the parent/ carer's mobile telephone number

Please note that you should provide both area code and telephone number, separated by a space
Parent/ Carer Email Address

Please provide the parent/ carer's email address
2nd Adult Name 2nd Adult Name First Last
Please tell us the name of the second adult on the membership
We may need to contact you or another responsible adult in an emergency; we may also need to seek medical assistance, so please CAREFULLY complete the details below...
Emergency Contact Emergency Contact First Last
Please provide the Name of someone who can be contacted in the unlikely event of an Emergency and if the main parent or carer is unavailable
Their relationship to you

e.g. Wife, husband, parent, family friend, other relative, etc.
Emergency Contact Phone

Please provide the Landline or Mobile Telephone Number of an Emergency Contact

IMPORTANT: this should be a number on which we can almost certainly reach them in the unlikely event of an emergency.
Doctor's Name

Please provide the name of the usual doctor of the applicant
Surgery Name

Please provide the name of the doctor's surgery normally used by the applicant. This should be the surgery at which the doctor named above is based
Surgery Phone

Please provide the telephone number of the doctor's surgery detailed above
Please note that you should provide both area code and telephone number, separated by a space
The next few questions apply to the parent/ carer of the applicant...
PARENT: Photography

As parent/carer for the applicant, I have no objection to their being photographed when playing, as authorised by their Coach
PARENT: Committee

I am interested in serving on the committee
PARENT: I Can Help By...

Our club is run entirely by volunteers. There are a large number of them, but more can help to expand and improve the club. As well as coaching, managing, umpiring, scoring for youth teams, there are admin roles, organising social events, barbecues, bar duties, maintenance on grounds & buildings etc. How might you be able to assist our club?
Almost finished, just the formalities to complete...
I have read & agreed the T&Cs

I have read & agreed the T&Cs

Please tick this box to confirm that you / the applicant have read and agreed to the relevant and applicable Terms & Conditions, Codes of Conduct and Rules
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
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Family Life Membership

Family Life Membership

£`0`

Total

Firstly, please tell us a little bit about the first child on the membership

Please tell us about the second child...

Next, please tell us how to get in touch with the applicant and their parent/ carer...

We may need to contact you or another responsible adult in an emergency; we may also need to seek medical assistance, so please CAREFULLY complete the details below...

The next few questions apply to the parent/ carer of the applicant...

Almost finished, just the formalities to complete...

£`0`

Total

Family Life Membership

Family Life Membership

£0

Total

Firstly, please tell us a little bit about the first child on the membership

Please tell us about the second child...

Next, please tell us how to get in touch with the applicant and their parent/ carer...

We may need to contact you or another responsible adult in an emergency; we may also need to seek medical assistance, so please CAREFULLY complete the details below...

The next few questions apply to the parent/ carer of the applicant...

Almost finished, just the formalities to complete...

£0

Total

£`0`

£`0`