(for players over the age of 18)

Once completed, the form should be returned to Pauline Harding



Age/ Date of birth

Home address

Post code




As the person completing this form, you must ensure each person whose information you include in this form knows what will happen to their information and how it may be disclosed.

Name of an adult who can be contacted in an emergency


Phone number of named adult

Relationship which this person has with you  




Have you played cricket before:          Yes No


If yes, where has this been played?

         Club              School Local authority coaching session(s)                 University

         Other (please specify)




We will use this information for statistical purposes as well as to establish if there are any additional needs / support / adjustments that you may require, please discuss this with us.

The Equality Act 2010 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 any physical or mental health conditions or illnesses that have lasted or are expected to last 12 months or more?             Yes No


Does this disability or illness affect you in any of the following areas?

       Vision impairment

       Hearing impairment

       Mobility impairment

       Dexterity impairment

       Learning impairment

       Memory impairment

       Mental Health impairment

       Stamina, Breathing or Fatigue impairment

       Developmental impairment

       Other type of impairment, please provide more details:



Please detail below any important medical information that our club volunteers need to know and which would be affected by your participation in cricket activities. Such as: allergies; medical conditions (for example- epilepsy, asthma, and so on); current medication; special dietary requirements, any additional needs, and/or any injuries. Please indicate if you would like to discuss this privately with us.


Name of doctor/surgery name

Doctor’s telephone number

Medical consent:

        I consent to my medical details to be shared with coaches/leaders for the purposes of the delivery of my safe participation in the cricket club activity.

Not providing consent will not affect your membership to the Club, however giving us consent to share this information will help club volunteers to know how to respond effectively in the case of any medical emergency.



I agree to taking part in the activities of the club.

I confirm I have read, or have been made aware of, the clubs policies concerning:


        Changing / showering                   Anti bullying and the code of conduct

        Transporting children                         

        Photography / video                    Social media, text and email

        I understand and agree to the responsibilities which I have regarding these policies





       I consent to the club photographing or videoing my involvement in cricket in line with the club    photography/video policy.


If you do not wish to give consent for this please contact us to discuss how we can manage any potential photography. Not giving consent will not affect your membership of the club.




We take the protection of the data that we hold about you as a member seriously and will ensure that the data you provide is processed in accordance with data protection legislation.

Please read the full privacy notice below carefully to see how the Club will treat the personal information that you provide to us.


By returning this completed form, I confirm that I have read and understood the permission statements on this membership form and the privacy notice below.

Date:                                                Signature:


Privacy Notice


Under new laws which came into effect in May 2018, we need to provide you with certain details concerning how your personal data will be used and protected.  

Sampford Peverell and Tiverton C.C. 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.


Names of data controller


Sampford Peverell and Tiverton C.C.

Categories of personal data we collect

  • Name and date of birth

  • Contact details

  • Medical/specific requirements information

  • Disability information

  • Emergency contact details

  • Sporting experience information

  • Video/Photography agreement

  • Participation agreement

Our sources of the personal data


We obtain personal data from:

  • The individual registering to join the club

  • Club coaches and junior co-ordinator

  • Play-Cricket database


Automated decisions we may take



Purposes for which we process personal data    

The club will process the personal data for:

  • Administering bookings and attendance at sessions

  • Dealing with medical needs/specific requirements

  • Supporting the delivery of cricket sessions  

  • For training and competition entry

  • Reporting of participation and any incidents and of figures and trends (including equality and inclusion information)

  • For quality and improvement monitoring

Who we will disclose your personal data to


  • Leagues

  • The ECB

  • Coaches and other volunteers for administrating training sessions

  • The County Cricket Board that supports the local Cricket Club whose programmes you have registered for

  • Volunteers who work at cricket clubs/venues to support the delivery of sessions.

Legal basis for processing your personal data

The legal basis for the collection and processing of your personal data is:

  • for administration and programme delivery: that it is necessary to fulfil the contract that you are going to enter into or have entered into with us

  • for dealing with medical needs:  that you have given your explicit consent or in your vital interests.

  • in all other cases: that it is necessary for our legitimate interests which are to build a programme to encourage participation in cricket and does not prejudice or harm your rights and freedoms.

Your right to withdraw consent

Where you have given your consent to any processing of personal data, you have the right to withdraw that consent at any time.  If you do, it will not affect the lawfulness of any processing for which we had consent prior to your withdrawing it.

Location of your personal data


The Club will keep your personal data within the European Economic Area.


How long we will keep your personal data for                              


We will not retain your personal data for longer than is reasonable and necessary for the purposes for which it was collected. We shall retain your personal data for such time as you are registered with  Sampford Peverell and Tiverton C.C. as a member.    

2 years after you cease to be a member of  Sampford Peverell and Tiverton C.C., or play an active part in  Sampford Peverell and Tiverton C.C., we shall delete your data.


Your rights in respect of your personal data


You have the right of access to your personal data and, in some cases, to require us to restrict, erase or rectify it or to object to our processing it, and the right of data portability.    

Our contact details



Contact person           Pauline Harding

                                  28 Lower Town

                                  Sampford Peverell

                                  EX16 7BJ


phone.                        01884 820603




If you have any concerns or complaints about how we are handling your data please do not hesitate to get in touch with the named person at the club. You can also contact the Information Commissioner’s Office.

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