SAMPFORD PEVERELL & TIVERTON CRICKET CLUB
CLUB SENIOR MEMBERSHIP APPLICATION FORM 2019
(for players over the age of 18)
Once completed, the form should be returned to Pauline Harding
SECTION 1: PERSONAL DETAILS OF PLAYER
Age/ Date of birth
SECTION 2: EMERGENCY CONTACT DETAILS
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
SECTION 3: SPORTING EXPERIENCE INFORMATION
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)
SECTION 4: DISABILITY
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?
Mental Health impairment
Stamina, Breathing or Fatigue impairment
Other type of impairment, please provide more details:
SECTION 5: MEDICAL INFORMATION
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
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.
SECTION 6: PLAYER PARTICIPATION AGREEMENT:
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
Photography / video Social media, text and email
I understand and agree to the responsibilities which I have regarding these policies
SECTION 7: CLUB PHOTOGRAPHY/VIDEO CONSENT
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.
SECTION 8: PRIVACY STATEMENT:
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.
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
Medical/specific requirements information
Emergency contact details
Sporting experience information
Our sources of the personal data
We obtain personal data from:
The individual registering to join the club
Club coaches and junior co-ordinator
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
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
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.