REGIONAL
CRICKET
Player
Details Sheet
Full Name : ____________________________________________
Address: ____________________________________________
____________________________________________
____________________________________________
Post Code: ____________________________________________
Phone: ____________________(h) __________________ (m)
Emergency
contact name : ___________________________________
Emergency
contact phone: ___________________________________
Family doctor name : ___________________________________
Family doctor phone : ___________________________________
Parent/guardian
email: _____________________________________
Date of Birth:
____________________________________________
County Board/Academy : ____________________________________
Throwing Arm : _______________________________________
Approx Clothing sizes : Shirts : ________
(S,M,L,XL etc)
Shorts : ________
T/suit
trousers : ________
REGIONAL CRICKET
MEDICAL DETAILS FORM
2009-2010-2011
For players aged
under 18, the form should be completed by the parent/guardian.
1.
Medical
information about your child
(a)
Any
conditions requiring medical treatment, including medication?
YES/NO
If
YES, please give brief details including how the medication is administered
(players
are required to provide their own medication)
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(b) To the best of your knowledge, has your
son been in contact with any contagious or infectious diseases or suffered from
anything in the last four weeks that may be contagious or infectious?
YES/NO
If YES, please give
brief details:
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(c) Is your son allergic to any medication?
YES/NO
If YES, please specify:
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(d) When did your son last have a tetanus
injection?
________________________________________________________
(e) Please
outline any special dietary requirements of your child (incl. allergies)
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2. Please provide any further information
that you think may be relevant
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Declaration (Please tick each and sign at bottom of page)
. I agree to my son taking part in the ECB
Regional cricket activities.
. I agree to my son receiving medication as
instructed and any emergency dental, medical or surgical treatment, including
anaesthetic or blood transfusion, as considered necessary by the medical
authorities present.
. I agree to photographs / videos being
taken involving my son during coaching sessions and/or matches as detailed
under the stated rules and conditions (ECB Safe Hands Policy)
. I agree to my son undertaking the fitness
assessment as used and approved by ECB
. I agree to my child taking part, under
supervision, in any water based leisure activities and confirm that they are
able to swim unaided for a minimum of 50 metres.
. I agree to my son being transported in an
appropriately insured vehicle of an ECB member of staff or ECB organised coach
transportation, as necessary.
. I will inform the Regional Performance
Manager as soon as possible of any changes to the medical or other
circumstances between now and the commencement of the event.
. I agree to abide by the ECB Regional Code
of Conduct and acknowledge the need for my son to abide by the code.
Signed: ___________________________(parent/guardian)
Full name: ____________________________________________
Signed: ___________________________(player)
Players
name: __________________________________________
Date:
______________________________