I …………………………………….hereby give my permission for …………………...…………….. to participate in cricket coaching sessions at Montague Gardens Action Cricket Arena under supervision of the trained staff of "The Complete Cricketer Academy"

Further, I authorise the Academy to provide emergency treatment of an injury to, or illness of my child if qualified medical personnel consider treatment necessary and perform the treatment. This authorisation is granted only if I cannot be reached and reasonable effort has been made to contact me.

My child and I are aware that participating in cricket coaching sessions is a potentially hazardous activity. I assume all risks associated with participation in this sport, including but not limited to falls, contact with other participants, contact with cricket balls and other equipment, and other reasonable-risk conditions
associated with the sport. All such risks to my child are known and understood by me.

I understand this informed consent form and agree to its conditions on behalf of my child.

I, the undersigned, Parent/Legal guardian of …………………………………….
hereby indemnify and hold harmless, The Complete Cricketer Academy, Montague Gardens Indoor Arena and their employees for any loss, damage or injury during the sessions.

Signature …………………………………….Date: …………………………………….

(please replace the dotted lines with your information)

Application Form

Required* Player Information Please note that before this form is completed and submitted you need to complete the Informed Consent Form and have scanned it so that you have it in electronic format so that you can attach it to the bottom of this form. Your application cannot be considered unless both forms are available. Surname  *   Please type in your Surname First Name  *   Field not valid (required or bad value) Address   Field not valid (required or bad value) Address   Field not valid (required or bad value) Address   Field not valid (required or bad value) Address   Field not valid (required or bad value) Postal Code   Field not valid (required or bad value) Home Tel.   Field not valid (required or bad value) Date of Birth  *   Field not valid (required or bad value) School Grade Parent/Guardian Info Parent/Guardian's Name   Field not valid (required or bad value) Cell No. Email address   Field not valid (required or bad value) 2nd Contact's name   Field not valid (required or bad value) Cell No.   Field not valid (required or bad value) Medical Information Medical Aid details Disability  Yes   No  If you have selected Yes then please click on the disability in the list below. You can select more than one by honding down the Ctrl button and clicking on more than one item. Disability Visual impairment  Hearing Impairment  Physical disability  Learning disability  Multiple disability  Family Doctor Doctor's Tel   Field not valid (required or bad value) If you have any pre-existing medical conditions (e.g. allergies or chronic illnesses) please list them. Condition Sporting Information Have you played cricket before?  Yes   No  If yes, where have you played the sport? Fill in the fields where applicable. School Sport Club Coach's Name Province Before Submitting Please remember to attach, via the Browse button below, your Informed Consent form. If you cannot scan the document to attach here please hand to Laurie Ward personally. Informed Consent Form     Incorrect, please try again.   Powered by CK Forms