{"id":565,"date":"2023-04-07T07:35:16","date_gmt":"2023-04-07T07:35:16","guid":{"rendered":"https:\/\/matlockandcromfordcc.co.uk\/wp\/?page_id=565"},"modified":"2026-02-23T07:38:09","modified_gmt":"2026-02-23T07:38:09","slug":"mcmcc-u12-membership-application-form","status":"publish","type":"page","link":"https:\/\/matlockandcromfordcc.co.uk\/wp\/mcmcc-u12-membership-application-form\/","title":{"rendered":"MCMCC U12 Membership Application Form"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">We are very pleased to welcome your junior to Matlock and Cromford Meadows Cricket Club.  <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This Membership Form must be completed <strong>on behalf of<\/strong> the junior member and this registration will affiliate all members to Matlock &amp; Cromford Cricket Club.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">By completing this form, you agree to us storing their and your data for the purpose of contacting in the event of an emergency. We will not use their or your personal information for any other purpose. In return, Matlock and Cromford Meadows Cricket Club commit to compliance with GDPR.<\/p>\n\n\n<div class=\"wrap pdb-signup pdb-instance-2\" >\n\n    <form method=\"post\" enctype=\"multipart\/form-data\"  autocomplete=\"off\" action=\"\/wp\/wp-json\/wp\/v2\/pages\/565\" ><input name=\"action\" type=\"hidden\" value=\"signup\" \/>\n\n<input name=\"subsource\" type=\"hidden\" value=\"participants-database\" \/>\n\n<input name=\"shortcode_page\" type=\"hidden\" value=\"\/wp\/wp-json\/wp\/v2\/pages\/565\" \/>\n\n<input name=\"thanks_page\" type=\"hidden\" value=\"https:\/\/matlockandcromfordcc.co.uk\/wp\/thank-you\/\" \/>\n\n<input name=\"instance_index\" type=\"hidden\" value=\"2\" \/>\n\n<input name=\"pdb_data_keys\" type=\"hidden\" value=\"60.1.2.3.4.5.7.62.31.34.35.63.25.26.27.29.22.61.44.47.48.50.49.51.28.59.37.38.39.68.8.9.21\" \/>\n\n<input name=\"session_hash\" type=\"hidden\" value=\"38b36d0afd\" \/>\n\n    <table class=\"form-table pdb-signup\">\n\n      \n      <tbody class=\"field-group field-group-main\">\n        \n                \n        \n        <tr class=\"heading member_details-input-group\">\n\n          <th for=\"pdb-member_details-2\">Member Details<\/th>\n\n          <td>\n\n            <p>Please enter the member details:<\/p>\n\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line first_name-input-group\">\n\n          <th for=\"pdb-first_name-2\">First Name<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"first_name\" id=\"pdb-first_name-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line last_name-input-group\">\n\n          <th for=\"pdb-last_name-2\">Last Name<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"last_name\" id=\"pdb-last_name-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line address-input-group\">\n\n          <th for=\"pdb-address-2\">Address<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"address\" id=\"pdb-address-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line city-input-group\">\n\n          <th for=\"pdb-city-2\">Town<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"city\" id=\"pdb-city-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line state-input-group\">\n\n          <th for=\"pdb-state-2\">County<\/th>\n\n          <td>\n\n            <input name=\"state\" id=\"pdb-state-2\" class=\" regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line zip-input-group\">\n\n          <th for=\"pdb-zip-2\">Postcode<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"zip\" id=\"pdb-zip-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n                \n        <\/tbody>\n\n      \n      <tbody class=\"field-group field-group-juniors\">\n        \n                \n        \n        <tr class=\"date dob-input-group\">\n\n          <th for=\"pdb-dob-2\">Date Of Birth<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"dob\" id=\"pdb-dob-2\" class=\"required-field regular-text date_field\" type=\"text\" value=\"\" \/>\n\n                        <span class=\"helptext\">Junior Member's Date of Birth (dd\/mm\/yy)<\/span>\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"heading juniors-input-group\">\n\n          <th for=\"pdb-juniors-2\">Parents'\/Guardian's details<\/th>\n\n          <td>\n\n            <hr \/>\n<p>Please enter Parent\/Guardian's details:<\/p>\n\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line parent_guardian-input-group\">\n\n          <th for=\"pdb-parent_guardian-2\">Parent\/Guardian First Name<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"parent_guardian\" id=\"pdb-parent_guardian-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line parent_guardian_last_name-input-group\">\n\n          <th for=\"pdb-parent_guardian_last_name-2\">Parent\/Guardian Last Name<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"parent_guardian_last_name\" id=\"pdb-parent_guardian_last_name-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line parent_guardian_address-input-group\">\n\n          <th for=\"pdb-parent_guardian_address-2\">Parent\/Guardian Address<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"parent_guardian_address\" id=\"pdb-parent_guardian_address-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line parent_guardian_town-input-group\">\n\n          <th for=\"pdb-parent_guardian_town-2\">Parent\/Guardian Town<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"parent_guardian_town\" id=\"pdb-parent_guardian_town-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line parent_guardian_county-input-group\">\n\n          <th for=\"pdb-parent_guardian_county-2\">Parent\/Guardian County<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"parent_guardian_county\" id=\"pdb-parent_guardian_county-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line parent_guardian_postcode-input-group\">\n\n          <th for=\"pdb-parent_guardian_postcode-2\">Parent\/Guardian Postcode<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"parent_guardian_postcode\" id=\"pdb-parent_guardian_postcode-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"checkbox parent-input-group\">\n\n          <th for=\"pdb-parent-2\">PARENT\/GUARDIAN AGREEMENT <span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"parent\" id=\"pdb-parent-2-default\" class=\"required-field\" type=\"hidden\" value=\"No\" \/>\n<label for=\"pdb-parent-2\">\n<input name=\"parent\" id=\"pdb-parent-2\" class=\"required-field\" type=\"checkbox\" value=\"Yes\" \/>\nYes\n<\/label>\n\n                        <span class=\"helptext\">By returning this completed form, I confirm that I have legal responsibility of the child named and that I have read and understood the permission statements on this membership form and the privacy notice posted on the club's website. <\/span>\n                        \n          <\/td>\n\n        <\/tr>\n  \n                \n        <\/tbody>\n\n      \n      <tbody class=\"field-group field-group-member_email\">\n        \n                \n        \n        <tr class=\"heading contact_details-input-group\">\n\n          <th for=\"pdb-contact_details-2\">Contact Details<\/th>\n\n          <td>\n\n            <hr \/>\n<p>Please enter your contact details:<\/p>\n\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line phone-input-group\">\n\n          <th for=\"pdb-phone-2\">Contact Phone Number<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"phone\" id=\"pdb-phone-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line email-input-group\">\n\n          <th for=\"pdb-email-2\">Contact Email<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"email\" id=\"pdb-email-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line email_verification-input-group\">\n\n          <th for=\"pdb-email_verification-2\">Contact Email Verification<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"email_verification\" id=\"pdb-email_verification-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n                \n        <\/tbody>\n\n      \n      <tbody class=\"field-group field-group-emergency_details\">\n        \n                \n        \n        <tr class=\"heading emergency_contact_details-input-group\">\n\n          <th for=\"pdb-emergency_contact_details-2\">Emergency Contact Details<\/th>\n\n          <td>\n\n            <hr \/>\n<p>Please enter Emergency Contact details for the member.<\/p>\n<p>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.<\/p>\n\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line emergency_name-input-group\">\n\n          <th for=\"pdb-emergency_name-2\">Emergency Name<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"emergency_name\" id=\"pdb-emergency_name-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line emergency_phone-input-group\">\n\n          <th for=\"pdb-emergency_phone-2\">Emergency Phone<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"emergency_phone\" id=\"pdb-emergency_phone-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line emergency_relationship-input-group\">\n\n          <th for=\"pdb-emergency_relationship-2\">Relationship to Member<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"emergency_relationship\" id=\"pdb-emergency_relationship-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n                        <span class=\"helptext\">Parent\/partner\/etc<\/span>\n                        \n          <\/td>\n\n        <\/tr>\n  \n                \n        <\/tbody>\n\n      \n      <tbody class=\"field-group field-group-medical_details\">\n        \n                \n        \n        <tr class=\"heading medical_details-input-group\">\n\n          <th for=\"pdb-medical_details-2\">Medical Details<\/th>\n\n          <td>\n\n            <hr \/>\n<p>Please confirm any known allergies\/medical conditions for yourself and any family member:<\/p>\n\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line allergy-input-group\">\n\n          <th for=\"pdb-allergy-2\">Allergy<\/th>\n\n          <td>\n\n            <input name=\"allergy\" id=\"pdb-allergy-2\" class=\" regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"text-line doctor-input-group\">\n\n          <th for=\"pdb-doctor-2\">Doctor's Information (Name and Phone)<\/th>\n\n          <td>\n\n            <input name=\"doctor\" id=\"pdb-doctor-2\" class=\" regular-text\" type=\"text\" value=\"\" \/>\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"dropdown medical_consent-input-group\">\n\n          <th for=\"pdb-medical_consent-2\">Medical Consent<\/th>\n\n          <td>\n\n            <select name=\"medical_consent\" id=\"pdb-medical_consent-2\">\n<option value=\"\"><\/option>\n<option value=\"Yes\" selected=\"selected\">Yes<\/option>\n<option value=\"No\">No<\/option>\n<\/select>\n\n                        <span class=\"helptext\">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. <\/span>\n                        \n          <\/td>\n\n        <\/tr>\n  \n                \n        <\/tbody>\n\n      \n      <tbody class=\"field-group field-group-consents\">\n        \n                \n        \n        <tr class=\"heading player_consents-input-group\">\n\n          <th for=\"pdb-player_consents-2\">Player Consents<\/th>\n\n          <td>\n\n            <hr \/>\n<p>Please consent to the following agreements:<\/p>\n\n\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"checkbox agree-input-group\">\n\n          <th for=\"pdb-agree-2\">Player Participation AgreementMENT<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"agree\" id=\"pdb-agree-2-default\" class=\"required-field\" type=\"hidden\" value=\"No\" \/>\n<label for=\"pdb-agree-2\">\n<input name=\"agree\" id=\"pdb-agree-2\" class=\"required-field\" type=\"checkbox\" value=\"Yes\" \/>\nYes\n<\/label>\n\n                        <span class=\"helptext\">I agree to myself\/the named player taking part in the activities of the club. <\/span>\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"checkbox ecb-input-group\">\n\n          <th for=\"pdb-ecb-2\">Child Welfare Policy<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"ecb\" id=\"pdb-ecb-2-default\" class=\"required-field\" type=\"hidden\" value=\"No\" \/>\n<label for=\"pdb-ecb-2\">\n<input name=\"ecb\" id=\"pdb-ecb-2\" class=\"required-field\" type=\"checkbox\" value=\"Yes\" \/>\nYes\n<\/label>\n\n                        <span class=\"helptext\">I confirm I have read, or have been made aware of, the clubs Child Welfare Policy which is in line with the England &amp; Wales Cricket Board (ECB) \"Safe Hands - Welfare of Young People in Cricket\" policy and any future versions of the policy.<\/span>\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"dropdown photography-input-group\">\n\n          <th for=\"pdb-photography-2\">Club Photography\/Video\/Live Streaming Consent<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <select name=\"photography\" id=\"pdb-photography-2\" class=\"required-field\">\n<option value=\"\" selected=\"selected\">&nbsp;<\/option>\n<option value=\"Yes\">Yes<\/option>\n<option value=\"No\">No<\/option>\n<\/select>\n\n                        <span class=\"helptext\">I consent to the club photographing\/live streaming or videoing myself\/the named player when involved in cricket in line with the club photography\/video policy. \r\n\r\nIf 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 you or your child's membership of the club. <\/span>\n                        \n          <\/td>\n\n        <\/tr>\n  \n        \n        <tr class=\"checkbox player-input-group\">\n\n          <th for=\"pdb-player-2\">Player Agreement<span class=\"reqd\">*<\/span><\/th>\n\n          <td>\n\n            <input name=\"player\" id=\"pdb-player-2-default\" class=\"required-field\" type=\"hidden\" value=\"No\" \/>\n<label for=\"pdb-player-2\">\n<input name=\"player\" id=\"pdb-player-2\" class=\"required-field\" type=\"checkbox\" value=\"Yes\" \/>\nYes\n<\/label>\n\n                        <span class=\"helptext\">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 on behalf of myself\/the named player.<\/span>\n                        \n          <\/td>\n\n        <\/tr>\n  \n                \n        <\/tbody>\n\n            \n        <tbody class=\"field-group field-group-submit\">\n      \n        <tr>\n          <td class=\"submit-buttons\">\n            \n           <input name=\"submit_button\" class=\"button-primary pdb-submit\" type=\"submit\" value=\"Sign Up\" \/>\n            \n          <\/td>\n          <td class=\"submit-buttons\">\n            \n                      \n          <\/td>\n        <\/tr>\n        \n      <\/tbody>\n      \n    <\/table>\n    \n  <\/form>  \n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>We are very pleased to welcome your junior to Matlock and Cromford Meadows Cricket Club. This Membership Form must be completed on behalf of the junior member and this registration will affiliate all members to Matlock &amp; Cromford Cricket Club. By completing this form, you agree to us storing their<span class=\"more-link\"><a href=\"https:\/\/matlockandcromfordcc.co.uk\/wp\/mcmcc-u12-membership-application-form\/\">Continue Reading<\/a><\/span><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["entry","author-admin","post-565","page","type-page","status-publish"],"_links":{"self":[{"href":"https:\/\/matlockandcromfordcc.co.uk\/wp\/wp-json\/wp\/v2\/pages\/565","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/matlockandcromfordcc.co.uk\/wp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/matlockandcromfordcc.co.uk\/wp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/matlockandcromfordcc.co.uk\/wp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/matlockandcromfordcc.co.uk\/wp\/wp-json\/wp\/v2\/comments?post=565"}],"version-history":[{"count":4,"href":"https:\/\/matlockandcromfordcc.co.uk\/wp\/wp-json\/wp\/v2\/pages\/565\/revisions"}],"predecessor-version":[{"id":684,"href":"https:\/\/matlockandcromfordcc.co.uk\/wp\/wp-json\/wp\/v2\/pages\/565\/revisions\/684"}],"wp:attachment":[{"href":"https:\/\/matlockandcromfordcc.co.uk\/wp\/wp-json\/wp\/v2\/media?parent=565"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}