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My child and I are aware that participating in cricket 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 and equipment the effects of weather and other reasonable risk conditions associated with the sport. All such risks to my child are known and understood by us. I understand this registration form and agree to its conditions on behalf of my child. Parent/Guardian Name Contact Phone Signature Club Use Only Entered in to Database by 2010 RDCA. All Rights Reserved. Version 1. Rdca.com REGISTRATION FORM Junior Senior Veteran Official Umpire category Registering Club Previous RDCA Club Title Season First Name Surname Middle Name Initial Date of Birth DD/MM/YYYY Birth Certificate No Juniors Only Address Suburb Home Phone Postcode Work Phone Mobile Email Pre-existing medical conditions e.g. Allergies or Chronic Illness PRIVACY ACT EXEMPTION We respect your privacy and by signing this form you agree that personal information currently stored on the MyCricket database may be used by the Ringwood District Cricket Association RDCA and your Club to facilitate communication with you as deemed appropriate to facilitate arrangements for insurance cover for you to communicate with Cricket Victoria and its affiliates as well as Victorian Cricket Registration Cricket Australia and other Cricket Associations and as required by law AND FURTHER you agree that the RDCA may use the database of MyCricket or its successors as is appropriate to achieve these purposes. Ringwood and District Cricket Association A116 Founded 1920 Affiliated with V. M. C. U. Web Site www. Player s Signature Date I hereby give permission for the above mentioned child to participate in cricket. Further I authorise the club 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 authorization granted only if I cannot be reached and reasonable efforts have been made to reach me. My child and I are aware that participating in cricket 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 and equipment the effects of weather and other reasonable risk conditions associated with the sport. All such risks to my child are known and understood by us. I understand this registration form and agree to its conditions on behalf of my child. Parent/Guardian Name Contact Phone Signature Club Use Only Entered in to Database by 2010 RDCA. All Rights Reserved* Version 1. Player s Signature Date I hereby give permission for the above mentioned child to participate in cricket. Further I authorise the club to provide emergency treatment of an injury to or illness of my child if qualified medical personnel consider treatment necessary and perform the treatment. Further I authorise the club 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 authorization granted only if I cannot be reached and reasonable efforts have been made to reach me.

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