U11 Winter Programme Registration Cricket Shropshire – U11 Boys Winter Programme Registration 2024 Child's Name Child's Date of Birth Player ethnicityWhite English, Welsh, Scottish, Northern Irish, or British Irish Gypsy or Irish Traveller Any other White background (please specify)Mixed or Multiple ethnic groups White and Black Caribbean White and Black African White and Asian Any other Mixed or Multiple ethnic background (please specify)Asian or Asian British Indian Pakistani Bangladeshi Chinese Any other Asian background (please specify)Black, African, Caribbean, or Black British African Caribbean Any other Black, African, or Caribbean background (please specify)Other ethnic group Arab Any other ethnic group (please specifyPrefer not to sayChild's Club What school does you child attend? ECB have requested that the following question be asked as part of the terms surrounding funding we receive for the CAG Programme: What type of primary/secondary school did you attend? A non-selective, state run school A state run or state funded school which required an entrance exam (e.g. grammar school) A state run or state funded school selective on religious or faith grounds A private or fee-paying school A private or fee-paying school, where I received a means tested bursary covering 90% or more of the total cost of attending throughout my time I was home-schooled Prefer not to say Other Do you have any other siblings that are involved in the Pathway? Yes No Parent Name Parent Email Parent Emergency Telephone Number Postcode Do you have access to transport to and from sessions Yes No Has your child been diagnosed with ADHD, Dyslexia, Autism etc. Yes No If yes, please provide details. Does your child have an Education Health Care Plan (EHCPs) Yes No If yes, please provide details. Does your child have any medical conditions or access requirements we should be aware of?How long has your child played cricket for? Please select which group your child has been invited to join: U11 Boys County U11 Boys North Development U11 Boys South Development I give consent for the SCB to capture photos/videos for coaching and promotional use on our social media sites and website Yes No I give consent for the coaching staff to take appropriate action in the unlikely event of an emergency, including the administering of Emergency First Aid. Yes No I confirm I have read and understood the Cricket Shropshire Code of Conduct attached to the original email. Yes, I have read and understood the Code of Conduct No
