Durham Cricket Academy

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Durham Cricket Academy     
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Durham Cricket Academy

23 Church street So. Ajax  L1S6A6. ON.  www.durhamcricketacademy.com                                                         -                                                  416 – 254 .2439

       Ajax – Pickering – Whitby – Oshawa - Uxbridge- East Scarborough

JUNIOR YOUTH CRICKETER    REGISTRATION FORM

Juniors under the age of 19 years participating in Cricket with DCA programs must complete and submit this form, signed by their Parents or Guardians, prior to participation.   

 Player Information

Name:

First name                                                       last name

Address:

 

City:

 

Postal Code:

 

Home Phone #:

(          )

Cell Phone #:

(          )

Email Address:

                                                                           @

D.O.B.

DD-MM-YYYY

Health Card #:

 

Allergies & Other:

                                        exercise induced Asthma / peanut etc

Doctor’s Name:

 

Tel  #:

 

Signature :

 

 

 

Playing Level:

Under 19

Under 17

Under 15

Under 13

Under 11

 

Membership:

*

, Under-17, Under-15, Under-13,  $150.00

 Under-19   Div. Colts Div  $175.00 + Uniform

**

 Under 11         $75.00

Payment must be made in full, prior to training or Playing League games. Cheques to “ durham cricket academy inc”.  

(Start dates & Training – game  locations  below)

 

 Emergency Contact Details:

Name:

 

Relationship:

                      

Home Phone #:

(          )

Bus. Phone #:

(          )

  Guardian/Parent Consent

I/WE THE PARENT/GAUADIAN OF THE ABOVE NAMED PLAYER, HEREBY GIVE OUR APPROVAL TO HIS/HER PARTICIPATION IN ALL DURHAM CRICKET ACADEMY PROGRAMS THAT HE/SHE IS SELECTED FOR.  I/WE ASSUME ALL RISKS AND HAZARDS INCIDENTAL TO THE CONDUCT OF THE ACTIVITIES AND TRANSPORTATION TO AND FROM SUCH ACTIVITIES. I/WE DO FURTHER RELEASE, ABSOLVE, INDEMNIFY AND HOLD HARMLESS THE ABOVE ACADEMY, THE ORGANIZERS, COACHES AND SUPERVISORS APPOINTED BY THEM.  I/WE LIKEWISE RELEASE FROM RESPONSIBILITY ANY PERSON TRANSPORTING OUR CHILD TO AND FROM THE ACTIVITIES.

 

__________________________     ______________________________     _______________________

Parents/Guardian Name                  Signature                                               Date

 

                                           Season Training & Game Dates:

 

    **Juniors Little Leagues Cricket (8-11 yrs) - Wednesday 5:30-7:30p June 23 to August 25th      *Junior’s ages Under-13/15/17/19                    - Friday          5:30-8:00p mid-May to  August 25th

 

Location:     Ajax Cricket Grounds, South on Monarch ave.  off Bayly. St. (south of Ajax. Com Centre)

 

23 Church street South, Ajax  L1S6A6. On.  www.durhamcricketacademy.com    Coach Phil – 416.254.2439