2022 National Academy Player Registration Form

*FIRST NAME

*MIDDLE INITIAL

*LAST NAME

*CLUB TEAM

*SCHOOL

*AGE GROUP

*PLACE OF BIRTH

*DATE OF BIRTH

*HOME ADDRESS

*PARISH

*PLAYER PHONE

*PLAYER EMAIL

CLOTHING SIZING

*SHIRT

*PANTS

*SHORTS

*TRACKSUIT

*CONTACT NAME #1

*RELATIONSHIP TO PLAYER

*EMAIL

*HOME PHONE

*MOBILE PHONE

*WORK PHONE

CONTACT NAME #2

RELATIONSHIP TO PLAYER

HOME PHONE

MOBILE PHONE

WORK PHONE

By signing this form you hereby give consent for your child to take part in the Bermuda Cricket Board’s Youth League and agree that the BCB will not be held liable for any injury that may occur from this participation. By signing you also agree any photos taken may be used in BCB promotional materials (websites, posters, etc.).

*SIGNATURE (Parent/Guardian)

SIGNATURE (Player - N/A if unable to sign)

*Date

Charities House, 25 Point Finger Road, Paget, DV 04
www.cricketbermuda.com E. info@cricket.bm T. 292 8958 F. 292 8959