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2017 CCA MEMBERSHIP APPLICATION

CCA membership application fee

$1000.00  

Applicant Information

Name of the player*

 

Date of birth*

 

Gender*

Male:  Female:   

Current address*

 

City*

 

ZIP Code*

 

Home phone*

 

Parent's Information

Mother' s Name*

 

Mother' s E-mail*

 

Mother' s Cell Phone*

 

Father' s Name*

 

Father' s E-mail*

 

Father' s Cell Phone*

 

Emergency Contact

Primary

Name*

 

Phone*

 
Secondary

Name

 

Phone

 

Please Select How You Would Like To Volunteer At CCA

*Select atleast one.

Scoring

 

Umpiring

 

Ground Manager

 

Team Manager

 

Team Mom/Dad

 

Data Entry

 

Fund Raising Help

 

Communications In-charge during tournaments

 

Creating Flyers/Newsletters

 

Coaching Help (for practice sessions, games)

 

Payment Method

I assume all responsibility and agree to indemnify any and all concerned authorities, school districts & organizations for any loss, damage or injury to myself or my child or my property which may have been caused during the class by accident, or negligence, or any act, of any person connected in any way with this event. I understand that the California Cricket Academy/City of Cupertino/City of Fremont/City of San Jose or the related School Districts do not guarantee the construction, condition, or safety of the facilities or the equipment and that this release agreement is to be binding on me, my heirs and assigns.
Tick here, if you have read the above, understand it's meaning and voluntarily accept it.

Applicant Information

Name of the player*

 

Date of birth*

 

Gender*

Male:  Female:   

Current address*

 

City*

 

ZIP Code*

 

Home phone*

 

Parent's Information

Mother' s Name*

 

Mother' s E-mail*

 

Mother' s Cell Phone*

 

Father' s Name*

 

Father' s E-mail*

 

Father' s Cell Phone*

 

Emergency Contact

Primary

Name*

 

Phone*

 
Secondary

Name

 

Phone

 

Please Select How You Would Like To Volunteer At CCA

*Select atleast one.

Scoring

 

Umpiring

 

Ground Manager

 

Team Manager

 

Team Mom/Dad

 

Data Entry

 

Fund Raising Help

 

Communications In-charge during tournaments

 

Creating Flyers/Newsletters

 

Coaching Help (for practice sessions, games)

 

Payment Details

First Name *

 

Last Name *

 

Card Type

 

Expiry Date

Credit Card Number *

 

CVV *

 

Street Address*

 

City *

 

State

 

Zipcode *

 

Country