Loughton Cricket Club

Loughton CC 2023 Membership Link
Congratulations to the U15's on winning the Cox & Kings Competition 2023, Congratulations to the Lynxes for winning their division and now being promoted

Loughton Day 2023


Self Declaration Form

Loughton CC Self Declaration Form





Part A

If you need more space to enter your details, or wish to give additional information, please use a separate sheet.




Surname: __________________________________________________________


First Name(s):  ______________________________________________________


Address:  __________________________________________________________


________________________________________  Postcode:  ________________


E-Mail:  ____________________________________________________________


Home telephone number:  _____________________________________________


Mobile telephone number:  _____________________________________________


With discretion, may we contact you at work?  ______________________________


Work telephone number:  ______________________________________________


Please list any previous clubs that you have played/worked/volunteered for:


1.                  _______________________________________


2.                  _______________________________________


3.                  _______________________________________


4.                  _______________________________________


5.                  _______________________________________




Part B

The England and Wales Cricket Board (ECB) and affiliated cricketing organisations, including this Cricket Club, aim to promote equality of opportunity for all persons and welcome participation from a wide range of individuals, including those with prior criminal records.  The membership/voluntary position for which you have applied is an exempted occupation for the purposes of the Rehabilitation of Offenders Act 1974 (as amended by the Rehabilitation of Offenders Act 1975).  All ‘spent’ and ‘unspent’ convictions must be declared.  Having an ‘unspent’ conviction will not necessarily impede your involvement with Cricket: this will depend on the circumstances and background to your offence.  If you fail to disclose an offence and the ECB or any affiliated organisation is later informed of any undisclosed criminal matter, you may be subject to disciplinary action.  Evaluation of information is based on strict confidentiality and discretion.


1.                   Have you ever been convicted of any criminal offences or accepted any reprimands or cautions or Police warnings?




Yes                  No                               


If yes, please supply details of any criminal convictions:






2.                   Are you a person known to any Social Services department as being an actual or potential risk to Children or Young People?




Yes                  No                               


If yes, please supply details:






3.                   Have you ever had a disciplinary sanction (from any sports or other organisation’s governing body) relating to child abuse?




Yes                  No                               


If yes, please supply details:






I understand that it is necessary for me to declare any information requested and that the membership/voluntary position for which I have applied may involve access to Children, Young People and/or Vulnerable Adults.  I hereby give my consent to the ECB for it to conduct a Criminal Records Bureau (CRB) check if so required.  The ECB Child Protection Manager may be informed of disclosed information.



Name:  __________________________________________Date of Birth:  ____________________



Signature:  ______________________________________  Date:  __________________________