Players Membership & Registration Form 2021-22

Players Name *

First

Last

Section/Team *

Date of Birth (dd/mm/yyyy) *

Does the Player have a Medical/Health Condition *

Was an on-line membership form submitted for the Player last season *

If you have submitted a form before you have already agreed to the RFU & Clubs Policies and Procedures and provided consent for medical treatment, photograph taking, filming and publication.

Add Another Player

Tick Yes to add

Home Address

Parent/Guardian and Next of Kin Information

Parent/Guardians Name or Next of Kin *

First

Last

Date of Birth of Parent/Guardian *

DoB for the Parent/Guardian is needed to confirm over 18 year old status to allow voting rights & to complete a mandator field entry on the RFU Games Management System (GMS) database, which is used to securely store your data.

Phone *

Email *

Membership Subs

Select Membership Required *

Subs are due by the first week of September.

Donation & Gift Aid (Optional)

The Clubs current fund raising drive is to help provide additional financial security during the pandemic and for further improvements within and around the clubhouse

Make a Donation *

Total to Pay

£ 0.00

Method of Payment *

Cash
Cheque
BACS Bank Transfer
Other (e.g. Authorised Concession)

Cash and cheques should be given to your Team Manager. Please write the names & teams of players on the reverse side of cheques used to make payments. BACS Transfers are made to : Sort code 30-94-26 and Account: 00026636

Declaration/Consent

Signature *

I, the signee, have the authority to sign on behalf of all the Players stated within this submission, and by signing entering into a Volunteer Player (unpaid player) Agreement/Contract as per the terms of this form for the period of 1 year from 1st Sept 2019 until the 31st August 2020 (To sign - Please draw your signature on the touch screen or by using the mouse. When using a mouse, hold down the left button to draw. You can start again by clicking on the x in the top right corner.)

Signees Name *

First

Last

Todays Date *

Captcha *

Please enter your answer in the box above. Please remember "*" is multiply and "/" is divide.