Please enable JavaScript in your browser to complete this form.Players Name *FirstLastSection/Team *Please select...Senior Mens TeamLadies TeamWildcats Girls Youth SquadUnder18'sUnder17'sUnder 16'sUnder 15'sUnder 14'sUnder 13'sUnder 12'sUnder 11'sUnder 10'sUnder 9'sUnder 8'sUnder 7'sUnder 6'sDate of Birth (dd/mm/yyyy) *Does the Player have a Medical/Health Condition *YesNoPlease give details of the Medical/Health Condition *Was an on-line membership form submitted for the Player last season *YesNoIf 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.Are you new to the Club, or have you left the Club and returned and require RFU Registration or Transfer to Westcliff Rugby Football Club? *YesNoIf you have not formally registered with the Club before, or if you have registered elsewhere and you are returning please tick the Yes box.Has the Player changed School/College *YesNoSchool/College *Players Email *Players Telephone Number *Welcome to Westcliff Rugby Football Club. Please select your registration type: *New RegistrationRe-registrationClub TransferSex *Please select....MaleFemalePrefered Playing Position *Please select...UnknownFront RowForwardBackTown of Birth *Country of Birth *Nationality *Ethnic Origin *Please select...Asian & Asian British: BangladeshAsian & Asian British: IndianAsian & Asian British: PakistanAsian & Asian British: OtherBlack or Black British: AfricanBlack or Black British: CaribbeanBlack or Black British: OtherMixed: White & Black AfricanMixed: White & Black CaribbeanMixed: White & AsianMixed: OtherWhite: BritishWhite: IrishWhite: OtherOther Ethnic GroupPrevious Club *Date of leaving previous club *Union (e.g. English, Scottish, etc) *Were you contracted or registered at your previous club *ContractedRegistered PlayerContracted players must provide contract details and evidence of release to the RegistrarAdd Another PlayerTick Yes to addName of Second Player *FirstLastSection/Team of Second Player *Please select...Senior Mens TeamsLadies TeamWildcats Girls Youth SquadUnder 18'sUnder 17'sUnder 16'sUnder 15'sUnder 14'sUnder 13'sUnder 12'sUnder 11'sUnder 10'sUnder 9'sUnder 8'sUnder 7'sUnder 6'sDate of Birth of Second Player *Does the Second Player have a Medical/Health Condition *YesNoPlease give details of the Medical/Health Condition of the Second Player *Was an on-line membership form submitted for this Second Player last season *YesNoIf 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.Is the Second Player new to the Club, or left the Club and returned and require RFU Registration or Transfer to Westcliff Rugby Football Club *YesNoIf you have not formally registered with the Club before, or if you have registered elsewhere and you are returning please tick the Yes box.Has the Second Player changed School/College *YesNoIf you have submitted a form before you have already agreed to the RFU & Clubs Policies and Procedures. School/College of Second Player *Email of Second Player *Telephone Number of Second Player *Welcome to Westcliff Rugby Football Club. Please select the Second Players registration type: *Please select...New RegistrationRe-registrationClub TransferSex of Second Player *Please select....MaleFemaleSecond Player Prefered Playing Position *Please select...UnknownFront RowForwardBackTown of Birth of Second Player *Country of Birth of Second Player *Nationality of the Second Player *Ethnic Origin of Second Player *Please select...Asian & Asian British: BangladeshAsian & Asian British: IndianAsian & Asian British: PakistanAsian & Asian British: OtherBlack or Black British: AfricanBlack or Black British: CaribbeanBlack or Black British: OtherMixed: White & Black AfricanMixed: White & Black CaribbeanMixed: White & AsianMixed: OtherWhite: BritishWhite: IrishWhite: OtherOther Ethnic GroupPrevious Club of Second Player *Date that the Second Player left previous club *Union (e.g. English, Welsh, etc) *Was the Second Player contracted or registered at the previous club *ContractedRegistered PlayerContracted players must provide contract details and evidence of release to the RegistrarAdd a Third PlayerTick Yes to addName of Third Player *FirstLastSection/Team of Third Player *Please select...Senior Mens TeamsLadies TeamWildcats Girls Youth SquadUnder 18'sUnder 17'sUnder 16'sUnder 15'sUnder 14'sUnder 13'sUnder 12'sUnder 11'sUnder 10'sUnder 9'sUnder 8'sUnder 7'sUnder 6'sDate of Birth of Third Player *Does the Third Player have a Medical/Health Condition *YesNoPlease give details of the Medical/Health Condition of Third Player *Was an on-line membership form submitted for the Third Player last season *YesNoIf 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.Is the Third Player new to the Club, or left the Club and returned and require RFU Registration or Transfer to Westcliff Rugby Football Club *YesNoIf you have not formally registered with the Club before, or if you have registered elsewhere and you are returning please tick the Yes box.Has the Third Player changed School/College *YesNoIf you have submitted a form before you have already agreed to the RFU & Clubs Policies and Procedures. School/College of Third Player *Email of Third Player *Telephone Number of Third Player *Sex of Third Player *Please select....MaleFemalePreferred Possition of Third Player *Welcome to Westcliff Rugby Football Club. Please select the Third Players registration type: *Please Select...New RegistrationRe-registrationClub TransferTown of Birth of Third Player *Country of Birth of Third Player *Nationality of the Third Player *Ethnic Origin of Third Player *Please select...Asian & Asian British: BangladeshAsian & Asian British: IndianAsian & Asian British: PakistanAsian & Asian British: OtherBlack or Black British: AfricanBlack or Black British: CaribbeanBlack or Black British: OtherMixed: White & Black AfricanMixed: White & Black CaribbeanMixed: White & AsianMixed: OtherWhite: BritishWhite: IrishWhite: OtherOther Ethnic GroupPrevious Club of Third Player *Date that the Third Player left previous club *Union (e.g. English, French, etc) *Was the Third Player contracted or registered at the previous club *ContractedRegistered PlayerContracted players must provide contract details and evidence of release to the RegistrarHome AddressSince last years on-line submission has the primary address changed for the player/players *YesNoIt is YOUR responsibility to keep the Club updated with changes in primary addressPrimary Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeParent/Guardian and Next of Kin InformationSince last years on-line submission has the Parent/Guardian/Next of Kin details changed for the player/players *YesNoIt is YOUR responsibility to keep the Club updated with changes in your contact information. These may be needed in cases of emergencies.Parent/Guardians Name or Next of Kin *FirstLastDate 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 SubsSelect Membership Required *Please select.....Senior Man/Lady playerU21 or full-time Education1 Youth/Girls Wildcat/Mini player2 Youth/Girl Wildcat/Mini playersSenior Mens/Ladies + 1 Youth/Girls Wildcat/Mini playersSenior Mens/Ladies + 2 Youth/Girls Wildcat/Mini playersSubs 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 clubhouseMake a Donation *Optional, Select if you wish....NoYes (£25.00)Yes (Other)Your Donation (£): *Total to Pay£ 0.00Community Amateur Sports Club (CASC) Gift Aid for Westcliff Rugby Football Club Limited (Optional). Do you wish to Gift Aid your donation *YesNoIf eligible, Gift Aid can boost your donation by 25p for every £1 donated.Gift Aid Eligability & Commitment. I am a UK taxpayer and I understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all of my donations in that tax year it would be my responsibility to pay any difference *YesHigher or additional rate payers who want to receive additional tax relief due to you should include all Gift Aid donations on you Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code. My Future Donations to Westcliff Rugby Football Club Limited (Optional). I want to Gift Aid my future donations to Westcliff Rugby Football Club LimitedYesPlease notify the CASC if you want to cancel the declaration; changed your name or home address, or no longer pay sufficient tax on your income and/or capital gains.Method of Payment *CashChequeBACS Bank TransferOther (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 Payment Type *CashChequeBACSStanding OrderOther (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 Standing Order forms can be found on the club website on the Documents and Forms page: https://westcliffrfc.co.uk/documents-and-forms/Enter the date that you will initiate the bank transfer *When making a bank transfer please ref the team of the first player on the membership form, His/her first name initial and as many letters of the surname as possible. Senior players ref "Sen" as team and then your initial and surname e.g. 2nd team Capt Ben Dane should ref "SenBDane" if he makes a BACS payment, or Jonny Johnson of the under 15's should ref "U15JJohnson". This will help hugely with membership administration.Declaration/ConsentMedical Treatment *I give my consentIn the event of injury / illness that may require medical treatment or use of anesthetic I agree to the Team Coach/Manager signing the necessary consent formPhotograph/Video Taking & Publication *I give my consentI confirm my consent to photographing/videoing and publication of images of my child whilst participating in rugby activityFair Play for All Code of Conduct *I agreeI have read and agree to follow the club Fair Play for All Code of Conduct Document and, if making the application for a minor, I will ensure that I draw this to the attention of my child.I certify that all the information is correct and agree to abide by the Laws of the Game, the Club & RFU rules, regulations and disciplinary requirements, which are available on the Clubs website or at www.englandrugby.com/governance *YesClub e-News Letter (Optional)I give my consent I give my consent for the club to send me "The Westcliff Word", the club e-News Letter via Mail Chimp which contains news, events, and links to sponsors websites. Mail Chimps privacy policy can be found by following the link: https://mailchimp.com/legal/privacy/ the news letter will also be published on the clubs website, and your consent can be removed at any time by selecting the Unsubscribe link on the publication, or by contacting the Clubs Data Officer.Club Lunch, Dinnner and Other Event Notifications (Optional)I give my consent I give my consent for the club to send me notifications via e-mail of planned lunches, dinners and other events Events will also be published on the clubs website, and your consent can be removed at any time by contacting a member of the Clubs Hospitality team.Signature *Clear SignatureI, 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 *FirstLastTodays Date *Captcha * = Please enter your answer in the box above. Please remember "*" is multiply and "/" is divide.Submit
