Players Membership Form

Players Name *

First

Last

Section/Team *

Telephone Number *

Email *

Date of Birth (dd/mm/yyyy) *

Preferred Possition

School, if applicable *

Does the Player have a Medical/Health Condition *

Yes
No

Please give details of the Medical/Health Condition *

Add Another Player

Tick Yes to add

Name of Second Player *

First

Last

Section/Team of Second Player

Email of Second Player *

Telephone Number of Second Player *

Date of Birth of Second Player *

Player 2 Preferred Possition

School of Second Player, if applicable *

Does the Second Player have a Medical/Health Condition *

Yes
No

Please give details of the Medical/Health Condition of the Second Player *

Add a Third Player

Tick Yes to add

Name of Third Player *

First

Last

Section/Team of Third Player *

Email of Third Player *

Telephone Number of Third Player *

Date of Birth of Third Player *

Player 3 Preferred Possition

School of Third Player, if applicable *

Does the Third Player have a Medical/Health Condition *

Yes
No

Please give details of the Medical/Health Condition of Third Player *

Parent/Guardian and Next of Kin Information

Parent/Guardians Name/Next of Kin *

First

Last

Phone *

Email *

Second Contact (Youth & Minis Only)

Second Parent/Guardian Name

First

Last

Secondary Phone

Secondary Email

Address

Primary Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Membership Subs

Select Membership Required *

Subs are due by the 2nd September.

Donation & Gift Aid (Optional)

The Club has decided that Lion Cub membership is free of charge, however if you wish to make a donation to the Club Legacy Fund and claim Gift Aid, you can do so below:

Make a Legacy Fund Donation *

The Clubs current fund raising drive is for the Legacy Fund. The fund will be used to provide security for future rugby player generations by extending the lease of the rugby club grounds and facilities. The current lease runs out in 2045 and we wish to extend this to 2075

Your Donation (£): *

Total to Pay

£ 0.00

Community Amateur Sports Club (CASC) Gift Aid for Westcliff Rugby Football Club Limited (Optional)

Yes, I want to Gift Aid my donation
No, thank you

If eligible, Gift Aid can boost your donation by 25p for every £1 donated.

Gift Aid Eligability & Commitment *

Yes, 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

Higher 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 Limited

Please 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 *

Cash (past to your Team Manager)
Cheque (Made Payable to Westcliff Rugby Football Club Ltd and passed to your Team Manager)
BACS Bank Transfer: Sort code 30-94-26 and Account: 00026636
Other (e.g. Authorised Concession)

Please write the names & teams of players on the reverse side of cheques used to make payments.

Payment Type *

Cash (past to your Team Manager)
Cheque (Made Payable to Westcliff Rugby Football Club Ltd and passed to your Team Manager)
BACS Bank Transfer: Sort code 30-94-26 and Account: 00026636
Standing Order (Forms can be found on https://westcliffrfc.co.uk/documents-and-forms/ )
Other (e.g. Authorised Concession)

Please write the names & teams of players on the reverse side of cheques used to make payments. 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 of Consent

Medical Treatment *

I give my consent

In 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 form

Photograph/Video Taking & Publication *

I give my consent

I confirm my consent to photographing/videoing and publication of images of my child whilst participating in rugby activity

Fair Play for All Code of Conduct *

I agree

I 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.

Club 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 *

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.

Todays Date *

Captcha *

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