Players Membership & Registration Form

Players Name *

First

Last

Section/Team *

Date of Birth (dd/mm/yyyy) *

Does the Player have a Medical/Health Condition *

Yes
No

Please give details of the Medical/Health Condition *

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

Yes
No

If you have submitted a form before you have already agreed to the RFU & Clubs Policies and Procedures.

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? *

Yes
No

If 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 *

Yes
No

School/College *

Players Email *

Players Telephone Number *

Welcome to Westcliff Rugby Football Club. Please select your registration type: *

Sex *

Prefered Playing Position *

Town of Birth *

Country of Birth *

Nationality *

Ethnic Origin *

Previous Club *

Date of leaving previous club *

Union (e.g. English, Scottish, etc) *

Were you contracted or registered at your previous club *

Contracted
Registered Player

Contracted players must provide contract details and evidence of release to the Registrar

Add Another Player

Tick Yes to add

Name of Second Player *

First

Last

Section/Team of Second Player *

Date of Birth of Second Player *

Does the Second Player have a Medical/Health Condition *

Yes
No

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

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

Yes
No

If you have submitted a form before you have already agreed to the RFU & Clubs Policies and Procedures.

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 *

Yes
No

If 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 *

Yes
No

If 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: *

Sex of Second Player *

Second Player Prefered Playing Position *

Town of Birth of Second Player *

Country of Birth of Second Player *

Nationality of the Second Player *

Ethnic Origin of Second Player *

Previous 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 *

Contracted
Registered Player

Contracted players must provide contract details and evidence of release to the Registrar

Add a Third Player

Tick Yes to add

Name of Third Player *

First

Last

Section/Team of Third Player *

Date of Birth of Third Player *

Does the Third Player have a Medical/Health Condition *

Yes
No

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

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

Yes
No

If you have submitted a form before you have already agreed to the RFU & Clubs Policies and Procedures.

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 *

Yes
No

If 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 *

Yes
No

If 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 *

Preferred Possition of Third Player *

Welcome to Westcliff Rugby Football Club. Please select the Third Players registration type: *

Town of Birth of Third Player *

Country of Birth of Third Player *

Nationality of the Third Player *

Ethnic Origin of Third Player *

Previous 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 *

Contracted
Registered Player

Contracted players must provide contract details and evidence of release to the Registrar

Home Address

Since last years on-line submission has the primary address changed for the player/players *

Yes
No

Primary Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Parent/Guardian and Next of Kin Information

Parent/Guardians Name or Next of Kin *

First

Last

Phone *

Email *

Since last years on-line submission has the secondary contact details changed for the player/players *

Yes
No
Don't know

Secondary Emergency Contact Name *

First

Last

Secondary Phone *

Secondary 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 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

Make a Legacy Fund Donation *

Your Donation (£): *

Total to Pay

£ 0.00

Community Amateur Sports Club (CASC) Gift Aid for Westcliff Rugby Football Club Limited (Optional). Do you wish to Gift Aid your donation *

Yes
No

If 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 *

Yes

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

Yes

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
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

Payment Type *

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 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.

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 *

Yes

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 *

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.)

Captcha *

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