Please enable JavaScript in your browser to complete this form.Name of Young Person Touring *FirstLastDate of Birth *Does the Young Person have any condition requiring special supervision, medical treatment and/or medication? *YesNoPlease provide medical requirements *Does the Young Person have any allergies? *YesNoPlease provide allergy information *Does the Young Person have any specific dietary requirements? *YesNoPlease provide dietary requirements *Does the Young Person have any other specific requirements (e.g. religious, cultural, etc.)? *YesNoPlease provide details of other requirements *Will a parent/guardian be on tour as well? *YesNoTouring Parents/Guardians Name *FirstLastParent/Guardian Date of BirthThis is required for the DBS checking process (if applicable)Parents / Guardians Mobile Phone Number *TOURING PARENT/GUADIAN AGREEMENT• I have read, understood, and will comply with the detail stated within this document • I have read, understood, and will comply with the Policies and Procedures of Westcliff Rugby club • I have read, understood, and will comply with the Safeguarding Policies, Tour Guidance and Procedures of the RFU • I will ensure that all private and confidential information is properly protected *Yes, I agree (required)Nominated Adult In Charge of Your Child *Tour Manager (Ty Harris)Tour First Aider (Mike Gillman)OtherThe RFU requires every child who is touring without a parent to have a nominated adult who is touring in charge of that young person.Please enter the nominated adult in charge of your child *FirstLastNominated Adults Phone Number *Add others to the tour:Yes, another ChildYes, another Parent/GuardianNoCheck the box if you want to add another child or adult to the booking. Check both boxes if you want to add both.Name of 2nd Young Person Touring *FirstLastDate of Birth of Second Young Person *Does the 2nd Young Person have any condition requiring special supervision, medical treatment and/or medication? *YesNoPlease provide medical requirements for the 2nd Child *Does the 2nd Young Person have any allergies? *YesNoPlease provide allergy information for the 2nd Child *Does the 2nd Young Person have any specific dietary requirements? *YesNoPlease provide dietary requirements for the 2nd Child *Does the 2nd Young Person have any other specific requirements (e.g. religious, cultural, etc.)? *YesNoPlease provide details of other requirements of the 2nd Child *Nominated Adult In Charge of Your 2nd Child (U9s) *Tour Manager (Ty Harris)Tour First Aider (Mike Gillman)OtherThe RFU requires every child who is touring without a parent to have a nominated adult who is touring in charge of that young person.Please enter the nominated adult in charge of your 2nd Child *FirstLastNominated Adults Phone Number for 2nd Child *2nd Touring Parents/Guardians Name *FirstLast2nd Parent/Guardian Date of BirthThis is required for the DBS checking process (if applicable)2nd Parents / Guardians Mobile Phone NumberTOURING PARENT/GUADIAN AGREEMENT• I have read, understood, and will comply with the detail stated within this document • I have read, understood, and will comply with the Policies and Procedures of Westcliff Rugby club • I have read, understood, and will comply with the Safeguarding Policies, Tour Guidance and Procedures of the RFU • I will ensure that all private and confidential information is properly protected *Yes, the 2nd Touring Parent/Guadian agrees (required)Emergency Contact DetailsPrimary Emergency Contact Name *FirstLastName of who we are to call first in an emergencyEmergency Home Contact Number *Primary Home Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeSecondary Emergency Contact Name *FirstLastName of who we are to call in an emergency if we are unable to reach the primary contactSecondary Emergency Cantact Number *Declaration & ConsentGeneral Declaration• I agree to my son/daughter attending the proposed rugby tour • I consent to my son/daughter taking part in the activities indicated • I have ensured that he/she understands the importance of his complying with the rules and instructions given by the adults in charge • I accept that I may be required to bear the cost of any loss or damage that he/she causes. • I agree that photographs may/may not be taken of my son/daughter and if I agree to photographs being taken they can be used by WRFC. • I have received comprehensive details of the above tour and am aware of the RFU Policies and guidelines in relation to tours • I agree to be at the pick-up/drop off point at the agreed time • I agree that the information provided can be used for the sole purpose of delivering the tour and that it will be kept and processed in accordance with the Clubs Data Protection Policy . I understand that I have a right of access to the information, and that I have the right to withdraw my permission and my information at any time. Consent1. I confirm to the best of my knowledge that my son/daughter does not suffer from any medical condition other than those detailed. 2. I authorise a member of the Tour Management who holds a first aid qualification (or any other person equally qualified and authorized by the Tour Management) to administer emergency first aid treatment where this is necessary. 3. In the event of a serious illness or accident requiring medical treatment; (a). I agree to my son/daughter receiving treatment including surgical operation, anesthetic, or serum injection (except as detailed in "exceptions" below) as considered necessary by medical professionals; and (b). I agree to this treatment being authorised by a member of the Tour Management, who may sign any written form of consent required by hospital authorities, providing that the probable delay to obtain my signature is considered by a doctor, likely to endanger my son’s/daughter’s health or safety. 4. I understand that the Tour Management and voluntary helpers will take all reasonable care of my son/daughter but cannot necessarily be held responsible for any loss, damage or personal injury suffered by him/her. Are there any medical consent exceptions? *YesNoPlease provide any medical consent exception details *Name of Signatory *FirstLastRelationship to Young Person on form *Signature *Clear SignatureYou can either draw your signature on a touch screen device, or use your mouse by holding down the left button and drawing it that way.Date *MessageSubmit
