Thornbury Rugby Club- Junior Section
Membership Application form – 2017/2018 Season
Please complete ALL pages before returning, with payment, to your Team Manager
Player 1 (JP)
Name: ……………………………………..Relevant Medical Conditions: …………………………..
DOB: …………………… Age Group: …….Date of last Tetanus Booster: ……………………………
School: ……………………………………….
Player 2 (JPA)
Name: ………………………………….Relevant Medical Conditions: ………………......
DOB: ………………… Age Group: …….Date of last Tetanus Booster: ……………………………
School: ……………………………………….
Player 3 (JPA)
Name: ……………………………………Relevant Medical Conditions: …………………………..
DOB: …………………. Age Group: ……Date of last Tetanus Booster: ……………………………
School: ………………………………………
Emergency Contact 1
Name: ………………………………………………….. Relationship to Child: …………………………………….
Address: …………………………………………………Home Tel No: …………………………………………………
………………………………………………… Mobile Tel No: ……………………………………………….
………………………………………………… Email Address: ……………………………………………….
Postcode: …………………………….
Emergency Contact 2
Name: ………………………………………………… Relationship to Child: …………………………………….
Address: …………………………………………………Home Tel No: …………………………………………………
………………………………………………… Mobile Tel No: ……………………………………………….
………………………………………………… Email Address: ……………………………………………….
Postcode: ……………………………..
Age Groups
Y1 Y2Y3Y4Y5Y6Y7Y8Y9Y10Y11
U6sU7sU8sU9sU10sU11sU12sU13sU14sU15sU16s
Membership Type (please tick all relevant boxes)
Cheques payable to Thornbury RFC Juniors.
BACS transfer information, Account name: Thornbury Rugby Football Club Junior Section,
Sort code: 55-61-38, Account number: 03245233. Please use Players full name as reference.
Payment and forms MUST be received prior to any player being eligible to play in festivals or cup matches. For returning players this payment Must be paid by 24th September
(JP) Junior Player( ) £45Cash( )
(JPA) Additional Junior Player(s)( ) £20 for eachCheque( )
(SM) Senior Member( )BACS( )
Total Membership Paid( )
Data Protection
Personal data contained in this form will be held by the Membership Secretary, The Child’s Coaches, Team Managers and the Clubs Safeguarding Officer (or nominated person) and will only be used by Thornbury RFC for memberships or health problems and/or any RFU audits
Photographs
From time to time Thornbury RFC may take photographs of the children for team pictures whilst playing rugby. These pictures will solely be for parents or publications such as programmes, website or promotional material in connection with Thornbury RFC. Names will not be used to identify individual children. Thornbury RFC are not responsible for any photography taken by person(s) not associated with the club.
If you are not happy for your child to be in photographs, please ensure the Coaches and Team Manager are aware of this so they can be excluded from photographs as far as reasonably possible.
First Aid
Occasionally players may sustain an injury which requires first aid. We have trained first aiders present at Thornbury RFC and by signing this form you agree for the necessary first aid to be provided and if considered necessary the right to call an ambulance.
It is essential that Parents update Coaches and Team Managers of any changes in medical conditions, especially any head injury that occurs outside of rugby.
Thornbury RFC are committed to player safety. All players who have sustained a head injury, regardless of whether this occurred within a game or not will need to seek medical advice and complete the Return To Play Protocol under said supervision before being allowed to play again.
Declaration
I/ we understand that Thornbury RFC have set club rules and guidelines which I/we agree to abide by. I/ we understand that Parents are responsible for their child off the field of play and within the clubhouse. It is the expectation of the Club that Parents, or a prearranged nominated adult, will bepresent at all times.
Signature of Parent: …………………………. Print Name: ………………………………. Date: ………………..