ࡱ> TVS'` bjbj >L TTT8, "x"z"z"z"z"z"z"$#h[&"""x"x"t p gT \"0"&&&l0"""" dT T  PERSONAL DETAILS CHILDS SURNAME:Childs Forename(s): Date of Birth:Age on 1st Sept 2011 SCHOOL:PARENT/ GUARDIANS SURNAMETitle: (e.g. Mr, Mrs etc)Parent/ Guardians ForenameRelationship to Child: PARENT*/GUARDIAN*/OTHER Spouses/Partners Name:Parent/Guardians Address: Telephone Numbers(home): (work):(mobile) :Alternative Next of Kin (in case of emergencies):Relationship to ChildTel NoE-mail address: (we do most correspondence by email, so wed be grateful for you email address) I am happy to/ dont want to* receive further information on Bakewell Mannerians RUFC via email I attach 50 in cash/cheque* to cover my childs registration fee (Please make cheques payable to Bakewell Mannerians Rugby Union Football Club) * delete as required. MEDICAL DISCLAIMER Has your child ever suffered from an illness affecting the following? Heart, Liver, Lungs, Epilepsy, Kidneys, Blood* If Yes to any of the above please give brief details: Does your child suffer from any other Medical condition? If so, please specify: Is your child on any long term medication? (If yes please state what it is):  CHILD PROTECTION FORM Please initialI have seen a copy of Bakewell Mannerians RFC Child Protection Policy. (See website).I am happy for my child to be photographed* and named* in photographs and articles to do solely with Bakewell Mannerians RUFC Junior and Midi/Mini Section.I know that Mark Burnett is Bakewell Mannerians RUFC Child Protection Officer, and his telephone number is 07878256885.I consent to my telephone number*, email address*, and home address* to be used by club officials and club members purely for means of communication about Bakewell Mannerians RUFC and its activities. I declare that the information given above is correct and that I, and my child, will comply with the rules of Bakewell Mannerians RUFC.Signed: Date:Name:  Club Use onlyPaid: Cheque/CashRFU Form ReceivedRFU Photos Received     BAKEWELL MANNERIANS RUGBY FOOTBALL CLUB www.bakewellrugby.org.uk JUNIOR/MIDI/MINI MEMBERSHIP REGISTRATION - Season 2011/2012 Data Protection Policy We are committed to protecting your privacy and security. We will only use the information we collect about you and your child to tell you about Bakewell Mannerians RUFC, and its activities. 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