ࡱ> g #bjbjVV ٙr<r<fffzzzzDz5B##7# C#x5z5z5z5z5z5z5$8:@5f&"|##&&55---&48fx5-&x5--V2N3#^[&V3 d5505b30;(j;33;f 4DK#$-$t%K#K#K#55,K#K#K#5&&&&;K#K#K#K#K#K#K#K#K# : SUDBURY RUGBY UNION FOOTBALL CLUB Headquarters & Playing Fields: Whittome Field, Spicer Way, Great Cornard, Sudbury, Suffolk CO10 0GB Tel: (01787) 377547 Please Complete Form in Black Ink and Block Capitals PAID: Cheque(Cash(Credit Card Team/Age Group RFU No. MEMBERSHIP MUST BE PAID AND CONFIRMED BEFORE PRACTICE OR PLAY MINIS U7 to U12s MEMBERSHIP APPLICATION FORM SEASON 2011-2012 PLAYER DETAILS Male / Female delete as appropriate 1st Name 2nd Initials Last Name DOB House Name No Street Address 2 Village Town County Post Code Tel. No: Home: Mobile: Email: Country of Birth Playing Position if known (please circle) Front Row / Forwards / Backs School Name: Please note below any medical details that the Club/hospitals should be aware of e.g. allergies, current medication, Asthma, Heart conditions etc. Players Doctor.. Tel.. Address.. Applicant Agreement I nominate Sudbury RUFC as my chosen club for all competition. I agree to abide by the rules of Sudbury Rugby Club and the decisions of the Committee. I certify that all the information provided is correct and I agree to abide by the Laws of the Game, the RFU Rules, Regulations and disciplinary requirements. I understand that I play at my own risk and that I am advised to arrange additional insurance to supplement limited cover provided by membership. I confirm that if I use multi-gym facilities I do so at my own risk and that I know of no medical reason why I should not use this apparatus. NB. Junior members under the age of 18 are not permitted to use the gym without the supervision of a suitably qualified adult. Signed: (Applicant the Player) ................................. Date: PARENT/GUARDIAN/N.O.K. DETAILS 1st N.O.K. 2nd N.O.K. Full Name: Full Name: Relationship to Player: Relationship to Player: Home Tel. No: Home Tel: No: Mobile Tel. No: Mobile Tel. No: Email: Email: Parental Consent I hereby consent to my son/daughter playing for Sudbury RUFC and confirm that, in the unlikely event of him/her needing emergency treatment, the Team Manager is empowered to act on my behalf. I include mobile telephone number/s above (if available) in order to be contacted in an emergency. I certify that all the information provided is correct and I agree to abide by the Laws of the Game, the RFU Rules, Regulations and disciplinary requirements. Signed: (Parent/Guardian) Date: FEES: - 50 per annum for U7 to U12 Please tick If you do not give photographic permission PLEASE RETURN WITH THE PAYMENT TO your Team Manager: or Roger Steed, Membership Secretary Wu Li Christopher Lane Sudbury Suffolk CO10 2AS, OR post in Membership Box in Clubhouse Please Make Cheques Payable to Sudbury Rugby Club PLEASE TURN OVER Data Protection Act The RFU and your club will use the data provided in your Registration Form for the purposes of administering the player registration system in accordance with the Registration of Players Regulations and Operating Procedures and for the purposes administering your participation in rugby and giving you information about rugby. IMPORTANT INFORMATION Registration Regulation 12.1 states that 1) supplying misleading, false or incorrect information or data to the Registrar or the RFU in any application to register a Player or 2) where any signature on the Registration Form or other document is not the original signature of the person purported to have signed it, the application for registration will be void and any Effective Registration will be invalidated from the date such Effective Registration would (but for the incorrect, false or misleading information or forged signature), have commenced. Where the system does not allow a registration to be completed and directs the user to send all documentation to the Registrar the registration process will not commence until the Registrar receives all of the correct documentation. All information entered is subject to the Data Protection Act Sports Equity Monitoring Whilst it is not compulsory that this section is completed the following paragraph explains why it is important. Sport can and does play a major role in promoting the inclusion of all groups in society. However, inequalities have traditionally existed within sport, particularly in relation to gender, race and disability. Sport England is committed to promoting and developing sports equity, which is about fairness in sport, equality of access, recognising inequalities and taking steps to address them. By monitoring the profile of young people in sports clubs, national governing bodies of sport and Sport England can identify any issues relating to under-representation of different groups and can together develop strategies to ensure that all young people have the opportunity in the future to develop and progress in sport. Ethnicity In order to help the club monitor its membership can you please tick one of the following boxes to identify your ethnic group/origin: Choose one section from A to E and then tick the appropriate box. A White  FORMCHECKBOX  British  FORMCHECKBOX  Irish  FORMCHECKBOX  Any other white background (please specify): B Mixed  FORMCHECKBOX  White & Black Caribbean  FORMCHECKBOX  White & Black African  FORMCHECKBOX  White & Asian  FORMCHECKBOX  Any other mixed background (please specify): C Asian or Asian British  FORMCHECKBOX  Indian  FORMCHECKBOX  Pakistani  FORMCHECKBOX  Bangladeshi  FORMCHECKBOX  Any other Asian background (please specify): D Black or Black British  FORMCHECKBOX  Caribbean  FORMCHECKBOX  African  FORMCHECKBOX  Any other Black background (please specify): E Chinese or other ethnic group  FORMCHECKBOX  Chinese  FORMCHECKBOX  Any other (please specify): Disability The Disability Discrimination Act 1995 defines a disabled person as anyone with a physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities. Do you consider yourself to have a disability?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, what is the nature of your disability?  FORMCHECKBOX  Visual impairment  FORMCHECKBOX  Hearing impairment  FORMCHECKBOX  Physical disability  FORMCHECKBOX  Learning disability  FORMCHECKBOX  multiple disability  FORMCHECKBOX  Other (please specify): Sporting information Have you played Rugby Union Football before?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, where have you played the sport: (please indicate below)  FORMCHECKBOX  Primary school  FORMCHECKBOX  Secondary school  FORMCHECKBOX  Local authority coaching session (s)  FORMCHECKBOX  Club  FORMCHECKBOX  County  FORMCHECKBOX  Other (please specify): PARENTS SKILLS RUGBY AND OTHER PLEASE STATE (for club knowledge base)   #$CKS]ſſŶŪtVHhoZh5OJQJaJ;jhNhN5CJ OJQJUaJ mHnHsH tHuhqh5CJaJhqhmm5CJaJhmm5CJaJho5CJaJhqhq5CJaJ hCJ hmmCJhhmmCJ hd/nCJhhCJh?j5CJaJh=55CJaJhF-Oh?j5CJaJ%jh?*{5CJUaJmHnHu$ X   r`  )+dhgd7' / 9!)dhgd7' Hgdp&( $da$gd# 9r J gdp&(: !9r S3j )$d%d&d'd1$NOPQgd%`#1$gdq #$1$a$gd $da$gdkY      W X Z [ ^ _ ` ннukbYPYD;hq5CJ aJ hqh?j5CJ aJ hY5CJ aJ htb5CJ aJ hp&(5CJaJhFhp&(5CJh%`OJQJaJhoZhOJQJaJho5OJQJaJhN5OJQJaJhp&(5CJ OJQJaJ hNhN5OJQJaJ% johoZh5CJ OJQJaJ hoZh5OJQJaJhp&(5OJQJaJhHL25OJQJaJh5OJQJaJ` a g h k        ' 0 ᾰ{sgs{Vs{{ hxhh?j5B*CJ aJ phh"#h"#CJH*aJh"#CJaJhF-Oh?\oCJaJhF-Oh?jCJaJhWKhp&(CJaJhWK5CJaJhmm5>*CJaJh7'hmm5>*CJaJh7'hp&(5>*CJaJhvg5CJ aJ hqhG|5CJ aJ hqh?j5CJ aJ hq5CJ aJ htb5CJ aJ  1 H ` y b  {i & F 9r 1$^gdF  9r 1$gdX )L,dh]gd7' 9r )dh1$gdHL2 J &B)L,dhgd7' &)dhgd7' })+dhgd7' )L,dhgd7'  ),dhgd7' 0 1 5 6 < = F G H _ ` g w x y ` a b i ĹıtghF-OhEMCJOJQJhF-OhEM5CJOJQJhF-OhCJaJhCJaJ hoZCJhF-OhoZCJhF-OhoZCJOJQJhEMCJaJhF-OhEMCJaJhoZCJaJh"#CJaJhF-Oh1CJaJhF-Oh?jCJaJhF-Oh?\oCJaJhF-OhvUCJaJ$ j )Assssss })dh]gduH j dhgduH $dha$gd7'dh&dPgd7' 9r }(dh1$gd7' & F 9r 1$^gdI & F 9r 1$^gdF & F[$\$^gdF i j  ),-OPԸԪ{mbMb{ChxhCJOJQJ(h-hxh5B*CJOJQJaJphhxh5CJOJQJhehxh5CJOJQJhF-OhxhCJOJQJhxhhxhCJOJQJ(h-hEM5B*CJOJQJaJphhxhhEM5OJQJaJhxhhEM5CJOJQJhF-OhEM5CJOJQJhF-OhEMCJOJQJ)hl[hFB*CJOJQJ^JaJphhFCJOJQJ !(){q\J{q#h^6B*CJOJQJ^JaJph)hl[h^6B*CJOJQJ^JaJphhbCJOJQJhF-OhbCJOJQJhF-Ohb5CJOJQJhuHhuHCJaJhuHhuHCJH*aJhuHCJaJh15>*CJaJh7'h?j5>*CJaJh$5>*CJaJh7'h5>*CJaJh7'h95>*CJaJhF-OhEMCJaJ$  [$\$gdl[ $ 9r 1$a$gdl[  9r 1$gd@'* 9r }(1$gdl[ 9r  ,dh1$gd4 9r }(dh1$gdl[ [$\$gd^6  9r 1$gdl[  9r 1$gduH #$+2CEWX[\|qcXIXIXIXh@'*5OJQJaJmH sH h=55OJQJaJhF-Oh95OJQJaJh`W5OJQJaJh A.5OJQJaJhq5OJQJaJhS/5OJQJaJhoZh5OJQJaJh)5OJQJaJh)5OJQJaJhoZh`W5OJQJaJh5OJQJaJhoZhmm5OJQJaJ-jh A.5OJQJUaJmHnHtH u\gis} 5波ugaS@0hl[CJOJQJ^JnH tH $h>hl[CJOJQJ^JnH tH hl[hl[5OJQJaJ hoZCJh`Wh`W5CJOJQJh@'*5CJOJQJmH sH  *h0hO45CJOJQJ *h0hO4CJOJQJ h@'*h@'*CJOJQJmH sH hO4CJOJQJmH sH h@'*CJOJQJmH sH hmECJOJQJhO4hO4CJOJQJhO4h=5CJOJQJhChCOJQJaJ  67^_`yҔtgt\P\A\jhF-OhCh[CJUaJhF-OhF-O5CJaJhF-OhF-OCJaJhF-OhF-OCJ^JaJ!hF-OhF-OB*CJ^JaJphhF-OhF-OCJOJQJaJhoZCJOJQJaJ$hohl[5B*CJ^JaJphhl[B*CJ^JaJph!hl[hl[B*CJ^JaJph)hl[hl[B*CJOJQJ^JaJph/hl[hl[5B*CJOJQJ\^JaJph 67 ^_`yJ OJ gdF-OgdF-OgdF-O $a$gdF-O &dP[$\$gdl[ & F Sd^`gdl[ & F Vd^`Vgdl[ 9:HIJ`abpqrӹӧӟӍ{saYhYCJaJ#jDhF-OhCh[CJUaJhhCJaJ#jhF-OhCh[CJUaJ#j\hF-OhCh[CJUaJhCJaJ#jhF-OhCh[CJUaJhF-OCJaJ#jthF-OhCh[CJUaJhF-OhF-OCJaJjhF-OhCh[CJUaJ#jhF-OhCh[CJUaJ"mfqZ zsgdF-OgdF-O OJ (gd j (gd f(gd Oj (,h-gdY Oj F](h-gd OJ gdF-O OJ (gd  ,-.<=>klno|j#jhF-OhCh[CJUaJ#jhF-OhCh[CJUaJ#jhF-OhCh[CJUaJ#jhF-OhCh[CJUaJ#j,hF-OhCh[CJUaJhF-OCJaJhCJaJjhF-OhCh[CJUaJ#jhF-OhCh[CJUaJhF-OhF-OCJaJ(,-.678FGHdepq ӹӱӟӍӱӁochF-OhF-OCJ\aJ#j@hF-OhCh[CJUaJhF-OhF-O5CJaJ#jhF-OhCh[CJUaJ#jXhF-OhCh[CJUaJhCJaJ#jhF-OhCh[CJUaJhF-OCJaJhF-OhF-OCJaJjhF-OhCh[CJUaJ#jphF-OhCh[CJUaJ" ! ! !!!!/!0!1!?!@!A!V!W!e!f!g!{!|!}!!ø}kY#j hF-OhCh[CJUaJ#j hF-OhCh[CJUaJ#jhF-OhCh[CJUaJhhCJaJ#j(hF-OhCh[CJUaJjhF-OhCh[CJUaJhF-OhF-OCJaJhF-OhF-O5CJaJ&jhF-OhCh[CJU\aJhF-OhF-OCJ\aJ jhF-OhCh[CJU\aJ Z !!!="~")#T#U###wl  9r 1$gdh  9r 1$gdv 9r &d1$PgdoZ# 9r YdgdgdF-O \ gdF-OgdF-O (gd dgd S&B*gdF-O S\ b9!*gdF-O !!!!!!!!!!!!!!!!!!"""" 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