ࡱ> QSP'` ~bjbjLULU 2J.?.?p 4444444n8" Hgiiiiii$0!h#h444ooo:44gogoo44o WN'@o0o$5$o$4o$>,o,$Pk5:" " " " " " H\j444444  Welwyn RFCMini / Junior Section Registration / Locum Parentis Form Please read this form carefully - This form is to be signed by the Parent or Guardian of the named child and is effective for the duration of the OPEN RUGBY SEASON ONLY. Please read all notes below before signing the form. PLAYERS FULL NAME:Date of Birth:Home Address:  Home Telephone Number:Name of Parent(s) / Guardian(s):Address of Parent / Guardian (if different from above) Telephone Number:Mobile Phone Number (s):Email Address(s): Does your child have any medical conditions / allergies / dietary problems: Date of Last Tetanus Vaccination:Name of Family Doctor:Doctors Address:  Doctors Telephone Number:School/Education Establishment:School Telephone Number: MEDICAL PERMISSION - I authorise the Club Official in charge to give medical staff permission to administer necessary treatment to the above named player, whilst representing Welwyn RFC. In the event of illness or accident requiring emergency Hospital treatment, I authorise the Club Official in charge, to sign on my behalf, any written form of consent required by the Hospital authorities, if the delay required to obtain my own signature is considered inadvisable by the Doctor / Surgeon in charge.PHOTOGRAPHY - I do/do not* give permission for the above player to be photographed in a group situation for use in in-house publications, the Club website and local media coverage (* delete as appropriate)IN THE EVENT OF CLUB/TEAM TOURS - I will inform you if the above named child has been in contact with any infectious diseases within 3 weeks of the event. If any medicine / diet are required to be taken / followed during the event, and with details of the appropriate hospital concerned if under current treatment. If He / She is required to take pills or medicine, I will hand these, clearly marked with Name, Exact dosage and specific instructions for use, to the Coach / Club Official prior to departure.DATA PROTECTION - The information above will be held for registration purposes only and will not be made available to any person outside the Rugby Football Union or Welwyn Rugby ClubHelpers - I am willing to help with: training / refereeing / cooking / transport / administration / social organisation / fund raising / general help (delete where appropriate) DECLARATION - I declare that the above is correct. In signing this form I agree that the above named player can be bound by the laws and resolutions of the Rugby Football Union and its constituent body and the rules of Welwyn Rugby Club. 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