ࡱ> ceb'` bbjbjLULU 4D.?.?,3^^^^8L Dx*hZZ(aaa)))))))$+hH.v*]a*^^2*^8))V[(@(N ઑJ( )4H*0x*(T.^.(.(au Saaa**d^aaax*^^^^^^  PLAYER REGISTRATION FORM 2011 2012 SEASON Player Information First Name . Last Name School: Previous Club?......................................RFU Number Position Played?D.O.B: School Year: Y M/F. Home address:... . Post code:..Tel.No: . E-mail Contact and Medical Information To ensure the safety of players, please complete the following details. This information will be passed on to coaches as applicable. Name of Parent / Carer / Guardian: . Emergency Contact Number: Mobile Number: Alternative Emergency Contact and Number: Has the player got any medical condition that we should be aware of? Please detail: ... If yes, please detail any medication that is taken for this condition: Membership fees 2011 2012 Season 35 player membership fee (U12 and below) paid [ ] OR 40 player membership fee (U13 and above) paid [ ] 5 parent fee paid [ ] Officials name (printed) Date .. Volunteering There are some key jobs in the club which need doing on a regular basis. If every parent could consider volunteering to help out at least once a season the load could be shared out across many, thereby reducing the burden. Please indicate which of the tasks below you would be willing to do either as part of a rota or for this season: (Tick all that apply) Helping in the kitchen on Sunday mornings Running the kit shop on Sunday mornings Being a manager for one of the teams Coaching Sundays Coaching Tuesday evenings Being part of the junior committee team Updating part of the website (eg results) Writing match reports Cleaning the bar area on Sundays Cleaning the changing rooms on Sundays Child Welfare officer Help run finances Help with the membership process Helping with fixtures School liaison PR Organise a fund raising event Organise food for Sundays Organise a tour for the older age group teams EQUITY MONITORING We wish to provide equal opportunities to all, and to help us do this we need to monitor who takes part in our activities. This section is optional, but your assistance in providing the following information would help us to ensure equality in our activity. The Disability Discrimination Act 1995 defines a disabled person as anyone with a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities. * Does the player have a disability? ( Yes ( No If yes, what is the nature of the disability? ( Visual ( Hearing ( Physical ( Learning ( Other Ethnicity A White: ( British ( Irish ( Other white background (please state): B Mixed ( White & Black Caribbean ( White & Black African ( White & Asian ( Other mixed background (please state): C Asian or Asian British ( Indian ( Pakistani ( Bangladeshi ( Other Asian background (please state): D Black or Black British ( Caribbean ( African ( Other Black background (please state): E Chinese or other ethnic group ( Chinese ( Any other (please state): * Responses to these questions are classed as sensitive data, which will be used for monitoring purposes and to promote equality. We are required by law to obtain consent from you before processing and passing on such information to approved organizations. PHOTOGRAPHY CONSENT STATEMENT Note: Your childs photo will be taken at registration. The Rugby Football Union requires that we produce Photo ID cards for all junior players. I consent to my child being in photographs [ ] (Please tick) (this might include photos for the local press and club website) I do not consent to my child being in photographs [ ] (other than the required RFU photo ID card) I wish to take photographs of my child [ ] DATA PROTECTION CONSENT STATEMENT Some of the data provided by players is classed as sensitive data, which will be used for monitoring purposes and to promote equality in coaching. If it was felt that they had the ability to further their playing career their details could be passed on to clubs at higher levels, District, County, Country. We are required by law to obtain explicit consent from you before processing and passing on such information to approved organisations. Please tick this box to enable us to do this [ ] MEDICAL CONSENT STATEMENT My child is in good health and I consider him/her capable of taking part in the playing and training of the game of rugby. I have completed the medical details and consent that in the event of any illness/accident, any necessary treatment can be administered to my child, which may include the use of anaesthetics. In all cases the organiser/coach will always make every reasonable effort to contact parents in an emergency. I also understand that the organiser/coach whilst taking every precaution to ensure that accidents do not happen, cannot necessarily be held responsible for any loss, damage or injury suffered by my child. To the best of my knowledge all of the information provided on this form is correct at the time of signing. Parent/Guardians name and relationship to player. 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