ࡱ> _a^  bjbjVV R<<*VV8dI4C2$}((((1111111g4 7B1!J+& (J+J+11f0f0f0J+ p1f0J+1f0f0 f0uZV,$f0120C2f0K7z-K7f0K7f0`(hR)Jf0)<)r(((11f0(((C2J+J+J+J+K7(((((((((V _: MEMBERSHIP APPLICATION FORM 2011-2012 Date: Name: Address:.. .. Post Code: Telephone no:.. Mobile no: Email address:........................................ D.O.B (Players Only). ................... Level of Membership: Life Membership (LM) 500.00 Member (CM) 30.00 Vice President (VP) 50.00 Student Member (SM) 20.00 Playing Member (PM) 40.00 I enclose a cheque / cash* to the value of __________. [Please make all cheques payable to Skipton R.F.C] or I have made a bank transfer / standing order payment* to the value of __________ with the following reference:_______________________________. MINI & JUNIOR SECTION Mini & Junior Member (JPM) 40.00 Players Name & D.O.B:....... (1 Parent/ 1 Child) School & RFU No: ..........................................................................  Family Member (FM) 65.00 Players Name & D.O.B:.. (2 Parents/ 2 Children) School & RFU No: ..........................................................................  Family Member (LFM) 85.00 Players Name & D.O.B:.. (2 Parents/ 3 Children) School & RFU No: .......................................................................... (only players under 17 years) Please complete and return this form to: By Post: Skipton RFC c/o WBW, Skipton Auction Mart, Gargrave Road, Skipton BD23 1UD; or By Hand: Skipton RFC, Sandylands, Skipton, North Yorkshire, BD23 2AZ. Membership Secretaries: General - Adam Winthrop -  HYPERLINK "mailto:adam@wbwsurveyors.co.uk" adam@wbwsurveyors.co.uk or 07885 243390 Players - Chris Sheehan  HYPERLINK "mailto:chris_sheehan@hotmail.co.uk" chris_sheehan@hotmail.co.uk or 07739 020532 FOR MINI & JUNIOR SECTION ONLY  Please detail any medical conditions the coach should be aware of .. Age Group (2011/12) U16s ( U15s ( U14s ( U13s ( U12s ( U11s ( U10s ( U9s ( U8s ( U7s ( U6s (  Name of Parents/Guardians: Who is the main contact person? Father? Mother? Other? ................... Father Mobile Phone No: Mother .. Mobile Phone No: Other Emergency Contact Name & Phone: .. E-mail Address ..... Preferred Method Of Contact Have you any knowledge of Rugby Yes / No If yes in what capacity ........................................... Are you available for limited volunteer activities? Yes / No Are you a qualified First Aider? Yes / No  I declare the given information to be true and confirm that I have read the conditions of membership on the following form i I agree to indemnify Skipton RFC its servants, agents and employees from and against all liability for loss of property, accidents or injuries howsoever caused and wheresoever arising involving the player while attending coaching sessions, training games and/or competitive matches, whether at Skipton or any other ground where the player is a representative of SRFC Junior Section or Colts. ii Photography I understand that images taken by SRFC officials may be used for publicity/coaching purposes (including publication on the club web site, local newspapers, etc). If you do not wish your child to be included on these please tick the box iii Travel I give permission for my child to travel with a SRFC representative I understand that I remain responsible for their behaviour. Data Protection Act The information contained above will be held for registration and membership purposes only and will not be made available to any person or organisations outside Skipton RFC, the Rugby Football Union and its constituent bodies, unless consent is given below. Members wishing to verify their computer details should contact the Membership Secretary.  Tick here if you would not like to receive mail from our sponsors or 3rd parties NOTE By signing this declaration I confirm my agreement to the above. Signed Parent/Guardian* ..Player      PAGE \* MERGEFORMAT 1 SKIPTON RUGBY FOOTBALL CLUB  Medical Consent Details: I agree that if my child urgently requires medical treatment during a Skipton RFC activity and it is not possible to contact me or my Childs other parent/guardian, the person in charge of the party is authorised to give consent on my behalf. 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