Player First Names

Address

Second Contact Number

Player Surname

Team to be registered with Team to be registered withU6 School Year 1U7 (Dave Garbutt) School Year 2U8 (Phil Wood) School Year 3U9 (Richard Turner) School Year 4U10 (Mick Coult) School Year 5U11 (Carl Duffin) School Year 6U12 (Gav Drewry) School Year 7U13 (Ian Lee) School Year 8U14 (Jonathan Clark) School Year 9U15 (Kirk Murray) School Year 10U16 (Dave Oldridge) School Year 11Girls U12 - U18 (Trisa Roberts, Becky Clarke) School Years 7 - 11+

I will provide the club with a photograph (taken on mobile is fine) for age groups U7, U13 boys, U13 Girls I will provide the club with a photograph (taken on mobile is fine) for age groups U7, U13 boys, U13 Girls Yes

Player Date of Birth (DD/MM/YYYY)

Email Address for club correspondence

Please outline any medical conditions that require medication

Kit Size Kit Size2 Years4 Years6 Years8 Years10 Years12 Years14 YearsXSSMLXL2XL3XL4XL5XL

Main contact telephone number for all club related correspondence

Please indicate how you intend to pay the subscription fees, club preference is by bank transfer but cash and cheque also ok. If paying by online banking please put the PLAYERS NAME AND AGE GROUP as reference, account details are: Name: Scunthorpe Mini Rugby Section Acc No: 30048977, Sort code: 05-07-57. Cheques should be made payable to 'Scunthorpe Mini Rugby' Please indicate how you intend to pay the subscription fees, club preference is by bank transfer but cash and cheque also ok. If paying by online banking please put the PLAYERS NAME AND AGE GROUP as reference, account details are: Name: Scunthorpe Mini Rugby Section Acc No: 30048977, Sort code: 05-07-57. Cheques should be made payable to 'Scunthorpe Mini Rugby' Pay online Cash handed to team manager Cheque

Please outline any special dietary requirements

Emergency Contact 1 Main Phone Number

Emergency Contact 1 Name

Emergency Contact 1 Second Phone Number

Relationship to child Relationship to child Parent Carer Person with parental responsibility Other

Emergency Contact 2 Name

Emergency Contact 2 Main Phone Number

Emergency Contact 2 Second Phone Number

Relationship to child Relationship to child Parent Carer Person with parental responsibility Other

Name of Doctor/Practice (For medical purposes)

Telephone

Address

Parent/Carer Consent Parent/Carer Consent I agree to my child’s participation in Rugby activities and I acknowledge the need for my child to behave responsibly and sensibly at all times. In respect of all Children under the age of 12, I confirm that myself or a duly authorised person will be present throughout any Rugby activities and my child not left unattended. All kit and equipment remains the property of Scunthope Mini Juniors unless otherwise stated and is chargeable if not returned. It is my responsibility to ensure that the Manager of my child’s team is fully aware of my child’s medical condition (e.g. asthma) or any allergies they may have, and has been, if necessary shown how to administer any medication. I/We consent to the Manager seeking the assistance of a Medical Practioner in the case of an emergency involving my child. N.B This is not consent for any treatment. Opportunities may occur where your child may be photographed or videoed i.e. for local press, for SRUFC mini junior social media pages, publicity for SRUFC mini juniors or by other teams. Please give consent for photographs & videos being taken. I confirm that I have read and accept the clubs Codes of Conduct for parents and young persons

*IMPORTANT INFORMATION* PLEASE READ & TICK TO CONFIRM YOU'VE UNDERSTOOD *IMPORTANT INFORMATION* PLEASE READ & TICK TO CONFIRM YOU'VE UNDERSTOOD Scunthorpe R.U.F.C. & it’s officials are not under any liability whatsoever for the loss of property, accidents or injuries howsoever caused during the course of training, preparation or matches played at Scunthorpe R.U.F.C. or other grounds. Registered playing members of Scunthorpe R.U.F.C. are covered by insurance against death or disablement as laid down in the Rugby Union Guidelines. Parents/Guardians are advised that any additional insurance is their responsibility. Injuries are rare but, I Agree to my child being treated by any qualified firstaider provided by Scunthorpe R.U.F.C. or opposing club should an injury occur & to my child being transported to a hospital should this be considered necessary. I understand that Scunthorpe R.U.F.C. will notify me as soon as practicable. We abide by England Rugby Headcase rules and if Concussion is suspected you must inform the childs school and G.P as a matter of urgency. Further Information can be found on the England Rugby website. All officials, Coaches, managers and First Aiders will hold a current and valid DBS. Parents/Guardians, Spectators & Players agree to abide by the RFU Codes of Conduct (These can be found on the notice board outside the Changing Rooms & on the RFU website www.rfu.com) and by the rules of Scunthorpe R.U.F.C. and Heslam Park Club (These can be found in the Green Book and Mini Junior booklet). Data protection: Parents/Guardians please note your privacy and the security of your personal information is always at the forefront of SRUFC. As a result, and as required by GDPR, we will make it easier for you to find out how we use your information. We collect and process personal data from you or your child when you join and when we carry out annual renewals of your membership, for the purpose of advertising club activities and promotions and we will share some of your data with the RFU. Please read the new Privacy Notice so you are fully aware of your rights and how we use your personal information. You can access the Privacy Notice detail via the RFU website www.englandrugby.com All players are registered with RFU

*CODE OF CONDUCT* PLEASE READ & TICK TO CONFIRM YOU'VE UNDERSTOOD *CODE OF CONDUCT* PLEASE READ & TICK TO CONFIRM YOU'VE UNDERSTOOD Please read and fill in the Code of Conduct, then check this checkbox to continue. || Code of Conduct