BBRFC Mini & Junior Registration 2017-18

Parent/Guardian Name ______

Postal Address ______

Post Code ______/ Home Tel No______
Mobile Tel ______/ Email ______
Parent/Guardian Membership Status / 200 Club/Main Club / Non Member

* Please consider becoming a member of Barkers Butts RFC by becoming a 200 Club member - there are many benefits of being a member, please see your Coaches/Admin person for full details.

Other Emergency Contacts

Name / Relationship to Child / Tel Number

Player Details

If the player has no previous experience then a RFU form MUST also be completed.

If the player has previously been registered with another club it would be useful to have their RFU Number.

Players aged 5 or over as of 1st September 2017. Please note special conditions for U6.

Player Name / DOB / M/F / Age Group / A.
Membership Fee
OR / B. Membership Donation / Total of
A + B
200 Club /Member / Non Member
1 / 5 / 25 / 50
2 / 5 / 15 / 50
3 / 5 / 5 / 50
4 / 5 / 0 / 50
5 / U6 / 5 / 5 / 20 / 25

I enclose cash/cheque for (Membership fee & membership donation) Total: £ ______

All fees to be paid in full by 24th Sept 2017.

Players will not be registered until payment is made.

Unregistered players may not be selected for ANYmatch or, after the date above, allowed to train.

Membership Agreement.

I wish for my son/daughter/ward to become a member of Barkers’ Butts Rugby Football Club Mini & Junior Section (BBRFC) and agree to him/her taking part in any and all of the activities that are arranged by the club.
I agree that I and my son/daughter/ward will abide by the Codes of Conduct published by Barkers Butts and note that failure to adhere to these will be dealt with as a disciplinary matter, as appropriate.

I agree that, while the club, coaches and officials will take all reasonable care of the young people, they cannot and will not be held responsible for any loss, damage or injury how-so-ever caused or suffered to or by my son/daughter/ward during a club session, match or activity, including the loss or damage to kit and equipment.

I give consent for the medical examination of my son/daughter/ward when necessary whilst he/she is participating in club activities and events, and I request that any operation or any measures considered necessary by a medical authority for his/her diagnosis and treatment shall be performed. In addition, I hereby give my permission for such an operation or other measures to be carried out in an emergency only and for the administration of local or general anesthetic if necessary.
My son/daughter may be photographed whilst taking part in club activities, training, matches club and grant BBRFC permission to use the photographic material and any other reproductions or adaptations of the photographs for the publicity and marketing of the club. I understand that BBRFC may submit photographs for newspaper, magazine and website articles without prior consent being obtained from parents/guardians. This permission granted will not interfere with any rights of the individual nor will it contravene the Data Protection Act of 1988.

Medical conditions:

Player Name / Medical condition
1
2
3
4
5

Childrenshould not be left alone during training or matches. E.g., dropping off and parent / carer going home. Barkers’ Butts RFC cannot be held responsible if a child leaves the premises or is injured. This is especially relevant in younger age groups when parents / carers should remain at pitch side at all times.
I accept the membership Agreement.

Parent Name (PRINT CLEARLY)…………………………………………………………………..…………………………….

Parent / Guardian Signature………………………………………………………………………Date:……………………….

PLEASE SIGN - Gift Aid Declaration Name of CASC: Barkers Butts RFC Ltd Details of donor: Title......

Forename(s)...... Surname......

Address......

...... Postcode(must be completed)......

Signed...... Date......

I want the club to treat all donations I make from the date of this declaration, until I notify you otherwise, as gift donations. I understand that I must pay enough UK Income or Capital Gains Tax to cover all of my charitable donations and that Council Tax & VAT do not qualify