BracknellRugby Football Club

FOUNDED 1955

“In Pursuit of Excellence”

CLUBHOUSE AND GROUNDS

LilyHillPark, Lily Hill Drive, Bracknell, Berkshire. RG12 2UG

WEBSITE:

TEL: 01344 424013 FAX: 01344 485268

APPLICATION FOR MEMBERSHIP FOR THE SEASON 2006/2007

I hereby apply for membership / to renew my membership of Bracknell Rugby Football Club.

I confirm that I have no outstanding obligations to any other club and I am not subject to any disciplinary action.

I, and any other persons named in this application, agree to abide by the Constitution and Rules and Regulations of Bracknell RFC as posted in the Clubhouse.

I, and any other persons named in this application, understand that the Club and its servants and agents are not under any obligation whatsoever for loss of property, accidents or injuries, of or to members or their guests, however caused, while at Bracknell RFC or at any other ground for any purpose.

I note that the club holds basic accident insurance cover in respect to all playing members, including Juniors / Minis. Details of cover held are available from the Secretary. Members are advised, by the Management Committee, that more comprehensive insurance is at their discretion and is their own responsibility.

Please complete the relevant parts of the form below, using CAPITALS

We are very pleased to welcome you to Bracknell RFC.To ensure that we have the correct contact details for you, please insert the information requested below and return this form to your age group manager. If you are under 16 please also ask your parents or guardian to sign this form before it is returned.We will also use this information to ensure that you are kept informed about club events.

Personal details (Player) EACH child has to complete a SEPARATE registration form

Name: Names of Younger Siblings if Oldest Child:

Address:

Postcode:

Home telephone number:

Mobile: email:

Date of birth: Gender: Male  Female 

Sports equity monitoring

Whilst it is not compulsory that this section is completed the following paragraph explains why it is important.

Sport can and does play a major role in promoting the inclusion of all groups in society. However, inequalities have traditionally existed within sport, particularly in relation to gender, race and disability. Sport England is committed to promoting and developing sports equity, which is about fairness in sport, equality of access, recognising inequalities and taking steps to address them. By monitoring the profile of young people in sports clubs, national governing bodies of sport and Sport England can identify any issues relating to under-representation of different groups and can together develop strategies to ensure that all young people have the opportunity in the future to develop and progress in sport.

Ethnicity

In order to help the club monitor its membership please tick one of the following boxes to identify your ethnic group/origin.

Choose one section from A to E and then tick the appropriate box.

AWhite

English Scots Welsh Irish

Any other white background (please specify):

BMixed

White & Black Caribbean White & Black African

White & Asian

Any other mixed background (please specify): ______

CAsian or Asian British

Indian Pakistani Bangladeshi

Any other Asian background (please specify): ______

DBlack or Black British

Caribbean African

Any other Black background (please specify):______

E Chinese or other ethnic group

Chinese

Any other (please specify):______

Disability

The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities’.

Do you consider yourself to have a disability? Yes No

If yes, what is the nature of your disability?

Visual impairment

Hearing impairment

Physical disability

Learning disability

Multiple disabilities

Other(please specify):

Sporting information

Have you played Rugby before? Yes No

If yes, where have you played the sport?: (please indicate below)

Primary school

Secondary school

Local authority coaching session (s)

Club

County

Other (please specify):

Medical information

Please detail below any important medical information that our coaches/junior coordinator should be aware of.

(For Example, Epilepsy, Asthma, Diabetes, etc.)

Emergency contact details

To be completed by parent/carer.

Please insert the information below to indicate the person(s) who should be contacted in case of an incident/accident:

Contact name (e.g. parent/carer):______

Emergency contact number:______

By returning this completed form, I agree to my son/daughter/child in my care taking part in the activities of the club.I understand that I will be kept informed of these activities – for example timing and transport details.I understand that in the event of any injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately.

Name of parent/carer:

Signature of parent/carer:

Date:

Membership Details

TYPE OF MEMBERSHIP / ANNUAL
SUBSCRIPTION
(2006/2007) / 
TYPE
REQUIRED / NOTES
Social Member / £20 / Non-playing member.
Senior Playing Member / £65 / Players over the age of 18 on 1st September 2006 (not Students)
Family Member / £70 / Family membership includes spouse/partner of the Ordinary Member, plus all their children aged under 19 on 1 September 2006. Children within this membership may play mini, junior or senior rugby. PLEASE INCLUDE 3 PASSPORT PHOTOS OF THE CHILDREN.
Junior Member under 19 years / £40 / Must be aged under 19 on 1st September 2006. Please note that this type of membership is for the Junior Member only. Includes Mini, Junior or Senior rugby where Family Membership is not required. PLEASE INCLUDE 3 PASSPORT PHOTOS.
Colt Member / £40 / May be playing or non-playing. Players over the age of 18 on 1st September 2006 must be Ordinary Members.
Student Member / £40 / May be playing or non-playing. Players over the age of 18 on 1st September 2006 must be Ordinary Members.. Must show Student Card.
Vice President / £60 / For those who wish to be associated and legible for International ticket allocation. Does not include spouse or partner.
I agree to this information being held on a computerised database and to be used only for the purposes of Bracknell RFC / Please return completed form/photo’s with remittance to
aNDY cROY
c/o BracknellRugby Football Club
LilyHillPark
I enclose cheque/cash for the total amount of £ / Lily Hill Drive
(cheques payable to BRACKNELL RFC MINIS AND JUNIORS) / Bracknell
Berkshire. RG12 2UG
SIGNATURE DATE: / Tel No. 01344 424013
The Club is always looking for extra volunteers to support Club activities. Please any of the following areas where you would be willing to help.
Sponsorship / Hospitality for Visiting Teams
Bar duties / Match Day duties
Social Events / Publicity & Programme
Admin and Finance roles
Total amount enclosed: £______
Signed: ______/ Age Group paid for Family Membership: ______
Date:______
For Office Use Only
Received £ ______Cash/Cheque / Date:______