MINI AND Junior Club Membership Form
Aston OLD EDWARDIANS RFC, mini & junior
We are very pleased to welcome you to Aston Old Edwardians Rugby Football Club.
To ensure that we have the correct contact details for you, please insert the information requested below and return this form to myself or the coach of your age group.
If you are under 16 please also ask your parents or guardian to sign the form before it is returned.
We will also use this information to ensure that you are kept informed about club events. We will not disclose any of the information to a 3rd party other than for Rugby Football Union club player registration.
I hope you enjoy your rugby!
Paul Glenn, Youth Development Officer, Aston Old Edwardians M&J Section.
Personal details
First Name:………………… Surname: …………………. …….Date of birth: ......
Address: ......
...... Postcode: ......
Male Female Home telephone number:………………………..……………….
email: ......
In order to help the club monitor its membership can you please tick one of the following boxes to identify your ethnic group:
White: British / Mixed: White & Black Caribbean / Asian and Asian British: Indian / Black or Black British: CaribbeanWhite: Irish / Mixed: White & Black African / Asian and Asian British: Pakistan / Black or Black British: Africa
White: Other / Mixed: White & Asian / Asian and Asian British: Bangladesh / Black or Black British: Other
Chinese / Mixed: Other / Asian and Asian British: Other / Other Ethnic Group
please turn overSporting information
Playing Position ……..Unspecified Front Row Forward Back
Do you play rugby at School?...... Yes No
Please give details of school
School Address………………………………………………………………………………
………………………………………………………………………………………………...
Postcode:……………………………………Contact Number…………………………….
Rugby Teacher/ Coach……………………………………………………………………...
medical information
Please detail below any important medical information that our coaches/junior coordinator should be aware of (e.g epilepsy, asthma, diabetes, etc.)
......
PARENT / Guardian COntact details – to be completed by parent/guardian
Please insert the information below to indicate the person(s) who should be contacted in case of an incident/accident:
By returning this completed form, I agree to my son/daughter/child in my care taking part in the activities of the club, and I also confirm that I have read, understood and agree to abide by the club rules and codes of conduct as detailed in the welcome pack.
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/guardian:......
Address of parent / guardian (if different from above)
......
………………………………………………………………………………………………… Postcode………………………
Contact Telephone Number:………………………......
E-mail Address:…………………………………………………………………………….
Signature of parent/guardian: ......
Date: ......
V1.0 / Oct-08 / by / P.Glenn / approved / A.Loffman