DUNMANWAY RUGBY FOOTBALL CLUB
Mini/ Underage Membership Application Form 2017/18 to be completed by parent/guardian
PLEASE USE BLOCK CAPITALS ONLY
Name: ______
Home address: ______
Nationality: ______
Parent or guardian: ______
Date of birth: ______
Gender: ______
School attended: ______
Email: ______
Work telephone: ______Home telephone:______
Parent’s mobile: ______
Name of GP: ______GP phone: ______
Outline medical conditions we should be aware of (please outline): ______
______
I give permission for my child to be a member of Dunmanway Rugby Club and that photographs/ video may be posted on the Rugby Club website. I also agree that they will abide by the rules of the Club. I confirm that I will be available for supervision on a rota basis.
Signed:x______Date:______
If your child is not a registered member of the IRFU, we need passport photos and a copy of Birth Certificate and €5 registration fee.
Annual Membership costs €35 each. For two or more the cost is €60. Family membership is €80 cheque/cash enclosed.
Youth Officer: Kevin Murphy 023 8845401; Mobile 086 7361922 Email:
Registrar: Harry Love 086 8847716
If you have previously played for another club please name the club:______
When did you last play with the club? ______
Data Protection
It is necessary for Dunmanway (“The Club”) to collect and record certain personal data relating to each member, including the member’s name, address, telephone number and date of birth. The data about each member shall be provided to the IRFU, the relevant branch and other third parties to facilitate any services provided relating to the Irish Rugby Football Union’s Player Registration Programme Website (“the Website”) and published on the Website. It is the IRFU that that controls any data provided. The system will be used for management and administration purposes only. Any third party receiving the information shall not use it for commercial purposes or release it to any party without prior approval. The Club wishes to ensure that each of its members (for the purpose of applicable data protection legislation) explicitly and unambiguously consents to the processing of personal data by the Club in conjunction with ordinary business. Therefore, a member’s parent or guardian should confirm the following:
I consent to the use of the player’s personal details as set out above and for such purposes as the IRFU considers reasonable and appropriate (including those activities detailed above).
Each member has the right to request in writing a copy of any personal data about themselves which is held and have amended any personal data which is incorrect, incomplete or misleading.
Signed (Player): x______
Print Player Name: ______
This section must be completed if the player is 18 or under
Please return completed form with €………., a copy of your Birth Certificate and two passport-sized photographs (signed on the reverse side) to your club coach/ Youth Officer.
I ,______, confirm the above information is correct and that the above named player has permission to participate in rugby activities for the above named club.Signed(Parent/ Guardian): x______
Date: ______
Signed (Youth Co- Ordinator): ______Date: ______
Club Use Only IRFU ID Number ______
Copy of Birth Certificate Signed Photos Fee to the branch
Parental Acknowledgement
As a parent of a playing member of Dunmanway RFC (the club), I hereby acknowledge that I am aware that the club only provides insurance cover under the IRFU’s standard policy of insurance which covers only serious disabling injury. I acknowledge that I am to be responsible for the organization of insurance cover for my son/daughter ______for all other events not covered by the IRFU insurance and in particular that I am to be responsible for my son’s/daughter’s own medical, physiotherapy, hospital, dental and other expenses, howsoever arising, while my son/daughter is a playing member of the club.
Date: ______
Signed x______
Contact Details: Dunmanway Rugby Football Club, Milleenannig, Dunmanway (