Staffordshire Rugby

Girls U15 & U18 Girls Trials

Burntwood RFC (WS7 3PH)

Sunday 2nd October 2016 1.00pm – 4.00pm

Welcome to the 2016 girl’s county season, please find below the application form that needs to be completed and submitted prior to the trial. This is best handed in on the day, to myself, Mark Tolley the County Manager.

Please complete all details as fully as possible. All contact details must for the person that has parental responsibilities, by all means add more than one contact email. All information distribution will come via email, so please use one that is checked regularly.

We do need one passport size photo, a recent small photograph will suffice. It is also essential that all participants remember to bring, Gum shield, Water bottle and both boots and trainers. Club training/playing kit is the preferred attire.

For those that have not participated in program before, welcome. The county program is the first stage of the player pathway. It is a short program made up off, a trial (2nd October 2016) a training day (16th October 2016) and three matches (details on the registration form). From these games we then nominate those that are ready for Midlands trials.

Format for the day

1.00pm Arrive and registration

1.15pm Welcome and Briefing

1.30pm Trials Start

4.00pm Trials finish

If you have any questions prior to the trials, please feel free to get in touch.

Mark Tolley - U15/U18 County Manager

07970 217208

Rugby Football Union

Staffordshire County Selection Form 2016 Season.

This form should be completed for all players wishing to be put forward for selection for theStaffordshire County Squad.

Please complete each section in BLOCK CAPITALS and returned to the address below or via your club coach. A passport size photograph must be attached to every application:

Surname: ______

First Name: ______

Name of Club: ______

Age: ______: Age Group; U15’s, U18’s (delete)

Date of Birth: ______

Home Address: ______

______: Post Code: ______

Home No: ______Parent Mobile: ______

Parent Contact E-Mail Address: ______

Name of School/College: ______

Medical Consent

Medical Conditions/Allergies ______

I give my consent that in an emergency situation, SRU Coaches and Staff may act in loco parentis, if the need arises for the administration of emergency first aid. I also understand that in such an occurrence that all reasonable steps will be taken to contact me or the alternative adult who I have named on the registration form.

I confirm that to the best of my knowledge, my child does not suffer from any medical condition other than those detailed by me on the registration form.

Signature of Player: ______Date: ______

Signature of Parent: ______Date: ______

PHOTOGRAPHIC CONSENT

During the course of the rugby programme a variety of photographs will be taken and used for promotional purposes by Staffordshire Rugby Union.

I confirm that I will allow my daughters photograph to be used in the promotion of the development of Girls Rugby.

Signature of Player: ______Date: ______

Signature of Parent: ______Date: ______

______

Representative Playing History: (please give date etc using separate sheet if needed)
Playing Position: (please Circle)Front Row Forwards Backs Unspecified
Please Delete Prop Lock Scrum Half
Hooker Flanker Fly Half
No8 Centre
Wing
Full Back

Dates: Venue

Trials:Sunday 2nd October 2016 Burntwood RFC 1.00pm – 4.00pm

Training:Sunday 16th October 2016 Burntwood RFC1.00pm – 4.00pmYES/NO

Round 1Sunday 30th October 2016 East MidsTBCPMYES/NO

Round 2Sunday 20th November 2016StaffordshireLichfield RFCPMYES/NO

Round 3Sunday 4th December 2016LeicestershireSyston RFCPMYES/NO

(Please indicate whether you are available or not)

Staffordshire U15 / U18’s Manager – Mark Tolley

Tel: 07970 217208 or email