Youth Registration Form Season 2016/17

Pocklington RUFC

Youth Registration Form Season 2016/17

Surname: / Forename(s)
DOB: / Previous Club*
Town of Birth* / Country of Birth*
Parents/Guardians: / 1 / DOB
2 / DOB
Address: / Post Code:
Contact Number / Home / Mobile
Email Address:
School:
Doctors Name:
Surgery:
If your child suffers from any medical conditions or allergies please list below. If applicable, Doctors letter regarding suitable treatment.

Team ______

RFU Number______*NewReturning

Membership Details – Please tick as appropriate

Family Membership–
£60 for 1st Child including Social Membership for 2 named Parent/Guardian
(If 1st Child is Under 6, Total Family Membership £30)
Full Family Membership–
£90 for 1st Child, 1 Adult with Voting Rights/1 Adult Player + 1 Adult with Social Membership (Adult Player to complete adult registration form)
Vice Presidents -
£30 for 1st Child if VP paid minimum of £60
Additional – £30 for 2nd Child in Family
Name of Child & Team
Additional – £20 for 3rd and other children in Family
Name of Child & Team
Please complete a separate registration form for each Child
Total Amount £_____ Cheques made payable to Pocklington RUFC
Calling All Volunteers
Pocklington RUFC enjoys a successful Mini/Junior section, but we can’t be successful without the dedication of our volunteers. Whether you are an Ex Player, been involved with other sports or have other experiences, we need people from all backgrounds to help us run a successful club, help us keep young players enjoying Rugby Union.
Whatever your skill, whatever time you could offer, we would value your support. Be part of the Rugby Family.
For those interested in Coaching/Refereeing – the club welcomes you and in return for your time and effort, the club will pay for all courses.
Please indicate below if you feel that you help us with:
Fundraising Activities / Team Admin/Management
Sponsorship Raising / Social/Event Planning
Coaching / Refereeing
Club Management / Club/Ground Maintenance
I don’t Care – I will volunteer for anything!!!!!
Declaration
I understand that Pocklington RUFC, its servants, officers, agents or employees are not under any liability for the loss of property, accidents or injuries incurred whilst participating in activities at Pocklington RUFC or any other venues where matches are played.
I accept that media images may be taken, by parents, coaches and other authorised persons while the player is playing.
I consent to any emergency treatment necessary during the course of the season and I will keep the club informed of any change in medical circumstances.
I agree to adhere to the club’s Code of Conduct for parents and spectators. These can be found on the clubs’ website:
Signature of Parent/Guardian / Date

Pocklington RUFC Mini/Junior Registration Form