Name: Youth Membership - Plan A (Monthly)
SKU: youth-mship-1
Price: 7.00 GBP
Availability: InStock

Players Full Name *

Address *

Post Code *

D.O.B: *

Age on 01/09/2018 *

School Year: *

Photo ID: *

Please upload a passport style photo, not more than 6 months old, taken against a plain background, clear and in focus. 80% of the image should be of the player’s face.

Example:

(max file size 128 MB)

School the player attends: *

Applying Parent / Guardian: *

Parents D.O.B *

Home Telephone: *

Mobile: *

Parents / Guardians Email: *

Previous Rugby Experience: *

Media Consent: *

Please select below if you DO or DO NOT want your child to be included or be used in any of the following:

Photo:

Video *

Internet: *

Ethnic Origin (Required for RFU registration) *

I confirm that I have read and will follow the BHRFC Parents Code of Conduct. *

I Agree

I confirm that I have read and will follow the BHRFC Players Code of Conduct. *

I Agree

Medical questionnaire and consent form 2018 / 2019 Season: *

The following information is required in order that it is available for emergency services medical staff to use in the event of
an accident or injury whilst your child is with the club.

Child’s Full Name

Name & Address of Family Doctor *

Doctors Tel Number *

Emergency Contact (1) Name & Number *

Emergency Contact (2) Name & Number *

Has your child had any of the following? Asthma or Bronchitis *

(We will administer supplied inhalers with your written permission. Please label any medication clearly with child’s name)

Yes

No

Heart Condition *

Yes

No

Fits, Fainting or Blackouts *

Yes

No

Severe Headaches *

Yes

No

Diabetes *

Yes

No

Allergies to any known drugs or medication *

Yes

No

Any other allergies e.g. material, food, insect bites etc. *

(We will administer supplied EpiPens with your written permission. Please label any medication clearly with child’s name)

Yes

No

Other Illness or disability *

Yes

No

Any recent contact with contagious diseases or infection *

Yes

No

Has your child received vaccination against TETANUS within the last five years? *

Yes

No

Youth Membership – Plan A (Monthly)

Players Full Name *

Address *

Post Code *

D.O.B: *

Age on 01/09/2018 *

School Year: *

Photo ID: *

School the player attends: *

Applying Parent / Guardian: *

Parents D.O.B *

Home Telephone: *

Mobile: *

Parents / Guardians Email: *

Previous Rugby Experience: *

Video *

Internet: *

Ethnic Origin (Required for RFU registration) *

I confirm that I have read and will follow the BHRFC Parents Code of Conduct. *

I confirm that I have read and will follow the BHRFC Players Code of Conduct. *

Name & Address of Family Doctor *

Doctors Tel Number *

Emergency Contact (1) Name & Number *

Emergency Contact (2) Name & Number *

Has your child had any of the following? Asthma or Bronchitis *

Heart Condition *

Fits, Fainting or Blackouts *

Severe Headaches *

Diabetes *

Allergies to any known drugs or medication *

Any other allergies e.g. material, food, insect bites etc. *

Other Illness or disability *

Any recent contact with contagious diseases or infection *

Has your child received vaccination against TETANUS within the last five years? *

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Youth Membership – Plan A (Monthly)

Players Full Name *

Address *

Post Code *

D.O.B: *

Age on 01/09/2018 *

School Year: *

Photo ID: *

School the player attends: *

Applying Parent / Guardian: *

Parents D.O.B *

Home Telephone: *

Mobile: *

Parents / Guardians Email: *

Previous Rugby Experience: *

Media Consent: *

Photo:

Video *

Internet: *

Ethnic Origin (Required for RFU registration) *

I confirm that I have read and will follow the BHRFC Parents Code of Conduct. *

I confirm that I have read and will follow the BHRFC Players Code of Conduct. *

Medical questionnaire and consent form 2018 / 2019 Season: *

Child’s Full Name

Name & Address of Family Doctor *

Doctors Tel Number *

Emergency Contact (1) Name & Number *

Emergency Contact (2) Name & Number *

Has your child had any of the following? Asthma or Bronchitis *

Heart Condition *

Fits, Fainting or Blackouts *

Severe Headaches *

Diabetes *

Allergies to any known drugs or medication *

Any other allergies e.g. material, food, insect bites etc. *

Other Illness or disability *

Any recent contact with contagious diseases or infection *

Has your child received vaccination against TETANUS within the last five years? *

Reviews

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