PULBOROUGH RUGBY CLUB – JUNIOR SECTION

           

Tel:          01903 746461                                                                                     60 Hormare Crescent

Mobile:    07763 916990                                                                                                     Storrington

E-Mail: prfcjnrmembership@googlemail.com                                            West Sussex. RH20 4QX

Web: www.pulboroughrfcjuniors.co.uk                                                                       

www.prfcyouth.org.uk                                                                     

                                                                                                                                                                                               

PLAYER REGISTRATION AND PARENT CONSENT FORM - SEASON 2009/10

 

Players Surname:

 

 
Players Forename:

 

Date of Birth:

 

 
Age Group:

               Under

(as at 1st September 2009)

Address:

 

 

 

 

 

Post Code:

 

 

Home Tel:

 

 

Mobile Tel:

 

 

E-mail:

 

 

School Name

& Address:

 

 

 

 

Doctor’s Name

& Address:

 

 

 

 

Disabilities & Allergies:

 

Parents Names:

 

PRFC Membership Number:

 

Previous Club if Any:

 

RFU Reg. Number:

 

 

As a player I declare that the above information is correct. In signing this form I agree to be bound by the laws and resolution of the Rugby Football Union and its Constituent Bodies and the rules of:

PULBOROUGH RUGBY FOOTBALL CLUB

Signed (player)

Date

 

GIFT AID DECLARATION - I am a UK taxpayer and wish PULBOROUGH RFC to claim back the tax on my gift. My tax bill this year will be more than the value of  this gift. I wish the club to treat all donations I have made from 20th August 2004, and all donations I make from the date of this declaration, as gift aid declarations, until I tell you otherwise.  (Please delete if this declaration is not applicable).

As a parent I consent to any emergency medical treatment necessary during the course of Pulborough Rugby Club activities

Signed (Parent/Guardian)

Date

 

Data Protection: The information contained above will be held for registration purposes only and will not be made available to any person outside the Rugby Football Union.