Membership

Membership Details for SOUTHWARK TIGERS RUGBY FOOTBALL club

Junior Club Membership Form

Welcome to the Southwark Tigers RFC.

To ensure that we have the correct contact details for you, please complete the information requested below and return this form to the Club Secretary. If you are under 16 please also ask your parents or guardian to sign the form before it is returned.

We will also use this information to ensure that you are kept informed about club events.

Personal details

Name:

Address:

Postcode:

Home telephone number:

Player Mobile: email:

Date of birth: Gender: Male ¨ Female ¨

In order to help the club monitor its membership and meet the different needs of our players, could you please specify your ethnic origin.

……………………………………………………… Religion……………………………………

School:…………………………………….

Do you consider yourself to have special needs. This can include, SEN learning difficulties or physical disabilities, Yes ¨ No ¨

If yes, what is the nature of your special need?

Sporting information

Have you played rugby before? Yes ¨ No ¨

If yes, where have you played the sport: (please give details)

……………………………. …………………………………………………………

medical information

Please detail below any important medical information that our coaches/supervisory staff should be aware of (e.g epilepsy, asthma, diabetes, allergies etc.)

Emergency contact details & parental agreement –to be completed by parent/guardian

Please insert the information below to indicate the person(s) who should be contacted in case of an incident/accident:

Contact name of parent/guardian:

Emergency contact number:

By returning this completed form, I agree to my son/daughter/child in my care taking part in the activities of the club.

I understand that all adults at the Club are volunteers, and are not paid staff.

I agree to my son/daughter being transported as necessary, under the supervision of an adult authorised by the club.

I understand that I will be kept informed of club activities – for example timing and transport details. I understand it is my responsibility to make the arrangements for my child to travel between home and the Club.

I understand that in the event of any injury or illness to my child that all reasonable steps will be taken to contact me. If I cannot be contacted, then I agree that the Club may arrange for my child to be medically examined, and the club may agree to any emergency treatment or action that is felt necessary. This may include, for example, anaesthetic.

I am clear that club membership is subject to the rules of the club and I will encourage my child to adhere accordingly.

Name of parent/guardian:

Signature of parent/guardian:

Date:

Agreement by Player:

I agree to abide by the rules of the club and understand that I may be disqualified from playing if my behaviour/language or attitude to others is unacceptable to the club.

Signature of Player…………………………………………………………………..

Annual Membership Fee

Please note that as of September 2006, an annual membership fee of £10.00 per child is being introduced to cover immediate costs such as insurance and administration.

Where a family has 2/3 children per family playing rugby, brothers/sisters will be charged a concession of £5.00 each.

i.e.

1st child - £10.00 membership

2nd child - £ 5.00 membership

3rd child - £ 5.00 membership

Weekly rugby training sessions is still FREE.

When there is an Away match or activity, the travel costs remain at the fixed contribution of £2.50 per child. All children are required to pay £2.50 for travel to matches or events, whether they go on the coach, minibus, or in a parent’s car; everyone pays the same.

Please return your membership form as soon as possible with the following items:

£10.00 Annual Membership Fee

2 passport sized photographs – for membership ID card

Please do not hesitate to discuss this with a member of our staff for further clarification.

Thank you

Southwark Tigers