BREDON STAR R.F.C. Ltd
Est. 1991
Incorporating Bredon Star Junior Rugby
Affiliated to the Rugby Football Union, North Midlands RFU
and Worcestershire & Herefordshire RFU
Membership Form (Junior Player 2015-16)
All Junior Players must complete this form.
Subs £65, siblings £55. Cheques payable to ‘Bredon Star RFC Ltd’.
New players also need to complete RFU Registration form and provide 2 passport-sized photos.
Part A – Player’s Personal details
Surname:
Date of Birth:
Address :
Forename(s):
Gender:
Age on 1st Sept
Existing or New Player
Medical Information: Please detail all relevant medical information (e.g. epilepsy, asthma, diabetes)
Part B – Parent/Guardian Contact Details
Please provide details of two parents/guardians for the above named Junior player contactable for all matters
Name:
Relationship:
Home Tel:
Mobile Tel:
Address:
(if different
from above)
Name:
Relationship:
Home Tel:
Mobile Tel:
Address:
(if different
from above)
I agree to my son/daughter/child in my care taking part in the activities of the club. I understand that in the event of any
injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately. I agree
to abide by the Policies and Rules of the RFU and Bredon Star RFC Limited.
Signature(s):
Date:
Part C – Photographic Consent – permission for the use of photographs and recorded images
The parent/guardians above consent / do not consent (pls circle which applies) to the photographing and/or videoing and
publication of images of the above named player, under the RFUs Child Protection and Best Practices guidelines and I
confirm that I am legally entitled to give this consent. It is also confirmed this person is not under a Court Order.
Signature:
Date:
Part D – For Club Use Only
Paid/Amt:
RFU Reg No:
ID:
Photo
consent:
RFU Form:
Industrial and Provident Society Registration No. 31539 R
President: Mr D Newcombe Tel. (01684) 772190
Junior Chairman: Mr S Jameson Tel. (01242) 609092
Chairman: Mr K. J. Falvey Tel. (01684) 773183
Secretary: Mrs S. Matty Tel. (01684) 773157
Treasurer: Mr A. Bawdon Tel. (01684) 773624
Membership Form (Junior Player) 2015-16
Edition 1 29-Sep-2015