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