EAST KILBRIDE RUGBY ACADEMY
East Kilbride Sports Club,
Strathaven Road,
Calderglen,
East Kilbride. G75 0QZ
Academy Membership Details for Season 2014 - 2015
(Incorporating Mini and Midi Sections)
Welcome to an adventure packed season with the Rugby Academy at East Kilbride.
Membership is paid as a yearly fee as laid out below. Alternatively the amount can be paid by monthly standing order
throughout the year.
There are 3 categories within which a player may become a member. Please ensure you pick the correct one. If you
have any doubt at all please contact any member of the coaching team.
Category
Membership
Fee
Monthly
Standing Order
Details of Category
Youth Player
£180.00
£15.00
Youth players – U18
Coach & 1 player
Coach & 2 players
£270.00
£450.00
£22.50
£37.50
Academy Coach & 1 youth players
Academy Coach & 2 youth players
Family membership
2 Adults & 1player
£300.00
£25.00
2 Adults & 1 U18 child/player
2 Adult & 2 players
£456.00
£38.00
2 Adults & 2 U18 children/players
Membership is for a full year and is not reduced if a player decides to leave. The responsibility for payment lies with
the parent / guardian of the player and no refunds are given.
You will find attached the following forms:Membership Form (1 page) – new members and members whose details have changed please complete & return
to any Coach.
Safe in Care Form (2 pages) -
All members (new & existing) to complete & return to any Coach.
Standing Order Mandate (1 page) – All members (new & existing) please complete & hand in to your bank as
soon as possible to allow for the first payment. Or set up online.
NB When completing the standard order form please ensure the first payment
date is at least 5 days in advance of the date you submit the form to your bank.
Thank you & here’s to another year of fun enjoyable Rugby
Craig Steven
Academy Convenor
Page 1 of 1
MEMBERSHIP FORM
EAST KILBRIDE RUGBY FOOTBALL
RUGBY ACADEMY
Playing Year 2014/2015
Players Name ..................................................................................... Date of Birth ................................
Address .................................................................................................................................................
.......................................................................................................... Post Code ....................................
Telephone Number: Home .....................................
Email Address: ………………………………………………….
1st Mobile ................................... Name .................................. Relation to player ......................................
2nd Mobile .................................. Name .................................. Relation to player ......................................
School ............................................................................................................... School Year .................
Is your child already a member of East Kilbride Sports Club/Rugby Club? YES/NO
MEMBERSHIPS: (Please tick box appropriate to player)
Category
Monthly
Details of Category
Standing Order
Junior Player
£15.00
Youth player/s – U18
Coach & 1 player
£22.50
Academy Coach & 1 youth players – U18
Coach & 2 players
£37.50
Academy Coach & 2 youth players – U18
Family membership
2 Adults & 1player
£25.00
2 Adults & 1 child/player – U18
2 Adult & 2 players
£38.00
2 Adults & 2 children/players – U18
Note: Membership entitles the member or the parents to purchase a season ticket for East Kilbride
Rugby Football Club 1st team home league games and free entry into national Cup games.
Please Complete (Please tick boxes to confirm):-
I confirm having forwarded the Standing Order Mandate to my Bank. / set up online.
I agree to ensure that my son/daughter/ward shall abide by the rules of the Club and uphold the constitution.
I enclose herewith a completed copy of the safe in care form.
I consent to the information submitted on the form being held and reproduced, as appropriate, by EKRFC.
Signature of Parent/Guardian ..........................................................................
Name (Capitals) .................................................................................. Date: ..........................
Page 1 of 2
FORM 9: SAFE IN CARE- EKRFC PARTNERSHIP WITH PARENTS
Name of Player : __________________________
Age Group : ___________________
EKRFC values the involvement of children in our sport. We are committed to ensuring that all children have
fun and stay safe whilst participating in rugby.
To help us fulfil our joint responsibilities for keeping children safe EKRFC has introduced Safe in Care
Guidelines. These Guidelines tell you what you can expect from us when your child participates in rugby
and details the information we need from you to help us keep your child safe.
We need you to you complete this form at the start of every season and to let us know as soon as possible
if any of the information changes. All information will be treated with sensitivity, respect and will only be
shared with those who need to know e.g. a team manager or first aider.
A. TRANSPORTATION OF CHILDREN
I consent / I do not consent* (*delete as appropriate) to my child being transported by persons representing
EKRFC or one of its individual members or affiliated clubs for the purposes of taking part in rugby.
I understand EKRFC will ask any person using a private vehicle to declare that they are properly licensed
and insured and, in the case of a person who cannot so declare, will not permit that individual to transport
children.
Signed : ______________________________________________
Date _________________
B. PHOTOGRAPHS AND PUBLICATIONS (INCLUDING WEBSITE)
Your child may be photographed or filmed when participating in rugby. All reasonable steps will be taken to
obtain parental consent In the absence of any explicit objection, those responsible will act in the best
interests of the child which may include assuming parental agreement for the above reasons.
I give / I do not give* (*delete as appropriate) my permission for my child to be involved in
photographing/filming and for information about my child to be used for the purposes stated in EKRFC Safe
in Care Guidelines.
Signed : ______________________________________________
Date _________________
C. SAFE IN CARE GUIDELINES
I am aware of the Safe in Care Guidelines for rugby and agree to work in partnership with EKRFC to
promote my child’s safe participation in rugby.
I understand EKRFC will listen to the views of my child in relation to all matters affecting them and require
to respect my child’s ability to give their own informed consent.
Parent/Guardian’s Name:
__________________________________________
Parent/Guardian’s Signature: __________________________________________ Date ____________
EKRFC Representative’s Name: ________________________________________
EKRFC Representative’s Signature: ____________________________________
Date ____________
Page 2 of 2
FORM 9: SAFE IN CARE- Continued
D. MEDICAL INFORMATION and CONSENT
Name of Player :
_____________________________________________
Age Group
_____________________________________________
:
Name of General
Practitioner (GP)
____________________________________________
Address of GP
____________________________________________
____________________________________________
____________________________________________
Telephone Number of GP
_________________________
Please complete the following details. If none, please state “none”.
1. Any pre-existing medical
conditions that may affect the
child’s participation in rugby:
2. Any medication or treatment
required:
3. Any existing injuries (include
when injury sustained and
treatment received):
4. Allergies, including allergies to
medication:
I consent to my child receiving medical treatment, including anaesthetic, which the medical professionals
present consider necessary.
I undertake to inform EKRFC should any of the information contained in this form change.
Parent/Guardian’s Name: _____________________________________________
Parent/Guardian’s Signature: __________________________________________ Date _____________
Page 1 of 1
Standing Order Mandate
East Kilbride Rugby Academy
Please pass this form to your bank after completion
To:
The Manager
Postal address:
Branch : _______________________________
Address : _______________________________
_______________________________
_______________________________
_______________________________
_______________________________
(your bank branch & Address)
Please pay:
The Royal Bank of Scotland
24-25, Princes Square,
East Kilbride,
Glasgow.G74 1LJ
For the credit of:
East Kilbride Mini Rugby Club
Account Number
00685984
Sort Code
83-28-13
First Payment to be made on
1st November 2014
£
Amount every 5th day of the
month thereafter:
£__ . __
Please debit my account accordingly:Reference to be used to
identify member
(Players Name)
______________________________________
Name of Account to be
debited:
______________________________________
Your Account number:
¦___¦___¦___¦___¦___¦___¦___¦___¦
Your Sort code:
___ ___:___ ___:___ ___
Signature: ________________________________
Date:____________________
This Standing Order Mandate supersedes all previous standing orders to East Kilbride Mini Rugby Club