Kings Norton Rhinos - Junior Club Membership Application Form

Kings Norton Rhinos - Junior Club Membership Application Form 2013-14

We are very pleased to welcome you to Kings Norton Rugby Football Club. To ensure that we have the correct contact details for you please complete this form and return it to us. If you are under 16 years old please also ask your parents or guardian to sign the form before it is returned to us.

Please note this KNRFC form is an annual requirement; you will need to complete an RFU Registration only if you are a NEW club member. http://files.pitchero.com/clubs/4837/RFUYoungPlayerRegistrationForm.pdf

Annual Membership for 2013/14 Payment before 30/9/13  £50 for one child and £45 for each other child of the same family  U6s £25 From 01/10/13  £60 per child  U6s £30 Those joining after 01/02/2014  £30 per child  U6s £15 Please make cheques payable to: “Kings Norton Rhinos RFC”

Personal Details

Player’s Name ……………………………………………………………………………………………………………………......

Address …………………………………………………………………………………………………………………………..

Post Code ………………….....…………………… Home Telephone Number ………………………………………

Mobile No. …………………………………………. Email Address ……………………………………………………… Please do let us have your email address so we can circulate important information without unnecessary paperwork

Player’s Date of Birth ………………………………….. Player’s Gender……………………………………………………..

School attended…………………………………………………………………………………………………………………………..

Medical Information Please detail below any important medical/behavioural information that our coaches/junior coordinator should be aware of – e.g. epilepsy, asthma, diabetes, allergies etc. If you wish to discuss any issues in private please contact the Rhino’s Safeguarding Officer – Corrina Burge.

……………………………………………………………………………………………………………………………… …………….

Emergency Contact details – to be completed by the parent or guardian Please insert the information below to show the person(s) who should be contacted in the case of an Incident/accident: Contact Name (parent or guardian) …………………………………………………………………………………………. Contact Number(s) ………………………………………………………………………………………………………………… By returning this completed form I agree to my son(s), daughter(s) or child (children) in my care (as detailed on this form) taking part in the activities of the Club I understand that in the event of injury or illness all reasonable steps will be taken to contact me and to deal with that injury/illness in an appropriate way

Photographs/Video/Media I consent to my child’s image being used in promotional publications by the Club and for Rugby Football Union (R.F.U.) registration Yes No

I consent to my child’s name being used alongside such promotional images Yes No

As a parent/family member of the Rhinos you will have voting rights at the AGM of Kings Norton RFC Limited

Name of parent/guardian ……………………………………………………………………………………………………….

Signature of parent/guardian ……………………………………… Date ……………………………………….

KNRFC is run by volunteers and we need help! Whatever skills you have we can use them; whether it’s coaching, photography, administration, match reports, planning events or just making a bacon sandwich. Could you spare around one hour per week? Regularly Yes No Occasionally Yes No or do you know someone who can? A friend, a relative or a neighbour, we will provide any training needs. It is truly rewarding and very much appreciated.

Copies of our policies regarding Child Protection & Equality may be obtained from the Club or via the web site:

Permission for Contact Rugby (only complete this section if your child wishes to play contact rugby)

Player Name: ………………………………………………………………………………………………………………………..

If your child is in the under 9’s (Year 4) or older they are able to play contact rugby. However, we do need your specific permission to train your son/daughter in contact rugby.

Only Rugby Football Union trained coaches will provide rugby training in a safe environment for your child. As with all sports, especially contact sports, there is an element of risk of personal injury. At Kings Norton RFC we take our responsibilities for health and safety with the utmost seriousness.

We strongly recommend that you provide your child/children with a gum shield to protect their teeth. Other safety equipment you may consider includes head guards and body armour.

Please feel free to talk to Kings Norton’s youth section coaches about any questions that you may have.

Name of Parent/Guardian …………………………………………………………………………………………………………….

“I understand the risks associated with playing Contact Rugby and hereby give my permission for my child/children/child(as detailed on this form) to be coached in and play Contact Rugby with Kings Norton Rugby Football Club”

Signed …………………………………………………………….. Date ………………………………………………………………..

For further information please visit: www.KNRFC.co.uk Copies of our policies regarding Child Protection & Equality may be obtained from the Club or via the web site: We are committed to providing fun and safe activities for all young people. We are dedicated to safeguarding and ensure any personal information collected is not passed onto any other parties for marketing or commercial purposes. Your details are securely held by the committee in both hard copies and on the (password protected) RFU Rugby First Web site.