Grasshoppers Rugby Football Club

Winnington Park Rugby Football Club Mini & Junior Rugby - Medical Information and Photo consent form

Player details

Name______Date of Birth______

Parent’s/Guardian’s Details

Relationship to Player above

Home address:

Home Phone Mobile Phone Email Address

Emergency Contact

Please give the name of another person who we can contact in case of emergency.

Relationship to Player

Home phone Mobile Phone

Medical Information

Please give details of any medical condition which might affect your child’s performance or safety while playing rugby.

Is your child receiving medical treatment at present? If so, please give details.

Statement I hereby give the Manager, Coach or nominated Winnington Park Rugby Football Club representative, coaching or supervising my child, and only in my absence, consent for suitable medical treatment to be administered, I understand that every reasonable endeavour shall be made to contact me, or any other person nominated by myself. I undertake to inform WPRFC of any changes in my child’s fitness and/or medical health.

Signed ...... Date ...... Parent/Guardian Permission to use photographs

On occasions photographs taken at Winnington Park RFC may be used to promote or advertise the aims of Winnington Park RFC through a variety of media. Winnington Park RFC will not allow any other company or individual to use these images without your prior permission and will take reasonable steps to prevent unlawful use of the images. Winnington Park RFC will own the copyright of any prints, images, negatives or film produced by Winnington Park RFC

I do/do not give permission for my Child’s photograph to be used for promotional purposes

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

Data protection: We keep data about the Children that attend and their parents in order to administer and manage Winnington Park RFC and to keep you up to date on our Club. The data includes names, contact details, and some sensitive information (for example information about medical conditions or ethnic origin). We do not transfer your information to third parties unless we are legally requested to do so. We keep all personal data in accordance with the Date Protection Act 1998