<p> The Gables Westcliff Rugby Football Club Aviation Way Southend-on-Sea Essex SS2 6UN YOUTH AND MINI MEMBERSHIP 2017-18 Tel: (01702) 541499</p><p>Please return this form together with subscription (cheques payable to Westcliff Rugby Football Club) to your team manager or to The Membership Secretary, at the club house drop box.</p><p>Player(s) Surname Forename DOB Team School</p><p>Player(s) Home Address Parents / Guardians at this address Title Forename Surname (if different to player) 1. Title Forename Surname (if different to player)</p><p>2. Home Tel: Other contact numbers – work / mobile:</p><p>Parents e-mail address(es):</p><p>Photographic Publication Consent</p><p>Please confirm your consent to the photographing/videoing and publication of images of your child whilst participating in rugby</p><p>Signed (Parent) Date: </p><p>Please turn over and read and complete the declarations on the reverse of this form.</p><p>Founded in 1922 as Old Westcliffians Rugby Football Club Westcliff Rugby Football Club Limited, Registered in England No. 531 343 Health Details and Consent RFU rules require you to declare any illness, mental or physical incapacity suffered by your child, such as asthma, eczema, please also detail any medication taken by your child in connection therewith:</p><p>In the event of injury / illness that may require medical treatment or the use of anaesthetic I agree to the team coach / manager signing the necessary consent form.</p><p>Signed (Parent) Date: </p><p>Fair Play For All Code of Conduct It is a condition of club membership that all members of WRFC read and follow the Fair Play for All Code of Conduct a copy of which can be obtained from the club house and from the club website.</p><p>SUBSCRIPTION</p><p>BACs/ Cheque / Cash / payment via Senior section BACs TSB Bank Account Name: Westcliff RFC, Account Number: 00026636, Sort Code: 30-94-26 Cheques payable to Westcliff Rugby Football Club Ltd.</p><p>Family / 1 player: £75  Please tick as appropriate</p><p>Family / 2+ players: £100 </p><p>Family + senior player: £150 </p><p>Optional legacy fund donation: £25 </p><p>Subscriptions are due by 30th September 2017. Subscriptions not paid by 1 November 2017 incur a £10 penalty. From 1st November 2017 there is a NO PAY NO PLAY rule</p><p>Founded in 1922 as Old Westcliffians Rugby Football Club Westcliff Rugby Football Club Limited, Registered in England No. 531 343</p>