PAORFC Young Player

PLYMSTOCK ALBION OAKS RFC

YOUTH PLAYER REGISTRATION FORM

This form should be completed for all youth players within the club who have NOT previously registered, are re-registering or have data amendments. Please complete each section in BLOCK CAPITALS and return to the Club Membership Secretary along with TWO passport size photographs YES / NO and any fee’s due PAID £ CASH/CHQ/DEBIT

Please tick where appropriate New Registration Re-registration Data Amendment Club Transfer

First Names: / Surname: / D.O.B.
Home Address:
Postcode:
Male/Female / Home Tel: / Mobile Tel:
Emergency Contact:
Email address:
Ethnic Origin (Please tick (✔) where appropriate):-
 White: British /  Mixed: White & Black Caribbean /  Asian and Asian British: Indian /  Black or Black British: Caribbean
 White: Irish /  Mixed: White & Black African /  Asian and Asian British: Pakistan /  Black or Black British: Africa
 White: Other /  Mixed: White & Asian /  Asian and Asian British: Bangladesh /  Black or Black British: Other
 Chinese /  Mixed: Other /  Asian and Asian British: Other /  Other Ethnic Group
Previous Clubs / Representative Playing History (please give details etc., using a separate sheet if necessary)
Playing Position:  Unspecified  Front Row  Forward  Back Plays at school: Yes / No
Medical Conditions/allergies (Asthma, Epilepsy, Allergic to penicillin) Please give full details using back of form if necessary: (Completing this section is not obligatory but the Club & RFU in the interests of child safety strongly recommend that you do so).
*Medical treatment will be arranged by a club official as appropriate and necessary by medical personnel unless indicated below while informing the parent / guardian as soon as reasonably possible.
Name and Address of Doctor
School/Education Establishment Name and Address:
Contact Number: Postcode:
Name of Parents/Guardians for Family Membership
Mother Occupation DOB
Mobile No:
Father Occupation DOB
Mobile No:
Address of Parent/Guardian (if different from above):
Postcode:
Contact Telephone Number: / Email address:
Other Family Playing Membersand age groups
If you do not wish your child to be photographed/videoed or have any images published tick here
If you do not wish to be contacted by e-mail (this is the clubs primary means of communication tick here
If you do not wish your child to have medical treatment tick here
Any Additional Information You Feel is Relevant
As an adult could you offer any skills to the club (eg first aid, admin, general)
Data Protection Act
The information you have supplied will on this form only be used for purposes of club administration in accordance with the principles of the Data Protection Act. By completing and signing this form you have consented to, and accept responsibility for, having these registration details recorded in a database for the purposes of Club administration. If these details are not your own, then you may also be held responsible for any errors, omissions or failure to obtain permission to register any of the information supplied.
As a member of Plymstock Albion Oaks it is your responsibility to ensure your details are correct.
This information will be saved such that it will only be visible to Officers of Plymstock Albion Oaks RFC. If you wish your details to be made available to other members of this Club, you must request this in writing to the Hon. Sec. of Plymstock Albion Oaks RFC.
I declare that theinformation is correct and I am legally entitled to give my consent. In signing this form I agree that the above named player can be bound by the laws and resolutions of the Rugby Football Union and its constituent body and the rules of Plymstock Albion Oaks Rugby Football Club.
Your players payment includes a £20 social membership fee, which will entitle you to full club membership benefits including access to international ticket ballots, catering facilities and preferential access to the function room. In addition to this there will be promotional prices available to you upon presentation of your membership card. If you wish to Gift Aid the donation element of the players payment please sign accordingly in section 3.
I will inform the club if any of my/our relevant details change
Signed (player): / Date
Signed (parent / guardian): / Date
Countersigned (Club Official): / Date

For club use only

Allocated Team / Lead Coach / Team Admin
Registration fee received / Albion pass issued / Fixtures booklet issued
PAORFC database updated / RFU form submitted

(tick when completed)

Section 3

Gift Aid declaration – for past, present & future donations

Plymstock Albion Oaks Rugby Football Club Limited

Please treat as Gift Aid donations the non membership element of the players payment and all qualifying gifts of money made

Today in the past 4 years in the future

Please tick all boxes you wish to apply.

I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 28p of tax on every £1 that I gave up to 5 April 2008 and will reclaim 25p of tax on every £1 that I give on or after 6 April 2008.

Donor’s details

Title ------First name or initial(s) ------

Surname ------

Full home address ------

------

Postcode ------

Date ------

Signature ------

Please notify the charity or CASC if you:

Want to cancel this declaration
Change your name or home address
No longer pay sufficient tax on your income and/or capital gains.

If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.

YOUTH PLAYER REGISTRATION RECEIPT

Please ensure you read and understand the codes of conduct on the back of this form. By accepting this receipt you are accepting you and the player(s) agreement of those codes.

£______ Paid Cash / Cheque / Debit Card

This represents my total payment, both membership and players payment or donation.

Club Officer ______Date______