PLAYER REGISTRATION FORM SEASON 2012/13
INDIVIDUAL ACADEMY MEMBERSHIP - SUBSCRIPTION £85 plus 5% GST = £89.25
First namePlease enter first name
SurnamePlease enter surname
DOBPlease enter date of birth
Age groupGirls U7 U8 U9 U10 U11 U12 U13 U14 U15 U16 Colts
School yearPlease enter school year
School attendingPlease enter school attending
AddressPlease enter address
Parent / Guardian name(s)Please enter parent / Guardian name(s)
Email addressPlease enter email address
Tel homePlease enter home telephone number
Tel mobilePlease enter mobile telephone number
New registrationYes No
Re-registrationYes No
Plays at schoolYes No
GenderMale Female
Consent for photosYes No
Medical conditions /Allergies / Dietary needs Please give full details
Please indicate what pain relief can be given?Any None Other
If other please state
Alternative emergency contact namePlease enter alternative emergency contact name
Relationship to playerPlease enter relationship to player
Tel homePlease enter alternative emergency contact tel home
Tel MobilePlease enter alternative emergency contact tel mobile
I confirm to the best of my knowledge that my child does not suffer from any medical condition other than as declared above. I consent to my child receiving medical treatment as deemed necessary by a qualified medical practitioner. Whilst on tour I understand that the Academy’s officials will take all reasonable care of my child but cannot necessarily be held responsible for any loss, damage or personal injury suffered and I accept that I may be required to bear the cost of any loss or damage that my child causes. Acknowledgement: I have read, understood and hereby agree to abide by and support the JRFCA Terms & Conditions and Parent Code of Conduct. Please tick if you understood and hereby agree to abide by and support the JRFCA Terms & Conditions and Parent Code of Conduct
I have read, understood and hereby agree to abide by and support the JRFCA Terms & Conditions and Parent Code of Conduct.
Thank you for completing the academy membership form. We will be in touch with you shortly.
Proud sponsors of the Jersey Rugby Football Club Academy:
