Player First Names

Player Surname

Email Address

Player Date of Birth (DD/MM/YYYY)

Address

Main contact telephone number for all club related correspondence

Second Contact Number

Team to be registered with Team to be registered withColtsAdult MenAdult Women

Please outline any medical conditions that require medication

Please outline any special dietary requirements

Ethnicity Ethnicity English, Welsh, Scottish, Northern Irish or British Irish Gypsy or Irish Traveller Any other White background White and Black Caribbean White and Black African White and Asian Any other Mixed or Multiple ethnic background Indian Pakistani Bangladeshi Chinese Any other Asian background African Caribbean Any other Black, African or Caribbean background Arab Any other ethnic group Prefer not to say Other

Please indicate how you intend to pay the subscription fees, club preference is by website at Scunthorperugby.com but cash and cheque are also accepted. Please put the PLAYERS NAME AND TEAM as reference, account details are: Name: Scunthorpe RUFC Acc No: 04825860, Sort code: 77-16-02 Cheques should be made payable to 'Scunthorpe RUFC Ltd' (WOMEN PLAYERS SELECT CASH OPTION) Please indicate how you intend to pay the subscription fees, club preference is by website at Scunthorperugby.com but cash and cheque are also accepted. Please put the PLAYERS NAME AND TEAM as reference, account details are: Name: Scunthorpe RUFC Acc No: 04825860, Sort code: 77-16-02 Cheques should be made payable to 'Scunthorpe RUFC Ltd' (WOMEN PLAYERS SELECT CASH OPTION) Website Cash handed to team manager Cheque

Emergency Contact 1 Name

Relationship to Player

Emergency Contact 1 Main Phone Number

Emergency Contact 1 Second Phone Number

Emergency Contact 2 Name

Relationship to Player

Emergency Contact 2 Main Phone Number

Emergency Contact 2 Second Phone Number

*IMPORTANT INFORMATION* *IMPORTANT INFORMATION* Scunthorpe R.U.F.C. & it’s officials are not under any liability whatsoever for the loss of property, accidents or injuries howsoever caused during the course of training, preparation or matches played at Scunthorpe R.U.F.C. or other grounds. Registered playing members of Scunthorpe R.U.F.C. are covered by insurance against death or disablement as laid down in the Rugby Union Guidelines. Parents/Guardians are advised that any additional insurance is their responsibility. Injuries are rare but, I Agree to my child being treated by any qualified firstaider provided by Scunthorpe R.U.F.C. or opposing club should an injury occur & to my child being transported to a hospital should this be considered necessary. I understand that Scunthorpe R.U.F.C. will notify me as soon as practicable. We abide by England Rugby Headcase rules and if Concussion is suspected you must inform the childs school and G.P as a matter of urgency. Further Information can be found on the England Rugby website. All officials, Coaches, managers and First Aiders will hold a current and valid DBS. Parents/Guardians, Spectators & Players agree to abide by the RFU Codes of Conduct (These can be found on the notice board outside the Changing Rooms & on the RFU website www.rfu.com) and by the rules of Scunthorpe R.U.F.C. and Heslam Park Club (These can be found in the Green Book and Mini Junior booklet). Data protection: Parents/Guardians please note your privacy and the security of your personal information is always at the forefront of SRUFC. As a result, and as required by GDPR, we will make it easier for you to find out how we use your information. We collect and process personal data from you or your child when you join and when we carry out annual renewals of your membership, for the purpose of advertising club activities and promotions and we will share some of your data with the RFU. Please read the new Privacy Notice so you are fully aware of your rights and how we use your personal information. You can access the Privacy Notice detail via the RFU website www.englandrugby.com All players are registered with RFU