Dunbar Rugby Football Club

Youth and Mini Rugby Registration Form

Season 2022 - 2023

Player Details

Surname

Forename

Address

Postcode

Date of Birth

Home Phone Number

Players Mobile Number

Players Email Address

School Attended

School Year

Front Row Trained

Position

Emergency Contact

Emergency Contact Phone Number

GP Name

GP Phone Number

Parent/Guardian Consent

Please select one option from dropdown list. If yes, please give details:

Is help needed with daily task e.g. tying laces?

Details

I/We give my child/ward consent to make their own way to/from training/home games?

P1 & P2 will not be permitted to make their own way home

I/We consent to my child/ward being transported to/from games in a vehicle or a coach or designated parent. I understand it is my responsibility to clarify exact travel arrangements for my child/ward for each journey?

Details

I/We give my permission for my child/ward’s photograph and/or name (probably first name only) being used by Dunbar RFC in any club related newspaper article, match reports, website and publicity events.

Details

I/We consent to my child/ward receiving first aid if required.

Details

I/We consent to any medical or dental treatment including the administration of anaesthetic as a result of injury pertaining to rugby training or match day activity.

Details

I/We consent to my child/ward participating in any and all rugby activity at Dunbar RFC

Details

I/We fully understand that rugby is a contact/collision sport where injuries can sometimes occur.

Details

Consent to Club Completing Injury Report to SRU

When a player is seriously injured during training or a match, Dunbar RFC is obliged to complete a Serious Injury Report and submit it to Scottish Rugby. The report will include information about the injured player, and the nature and circumstances of the injury.

I/We agree to co-operate with Dunbar RFC in completing the Report and agree that Dunbar RFC may submit the Report to Scottish Rugby. Any personal data submitted on the report shall be used only for the purposes set out in the Report

Details

Medical Information

It is very important for the safety and well being of the player that the coaching staff is aware of any medical condition that you may have. We would appreciate your help in this matter and all information will be treated in the strictest confidence.

Please select from the dropdown list, if Yes, please give details:

Are you currently taking any medications (including inhalers) (Bring inhalers to training/games)

Details

Do you suffer from any allergies?

Details

Any other medical problems or specific dietary requirements? (e.g. asthma, epilepsy, gluten intolerant, etc)

Details

Any strapping or supports or contact lenses used during training or games?

Details

Have you received a tetanus injection in the last ten years?

Details

I/We agree that our child named above, agree that Dunbar RFC may complete any injury reports on my behalf and submit the report to Scottish Rugby on my behalf.

P3 – U18 players are required to wear a mouth-guard when training/participating in ANY Dunbar RFC squad/match/rugby event and may be withdrawn if this does not happen.

DATA PROTECTION/CHILD PROTECTION

The information you provide will be used solely for detailing you as a member of Dunbar RFC.

The club has a Data Privacy Policy which can be found at https://dunbarrugbyclub.com/privacy-policy-dunbar-rfc/. Your data will be stored and used in accordance with this policy.

Dunbar RFC’s child protection policy can be found at https://dunbarrugbyclub.com/drfc-child-protection-policy/.

Membership Type

Payment Method

DRFC Bank Account Details

Sort Code : 80-13-28

Account Number : 00175274

Parent/Guardian Details

Parent/Guardian 1

Parent/Guardian 2

Name

Mobile Number

Email Address

Date