YOUTH & JUNIOR REGISTRATION FORM

PLEASE USE BLOCK CAPITALS & ENSURE YOUTTHE BOXES & COMPLETE ALL RELEVANT SECTIONS OF THE FORMPlease note the provision of false information on this form may affect your claim should you wish to use the insurance

PLAYER ID NUMBER

PLAYER STATUSRe-Registration ! New Player I Free Agent I Transfer I

DATA PROTECTION NOTICEThe RFL, BARLA, English Schools Rugby League. Combined Services Fugby League and StudentRugby League wiLl use your personal data (including sensitlve personal data) to administer RugbyLeague matches, tournaments etc and send you by post/e mail/SN,4S information related to thosepurposes.

We may send you information about ours and selected third pady goods or services, bypost/e-mail/SMS. By completing this lorm we will assume you have consented to this unless youtick this box. ETo help raise funds for Rugby League we may pass your contact detalls to sponsors of thegame so that they can send you by post/e-mall/SMS details of their products and servlces. Bycompletlng thls form we will assume you have consented to this unless you tick this box. ETo monitor panicipation and satisfaction within Rugby League, we may use or pass your contactdetails to Spo11 England (or their authorised representatives) so that you can be ccntacted byposve-mall/Sl\lS. By completing thls form we will assume you have consented to this unless youtlck this box. n

PLAYER DECLARATIONI declare that I am not registered with any professional club and agree to abide bythe Rugby League Code of Ethics and Conduct, Communrly Game OperationalRules and associated policjes. I acknowledge that the sport o{ Rugby Leagueinvolves a high degree of physical contact and as such can result in injury. I

acknowledge that if I am injured in a match I may receive certain compensationunder the terms of the policy of insurance. I acknowledge that such insurance covermay be excluded for illegal or foul play or contact, which is contrary to the rules andcustoms of Rugby League whether committed by me, or by any other person as aresult ol which an injury arises.

I acknowledge that the insurance cover may not be sufficient to compensate me forcenain types of injury or disability. I further acknowledge thai I am aware the policy ofinsurance does not include cover for players' liability for injury or financial losscaused to the other players during Rugby League matches and training sessions, sothat any claim I wish to make against another player, or which may be broughtagainst me, in respect of such injury or loss, will not be covered by the policy. I canconlirm that I unders'iand lhat I have the right to obtain my own personal accident,liability or injury cover should I wish to do so.

For more in{ormation please refer to www.therfl.co.uk

Signed

Name

Date

League Official Use-Only new players aged under 1B must provide proof of age

Bidh Certificate No

Medical Card No

Passport No

Playing League

Signed

Name

Date

JUNIOR ONLYSECTION A CLUB DETAILS

SECTION B (tf atransfer)Please note, an authorised transfer form must be attached.

Season

Age Group

Previous Club

Age Group

I do not owe monies to my previous club f]

Club

Season

YOUTH ONLYSECTION A CLUB DETAILS

Age Group 16 E 17 n 1s E Adutt fl(Please tick the age groups you wish to register for)

SECTION B (tf atransfer)Please note, an authorised transfer form must be attached.

I do not owe any monies to my previous club fl(Once a player has attained the age of 1 6 they are eligable 10 play for all the teamsindicated above. Please tick the age groups you wish to register for)

Previous CIub

Age Group

Club

SECTION C (lo be completed by player)

Name

D.O.B. Gender - Male / Female

PARENT/GUARDIAN DECLARATIONl, the parent/guardian. am not aware of any medical reason why the above namedshould not take part in contact sport and i have provided any relevant medicalinformation o{ the above named to the club. I agree to abide by the Rugby LeagueCode of Ethics and Conduct. I also agree to the use of the information as set out inthe Dala Protection Notice.

I acknowledge that upon my child attaining the age of 16, he/she is eligrble to playfor all the teams which have been indicated on this form. I understand and permit mychild to play at these levels in full knowledge tha't the FIFL Saleguarding Policy islimiied to its effects at Adult Level includinq the Club Welfare Olficer not being atattendance.

Signed

Name

Date

CLUB OFFICIAL DECLARATIONI cedify that this form was signed by the player and, if under the age of 1 8, theirparent/guardian was in my presence and the details are correct.

Signed

Name

Date

TBIPLICATE FORM: WHITE BFL, YELLOW LEAGUE, PINK CLUB

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