Junior Registration Form First Names *Surname *Street Address *Apartment, suite, etcCityCountyPostal CodeCountry AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweDate of Birth *Birthplace *Parent / carer's email Address *Parent / Carer's Mobile Number *Another Emergency NumberTeam Registering For *Team Registering ForPlease selectU8 mixedU9 mixedU10 mixedU11 mixedU12 mixedU14 boysU16 boysU16 girlsU19 boysGender *ChooseBoyGirlOther / Prefer not to sayWhich school do you attend? *Last year's club and age group (if applicable) *Current rugby union club (if applicable) *Preferred Playing Position *ChooseFull-backWingCentreInside CentreHalf-backUtility BackPropHookerSecond RowBack RowLoose ForwardUtility ForwardCoachOther Club VolunteerShorts size (for your free pair of shorts) *Shoe size (for your free pair of socks) *Do you have any holidays planned between beginning of May to end of August? Please tick relevant box. *YesNoIf you have any holidays planned, please give dates here, or write N/A *Does the player any health problems? If yes, please give details (to be treated in strictest confidence) *Does the player suffer from any allergies, eg allergy to Penicillin, nuts etc? If yes, please give details: *Name and address of family GP: *Contact number of family GP: *• If player has an injury/accident requiring first aid, I consent to coaches/first-aiders administering emergency first aid. *YESNO• If player has an injury/accident requiring urgent medical treatment/attention, I consent to coaches contacting his doctor, or calling an ambulance. *YESNO• I consent to personal medication only being administered by a third party in life-threatening cases, eg Epi pens, Asthma pumps etc. *YESNO• I consent to photographs and video footage being taken of player to be used for advertisement purposes of the club, placed on social media (including the club’s open Facebook page), or used for presentation evening. Video footage of matches is a WRL requirement this season. IMPORTANT: If you do not consent to this, please let the General Manager (Helen Treherne) know at start of season.YESNO• Data protection – I consent to this form being kept by the club for two years only on the understanding that the details contained therein will not be passed to any third party without my consent. *YESNO• I consent to emergency contact details/health information being held by each coach at training sessions or matches.YESNO• I confirm that, as a parent/carer, I will abide by the Parent Code of Conduct, have read the policies on the club website, and that if I do not, I may be suspended from, or asked to leave the club *YESNOPlayer profile picture *Choose FileNo file chosenDelete uploaded filePlease upload a profile picture of yourself, preferably in the shirt or leisurewear of your registered club. It is preferred that the name of the file uploaded is the name of the player and club.Name of Parent / Carer *Consent *Yes, I agree with privacy policy, terms and conditions. GDPR notice can be seen here. Please email the address on the link before submitting the form with any queries if needed.If you would like to become involved with the club in a volunteer capacity, please insert which role you would be interested in *Please select if applicableCoachTeam ManagerFirst AiderRefereeMatch Day VolunteerSponsorship ManagerSocial Media ManagerSend Message