Open age registration form – Aber Valley Wolves RLFC

First Names *

Surname *

Street Address *

Apartment, suite, etc

City

County

Postal Code

Country

Date of Birth *

Birthplace *

Email Address *

Phone Number *

Team Registering For *

MenWomen

Last year's club and age group (if applicable) *

Preferred Playing Position *

Shorts size (for your free pair of shorts) *

Do you have any holidays planned between beginning of May to end of August? Please tick relevant box. *

YesNo

If you have any holidays planned, please give dates here, or write N/A *

Do you have any health problems? If yes, please give details (to be treated in strictest confidence) *

Do you 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: *

Player profile picture *

No file chosen

Please 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.

GDPR *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.