2016 Player Dispensation Request Form
Secondary School Rugby Players must play in the grade that corresponds to their age as at 1st January 2016. A player will be
considered for dispensation due to either: medical or ability reasons also provided they meet the appropriate weight
criteria for the relevant grade.
Process:
 This form must be submitted to the MRU by a Secondary School Administrator prior to 3pm Tuesday 3rd May 2016.
 Wherever possible, the MRU will approve/deny the dispensation based on the application.
 In some cases the MRU will need to view the player. In this case, the School will be informed and a pending
dispensation granted until viewing has taken place.
Dispensation Grade Request (Tick appropriate box):
Under 15
Under 14
Player’s Details:
Full name:
____________________________
School:__________________________________
DOB:
__________/_________/________
Age as at 1st January 2016:
__________
Players Weight
__________kg
Number of seasons playing rugby: _________
Dispensation Details:
Reason for dispensation: (Circle one)
Please explain:
Medical
Ability
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
School Administrator signature:
Name: _________________________
Signature: _________________________ Date:_______/_______/_______
Submit this form to:
Manawatu Rugby Union, P O Box 1729, Palmerston North
Fax: (06) 354 1670, Email: [email protected]