2017 Player Dispensation Request Form
Club Rugby Players play in the grade that corresponds to their age as at 1st January 2017. A player will be considered for
dispensation due to either: medical or ability reasons.
Process:
• This form must be submitted to the MRU by a Club Captain prior to 5pm Friday 31st March 2017.
• 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 Club will be informed and a pending
dispensation granted until viewing has taken place.
Dispensation Grade Request (Tick appropriate box):
Colts / Under 85kgs (Weigh in day Monday 3rd March)
Presidents
•
•
Dispensation can be sought for a Colts player only if that player is under 23 years of age as at 1st January 2017 but
over the weight limit of under 85kgs.
Dispensation can be sought for a President’s player only if that player is under 30 years of age as at 1st January
2017.
Player’s Details:
Full name:
____________________________
Club:__________________________________
DOB:
__________/_________/________
Age as at 1st January 2017:
__________
Grade played in 2016:
__________
Number of seasons playing rugby: _________
Dispensation Details:
Reason for dispensation: (Circle one)
Please explain:
Medical
Ability
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Club Captain’s / President’s signature:
Name: _________________________
Signature: _________________________ Date:_______/_______/_______
Submit this form to:
Manawatu Rugby Union, P O Box 1729, Palmerston North
Fax: (06) 354 1670, Email: [email protected]