NATIONAL RUGBY LEAGUE
PLAYER REGISTRATION FORM
Personal Details
LEGAL FIRST NAME: _________________________________________
SURNAME: ___________________________________________
MIDDLE NAME: _______________________________________
DOB: _________________________________
GENDER: M / F
PREFERRED NAME/AKA: _____________________________________________
Contact Details – Player
ADDRESS: __________________________________________________________________________________________________________
SUBURB: _______________________________________ STATE: ________________________
POST CODE: _______________
PHONE (H): ________________________
(M): _____________________
(W): __________________________
EMAIL:__________________________________________________ EMAIL 2:________________________________________________
Contact Details - Parent/Primary Care Provider
FIRST NAME: ______________________________________
SURNAME: ______________________________________________
PHONE No: (if different to above): ___________________________ EMAIL: _________________________________________________
Identification (MUST sight 1 of the 3 options below)
BIRTH CERTIFICATE NO: ____________________________
PASSPORT NO: ______________________ COUNTRY: ________________
DRIVERS LICENCE NO: _____________________________
OTHER:____________________________________________________
Ethnicity (please circle one option ONLY)
Aboriginal
African
American
Asian
European
Maori
Pacific Islander
Torres Strait Islander
British
Country of Birth
PLAYER: _______________________
MOTHER: ________________________
FATHER: ________________________
NRL Fan Engagement
NRL TEAM SUPPORTED: __________________________
STATE TEAM SUPPORTED: New South Wales Blues / Queensland Maroons
ARE YOU AN NRL CLUB MEMBER?
NUMBER OF NRL GAMES ATTENED IN A SEASON? _______________________
Yes / No
Registration Details (Complete applicable fields only)
DIVISION/REGION: __________________________________
LEAGUE/GROUP: ________________________________________
CLUB NAME: _______________________________________
AGE/GRADE: ___________________________________________
Previous History /Clearance
Have you played Rugby League before Yes/No If YES, a clearance from your LAST club is required.
I authorise a clearance under the terms of the NRL Clearance Policy from the below Club – Players Initial: _____________________________
Previous Club: ____________________________________ League/Group/State: __________________________ Last Season Played 20 _____
By signing this form I declare that the above information is true and correct and I understand that the information will be held securely within the NRL national
participation database and may be used within the game only.
I agree to abide by the Constitution and by-laws of the State/Division/League that I am registering with and their Terms and Conditions. I have read and
understand the Liability and Indemnity on the reverse of this form and also agree to abide by the following NRL Policies and understand that the documents in
their entirety are available to be downloaded from www.leaguenet.com.au NRL Participation Code of Conduct, NRL Laws of the Game, NRL Mini/Mod Rugby
Leagues Laws, NRL Safe Play Code, NRL Images Policy, NRL Clearance Policy and the NRL Anti-Doping Rules.
_________________________________
Players Signature
______________________________________
Parent/Primary Care Provider
__________________
Date
_________________________________
Club Secretary/Registrar Signature
_____________________________________
Club Sec/Registrar (Print Full Name)
__________________
Date
________________________________
League/Group Secretary Signature
_____________________________________
League/Group Secretary (Print Full Name)
__________________
Date
LIABILITY AND RISK
Rugby League is a body contact sport which carries a risk of personal injury. The League (herein defined to include the National Rugby League,
the State Leagues and the League in which the Player participates), and the Player’s Club; each take steps to reduce the risk of serious injury,
but it is not possible to eliminate risk in a sport involving forceful body contact. By signing this registration form, the player and his
parent/guardian voluntarily assume the risks associated with participating in this sport; and acknowledge this warning of the injury risks
involved.
Whilst some limited statutory insurance cover is available in some States for some participants in the sport who suffer particular injuries, the
Civil Liability Act in each State (“the Act”), limits the liability of the League, the Clubs and their employees and officials from civil litigation
arising out of injuries suffered whilst playing, or training for, rugby league.
The League is required by the Act to warn persons playing and involved in the game, and their parents and relatives, of the not insignificant
risks of injury involved in the sport, which the League hereby does.
INDEMNITY AND COMPLIANCE
It is a condition of membership and/or registration with the League that the Player and/or his parent or guardian acknowledges:1.
That membership and/or registration is conditional on continued observance of and compliance by the Player with the provisions of
the Rules of the Game, the NRL Policies referred to on the front page hereof; the Constitution, and the Competition Rules of the
League in which the Player participates (together,“the Rules”).
2.
That the Player will accept the decisions and directions of the League and its committees made in accordance with the Rules and
Regulations and the League Constitution
3.
That the Player will not during the currency of his membership and/or registration or at any time thereafter, should he cease to be a
member/registered, make any claim against the League or the Player’s Club for damages in negligence or contract related to any
alleged act or omission of the League, the Player’s Club, the Referee’s Association or any of their members, officials or employees, for
injury arising out of any game or training program under the control or supervision of the Player’s League or the Player’s Club;
4.
That in the event of any person commencing any proceedings against the Player for any assault, breach of the Rules, or negligence;
causing injury, the Player hereby indemnifies: the League, the Club, the Referee’s Association; and any of their officials and
employees against any order of the Court including any award for damages, legal costs and disbursements which may be awarded or
ordered against any of them.
5.
That the indemnity and waiver herein may be pleaded in bar to any such proceedings aforesaid.
6.
If the Player shall suffer any injury including death whilst engaged in training or playing the game of rugby league and a cause of
injury was the negligence, trespass, assault or a breach of other obligations imposed by laws or any of their persons or bodies named
in the Rules, then the liability of the League (including its volunteers, officials and employees) is limited to the extent of any insurance
policy held by the League or Club; and the amount which such insurer is liable to pay under the policy, and/or the amount of
insurance payable by any applicable statutory insurance schemes.
7.
The Player agrees that this limitation of liability applies even if he ceases to be a member of the League or Club.
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