BY SIGNING THIS FORM YOU ARE AGREEING TO THE FOLLOWING
YOUTH SECTION
PLAYER REGISTRATION FORM
2016 - 2017
1.
The above provided is accurate and that there is no further information that would prevent in any way the
child/children listed from participating safely in the activities of the H&FRFC Youth Section.
2.
That I, or a responsible adult organised by me, will be present to supervise the child/children listed at all sessions
whether home or away. If, in the absence of both myself and a responsible adult organised by me, my child is injured I
authorise the Club to approve such medical procedures, as advised by a medical practitioner as being necessary to treat
the injury.
3.
That the H&FRFC Youth Rugby Section does not take legal responsibility or act in loco parentis for players whose parent
or guardian leaves them during a session.
4.
The child/children listed may be transported by car, minibus or coach to away fixtures as arranged by the H&FRFC Youth
Section.
5.
H&FRFC may use photographs of the child/children listed, either by themselves or with others, for the purpose of
promoting the Club’s activities.
6.
The child/children listed may train & play rugby at H&FRFC and that I and they will be bound by the policies, rules and
regulations of the H&FRFC, Middlesex County Rugby Football Union and the Rugby Football Union. All policies, rules
and regulations can be found on the Club’s website (www.FulhamRugby.co.uk) or are available on request.
7.
That the H&FRFC Youth Rugby Section is run entirely by the efforts of volunteers and I accept that I will be asked to help
on an occasional or regular basis. Please indicate below the area in which you would be willing to help:
PLAYERS MUST BE OVER 5 AND BELOW 18 YEARS OF AGE AS AT 31st AUGUST 2016
FIRST PLAYER’S DETAILS
NEW PLAYER  RETURNING PLAYER 
Surname
First Name
Address 1
Nationality
Address 2
School
Post Code
Date of Birth
Age
Medical Condit.
SECOND PLAYER’S DETAILS
NEW PLAYER  RETURNING PLAYER 
Surname
First Name
Address 1
Nationality
Address 2
School
Post Code
AT LEAST ONE BOX MUST BE SELECTED
Date of Birth
ON FIELD
Age
Medical Condit.
THIRD PLAYER’S DETAILS
OFF FIELD
Age Group Administration
Café & Shop rota
Coaching
Club Administration
First aid
Publicity & Fund Raising
NEW PLAYER  RETURNING PLAYER 
Surname
First Name
Address 1
Nationality
Address 2
School
Post Code
Date of Birth
REGISTRATIONS WILL NOT BE ACCEPTED WITHOUT PAYMENT
Full Youth Playing Membership is £100 per child per season
Trial is £10 per child (covers two sessions)
The £10 trial membership is refundable against full membership.
Payment can be made at the Club in cash or by debit or credit card.
Age
Medical Condit.
MOTHER 
REGISTERING PARENT’S CONTACT DETAILS
FATHER 
Surname
First Name
SIGNATURE OF
REGISTERING PARENT:
DATE
Home phone
Families on a low income should contact the Membership Secretary for details of concessions and
support available.
Work phone
Mobile phone
Email
TO BE COMPLETED BY THE CLUB
IN CASE OF EMERGENCY THE CLUB SHOULD CONTACT
Name:
Relationship to child(ren):
Phone no:
Date
Amount
Payment Method
Cash / Debit Card / Credit Card