Aber Valley Wolves open age regsitration

First Names *

Surname *

Street Address *

City *

County *

Home Postcode *

Date of Birth (please put the correct year in. Do not leave at this year!) *

Birthplace *

Email Address *

Mobile Number *

Another Emergency Number

Gender *

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

Current rugby union club (if applicable) *

Preferred Playing Position *

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 *

Does the player any health problems? If yes, please give details (to be treated in strictest confidence) *

Does the player 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: *

• If player has an injury/accident requiring first aid, I consent to coaches/first-aiders administering emergency first aid. *YESNO

• If player has an injury/accident requiring urgent medical treatment/attention, I consent to coaches contacting his doctor, or calling an ambulance. *YESNO

• I consent to personal medication only being administered by a third party in life-threatening cases, eg Epi pens, Asthma pumps etc. *YESNO

• I consent to photographs and video footage being taken of player to be used for advertisement purposes of the club, placed on social media (including the club’s open Facebook page), or used for presentation evening. Video footage of matches is a WRL requirement this season. IMPORTANT: If you do not consent to this, please let the General Manager (Helen Treherne) know at start of season.YESNO

• Data protection – I consent to this form being kept by the club and Wales Rugby League for two years only on the understanding that the details contained therein will not be passed to any third party without my consent. *YESNO

• I consent to emergency contact details/health information being held by each coach at training sessions or matches.YESNO

• I confirm that, as a parent/carer, I will abide by the Parent Code of Conduct, have read the policies on the club website, and that if I do not, I may be suspended from, or asked to leave the club *YESNO

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.

Name of Parent / Carer *

If you would like to become involved with the club in a volunteer capacity, please insert which role you would be interested in *

Please pay the £5 league administration fee *

You will be told if you need to fill this in, otherwise leave blank

I consent to receiving marketing communication from Wales Rugby League, including promotional offers and ticketing information.Yes