Player Registration – Blaenau Gwent

First Names *

Surname *

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

Birthplace *

Current home Postcode

Gender *

Gender assigned at birth *

Email Address (parents or guardian's if aged 17 or under) *

Phone Number (parents or guardian's if aged 17 or under) *

Team Type Registering for *

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

Preferred Playing Position *

Name of School (if at school)

For Wheelchair or PDRL registration only (or please leave as able body)

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.

Parent / Guardian name (if you are under 18)

Relationship (e.g. mother, father etc)

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