Mini Rugby Registration – Dartmouth PigDogs RFC

Please fill out the below form, to get your child registered for this summers program.
Payment will need to be made before the first session.

PLEASE COMPLETED THIS FORM BY TICKING THE BOXES AND FILLING IN THE MEDICAL INFORMATION BELOW *

I agree to let my son/ daughter/ child in my care, taking part in the activities of the Club.
I confirm that my child will comply with the mini/youth rules
I give consent to use of photography for coaching/playing of rugby in printed publications, website or promotional material.
I understand that in the event of any injury or illness, all reasonable steps will be taken to contact me to deal with that injury/illness appropriately, and it is my responsibility to inform Coaches/managers of any known illness/allergy or injury the child may have.
I accept that when attending matches or practices, my safety, and that of any non-participating children in my charge are my responsibility.
I give my consent for medical information provided by me about my child to be held by the club and provided to individuals identified and approved by the club where it is, or may be, material to my child's welfare.

NAME OF PARENT / GUARDIAN *

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Last

ADDRESS: *

POSATL CODE: *

EMAIL ADDRESS *

CONTACT PHONE NUMBER *

EMERGENCY CONTACT NAME

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Last

EMERGENCY CONTACT NUMBER

CHILDS NAME *