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Rosslyn-Park-Membership-form-11-12-2

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					                                                                                                 RFU Registration Number (if known)
ROSSLYN PARK FOOTBALL CLUB
YOUNG PLAYER REGISTRATION FORM 2011/2012 SEASON



This form should be completed for each player within the club who has NOT previously registered with the Rosslyn Park,
is re-registering or has data amendments. Please complete each section in BLOCK CAPITALS and return to the RPFC
Office or email to jo.thesiger@rosslynpark.co.uk.

Please tick where appropriate          New Registration            Re-registration            Data Amendment               Club Transfer

First Name:                         Surname:                             Date of Birth:                                           Male/female:


Home address:



Primary mobile:                                                          Secondary mobile:

Home tel:

Name of joining parent(s):

Contact email (s):


Type of membership:

      Standard (£100)            Full (£150)          Standard Family (£150)                Full Family (£200)

      Additional child (£25 each) )           Voluntary donation £                                  Total Amount £ _________________


Ethnic Origin (please tick where appropriate)
                                                        FOR RFU RECORDS ONLY
   White: British    Mixed: White & Black Carribean       Asian & Asian British: Indian          Black or Black British: Carribean
   White: Irish      Mixed: White & Black African         Asian & Asian British: Pakistan        Black or Black British: Africa
   White: Other      Mixed: White & Asian                 Asian & Asian British: Bangladesh      Black or Black British: Other
   Chinese           Mixed: Other                         Asian & Asian British: Other           Other Ethnic Group


Medical conditions/allergies (asthma, epilepsy, penicillin) – full details please using separate sheet if necessary:


School:

Data sharing:
Rosslyn Park FC reserves the right to share its database of names and addresses with third party sponsors and rugby
related organisations from time to time. Please tick this box if you wish your details to be removed from the promotional
database
I declare that the above is correct. In signing this form, I agree that the above named player can be bound by the terms
and conditions of Rosslyn Park (available on www.rosslynpark.co.uk together with those of the Rugby Football Union.
Signed (player):                                                 Date:
Signed (parent/guardian):                                        Date:

				
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