RUGBY FOOTBALL UNION

YOUNG PLAYER REGISTRATION FORM

 

 RFU Registration Number (if known)
Please complete each section in BLOCK CAPITALS and return it to your Cliub Registration Officer with ONE HEAD AND SHOULDERS PHOTOGRAPH that will be digitally copied
New Registration Re-registration Data Amendment Club Transfer
Please tick as appropriate
Surname First Names Date of Birth

Home address (including post code)

 

 
Male Female Contact Home phone
Mobile
Email
Ethnic Origin Afro-Caribbean UK Afro- Caribbean UK Asian

I have attended an Active Sport rugby course

Yes/No
UK European/Irish Other European Other
Name of Parents/Guardians

Address of Parents/Guardians

(if different from above)
Contact telephone number Post code

School/Education Establishment

Name and Address

 

 
Contact telephone number Post code
Medical Please give details of Asthma, Epilepsy, Allergies, Migraine/Chronic Headache, Broken Bones or Other Injury/Issue that has prevented participation in sport for more than one week. In the interests of child safety, both the RFU and Shrewsbury RFC strongly recommend you provide all relevant medical information

 

 

 

Previous rugby club (if any)

 

 Representative Playing History - please give dates etc using a separate sheet and tick position(s) played
Tight Head Hooker Loose Head Left Lock Right Lock
Blindside Flanker Openside Flanker Number 8 Scrum Half Stand Off
Left Wing Inside Centre Outside Centre Right Wing Full Back
Name of Current Club
I declare that the above is correct. In signing this form I declare that the above named player is bound by the laws and resolutions of the Rugby Football Union and its constituent body and the rules of the above named club.
 

Signed (Player)

 

Signed (Parent/Guardian)

 

Countersigned (Club Official)

 
Data Protection The information above will be held for registration purposes only and will not be made available to any person outside the RFU.