ST Ives Rugby Football Club Youth Section Player Detail and Consent Form

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This form MUST be completed by the players parent/guardian and returned to the Coach or Committee AS SOON AS TRAINING BEGINS without fail in order for St Ives RFC to ensure child safety at all times.

Player Surname: *

Player First Names: *

D.O.B. *

Address: *

Postcode: *

Medical Details (Please include any allergies, medication taken etc) Please note, no Youth Section Representative can administer medication. *

Parent/Guardian Contact Details

Surname: *

First Name:

Address (if different from above): *

Tel Number: *

Mobile Number: *

Name & Numbers of alternative Contact

Full Name: *

Relationship to Child *

Contact numbers: *

Emergency Medical Treatment

All possible steps will be taken to contact you and or your "Alternative Contact" as detailed above in the event of an emergency.

In the event of the above named player requiring emergency medical treatment: *

I DO give consent for an accredited representative of St Ives RFC Youth Section to act in my abscence.

I DO NOT give consent for an accredited representative of St Ives Youth Section to act in my absence

Safe Guarding and Codes of Conduct

All relevant documents and letters are available to be read, downloaded and/or printed off at: http://www.stivesswrfc.co.uk/

Having read the above documents, I recognise that all Officials of the SIRFC Youth Section are volunteers, giving up their time for Youth Rugby and I agree to adhere to the codes of conduct expected of players, guardians and spectators.

Player Signature ------------------------------------------------------------------------------------------------------------------------------

Parent/Guardian Signature --------------------------------------------------------------------------------------------------------------

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Publication of Photographs

I DO give consent for photographs to be used to promote the Club, Youth Section and Rugby.

I DO NOT give consent for photographs to be used to promote the Club, Youth Section and Rugby.

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I declare that all information provided is correct:

Signed: -----------------------------------------------------------------------------------------------------------------------------------------------

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Please note:

1. The club nor its servants can be held responsible for losses or injuries.
2. The club will only be responsible for players during their session time.

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