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Parents Surname(s)
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Parents First Names
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Address
Postcode
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Home telephone no.
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E-mail
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Mobile telephone no.(s)
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Players details
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Child one
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Child two
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Child three
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Name
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Date of birth
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Playing Age Group
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School
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Details of any
medical conditions
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Date of joining
(new members)
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Subscription
(Concessions available)
Parents plus one child - - - - - - - - £70
For each additional child - - - - - - - - £20
Family membership (per child) for Senior Club Members - - - - £20
Subscriptions cover approx 30 training/match sessions per season. Additional charges may have to be made for players participating in tournaments or festivals. All paid up Members are entitled to apply for International tickets.
I enclose a cheque for £………………… payable to Haslemere Junior Rugby Club
I can help the Club with:
o Catering (tick as appropriate)
Child Welfare and Photography
Our principal concern at HJRC is the welfare of all young members participating in club activities. We that ask all parents, whilst at the club or spectating at club events, act with a PTO
sense of responsibility towards the young players. This includes being positive and supportive rather than critical of players during matches, and not pressurising a child to play if he or she does not wish to.
Parents should also ensure that their child is appropriately dressed for the weather conditions. This is particularly important in very cold weather when woolly hats, gloves, training tops and trousers should be worn in addition to basic rugby kit.
Parents/guardians should be aware that photographic images of their children may be taken during training sessions and matches by coaches or other parents. The RFU publishes guidelines on this matter; If you have any concerns, require further information, or object to your child being photographed, please contact the Club’s Child Protection Officer.
Medical Consent
Should the necessity arise, I agree to the Coach or First Aider giving consent on my behalf for an anaesthetic to be administered or for any other urgent medical treatment to be given (including but not limited to blood transfusions and invasive surgery.)
I have read and agree to the above.
Signed……………………………………………. Name…………………………………………. Date……………………
In the first instance, where possible, this form and the cheque should be handed in to the Team Rep. for your child’s age group.
Alternatively, please return completed form with your cheque to:
Tanya Parkes
Bark Hart
Tilford Road
Hindhead, Surrey
GU26 6RQ
tanyaparkes@talktalk.net
RFU.com 
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