Northumberland Rugby Union Representative Rugby Registration Form Season 2023/24 – County Under 20s Boys

"*" indicates required fields

Player Information

Address*
DD slash MM slash YYYY
Preferred Playing Position(s)*
If none please type N/A
If none, please use the ‘I’ve not played for any University teams.’ option in the dropdown
Please note any allergies and include details of any past injuries including concussions.

Representative Rugby Permissions

Emergency Contacts*
First Name
Surname
Phone Number
Relationship to Player
 

Playing & Training Permission

I GIVE PERMISSION FOR MY INFORMATION TO BE KEPT ON FILE AND ACKNOWLEDGE THAT INFORMATION WILL BE GIVEN TO TEAM MANAGERS, COUNTY PHYSIOS, COUNTY COACHES AND (IF APPLICABLE) NORTH SELECTORS AND FALCONS ACADEMY COACHES, ENSURING DUTY OF CARE IS FOLLOWED WHILST TRAINING OR PLAYING RUGBY FOR NORTHUMBERLAND RUGBY UNION.
DD slash MM slash YYYY
I GIVE PERMISSION TO BE PHOTOGRAPHED AND/OR VIDEO’D WHILST PLAYING IN FESTIVALS OR COUNTY MATCHES OR TRAINING WITH OTHER COUNTY PLAYERS.
DD slash MM slash YYYY
I GIVE MY PERMISSION FOR MEDICAL TREATMENT FOR ANY INJURY RECEIVED WHILST TRAINING OR PLAYING FOR NORTHUMBERLAND RUGBY UNION. PLEASE NOTE, A COPY OF THIS FORM IS GIVEN TO LEAD COACHES / TEAM MANAGERS IN A SEALED FILE SO THEY HAVE CONTACT INFORMATION AND THE RELEVENT PERMISSIONS FROM YOU IN THE EVENT OF AN EMERGENCY AT TRAINING OR AT MATCHES.
DD slash MM slash YYYY
I AGREE THAT I WILL FOLLOW THE CORE VALUES OF THE GAME – TEAMWORK, RESPECT, ENJOYMENT, DISCIPLINE AND SPORTSMANSHIP (TREDS). VERBAL ABUSE OF REFEREES AND COACHES UNFORTUNATELY IS ON THE RISE. IT WILL NOT BE ACCEPTED AND IF YOU ARE SEEN OR HEARD TO BE ABUSIVE TOWARDS REFEREES, COACHES AND VOLUNTEERS INVOLVED IN RUNNING COUNTY RUGBY, YOU WILL BE ASKED TO LEAVE THE GROUND AND MAY BE REMOVE FROM THE UNDER 20S SQUAD.
DD slash MM slash YYYY

Northumberland Rugby Partners