Registration - Maldon Rugby Club

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Mini / Midi & Youth Registration Form

Please note: If you have more than one child to register - please complete the registration form below and make a Paypal payment for each child in turn (remembering to click the - more than 1 child payment options). However, if you would prefer to make one payment for multiple children please pay at the clubhouse in person.

Player Details

Full Name*
First Name Last Name
RFU Reg. No.
If Known
Date of Birth*
Day Month Year
School Yr Group as 1st Sept.*

Address*

Address
Address Line 2
Town / City	County
Postcode	Country

Parent / Guardian Contact Details

Name(s) of Parent/Guardian*
Home Phone Number*
Mobile Phone Number*
Email Address*

Medical Conditions / Allergies (asthma, epilepsy, allergic to penicillin etc.)

Please specify*
Please write NONE, if not applicable.
Ethnicity*
e.g. White European (For RFU Seal of Approval use only)

Membership Rates (2011/12 Season)

Please select just one of the following six membership rates for your child* Please choose appropriate standard rates for 1 child:
Under 6 (1 Child Only) £45.00 GBP
Under 7 - 12 (1 Child Only) £65.00 GBP
Youth (1 Child Only) £80.00 GBP

If you have more than one child at the club please select these rates:
Under 6 (More than 1 Child) £40.00 GBP
Under 7 - 12 (More than 1 Child) £60.00 GBP
Youth (More than 1 Child)) £75.00 GBP

Total: £0.00 GBP

Declaration

I agree that my childs photograph can be used for promotional purposes by MRUFC.
All polices / procedures are in accordance with RFU rules / guidance.
Should be Empty:

You will be transferred to make a secure payment via PayPal.