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EWS Club Night : Pontrhydyfen RFC 3.9.25

This form is to register your child on an OiTC Club night.
Please input the information outlined below.

Note: Please enter the childs details throughout the form and not that of the parent

Once you reach the emergency contacts section, you can then input parental name's.

please use Emergency Tel as primary adult and other contact number if you require a second.

Thank You.

Participant Identity

This section is for entering the details of our participants

Participant First Name

Participant Last Name

Participant Date of Birth

Gender

Additional Needs &/or Allergies

If Yes, please give details:

Education

Provide the education information of the participant's

School

School Year Group

Demographic

This is to assist us with demographic statistics

Ethnicity

Address

This section is for the address of the participant if 18+

Otherwise please enter the parents address

Address 1

Address 2

Town

Post Code

Other Information

Any other information

Are you a member of a rugby club?

Rugby Club

Team Age Group

Emergency Contact Identity

This section is for all the emergency contact details needed for a participant who is part of one of our programmes.

Emergency contact details must be added in this section such as parent if under 18 or a next of kin / carer for over 18's

Contact First name

Contact Surname

Relationship To Participant

Emergency Contact Email

Please enter an emergency telephone number

Please Enter an additional contact number if required:

Any Additional Emergency Contact information

EWS Club Night : Pontrhydyfen RFC 3.9.25

Participant Identity

Education

Demographic

Address

Other Information

Emergency Contact Identity

Consent

Please confirm the following details are correct

Participant Identity

Emergency Contact Identity