Give Rugby a Try Registration Form

Give Rugby a Try Registration Form

Ages 10 to 14 years
Players Information
Player Name

First NameLast Name
Players Date Of Birth
Guardian / Parents Names

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal Code
Mobile Number
E-mail
example@example.com
Rugby skill level

1

2

3

4

5

1 is Beginner, 5 is Advanced
Any additional information about the players experience of rugby
Important Notes

· Dress appropriately.

·  Bring plenty of water

·  Please do not wear tops with a zip or hood

·  Trainers or rugby boots will be fine to wear on the day
Emergency Contact & Health Insurance Information
Emergency Contact's Name

First NameLast Name
Relationship
Emergency Contact's Mobile Phone Number
Do you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?
Please describe
Child Participation Consent

I hereby give my consent for my child to participate in the Give Rugby a Try Event organised by Bedford Junior Blues on the 5th July 2026. I acknowledge and accept that rugby is a contact sport that carries inherent risks of injury. I confirm that the participant is physically fit, capable of engaging in these activities, and will adhere to all rules, regulations, and codes of conduct.
Do you give your consent for your child's participation in this event?
Medical Treatment

In the event of an injury or medical emergency, do you give consent for qualified event personnel or medical practitioners to provide or authorise any necessary medical, surgical, or dental treatment for your child? Every reasonable effort will be made to contact you using the emergency contact details provided
Do you give your consent for Medical Treatment?
Photography, Media, and Filming

During the rugby event we may take photographs, videos, and audio recordings of your child for promotional purposes, including print publications, official websites, and social media. Please indicate below if you grant Bedford Junior Blues and its affiliated bodies (e.g., RFU) the right to use these images for this purpose.
Do you give your consent to Photography, Media and Filming of your child?
Confirmation E-mail
example@example.com
Signature
After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at info@example.com.
Should be Empty:

Give Rugby a Try Registration Form

Players Information

Emergency Contact & Health Insurance Information

Child Participation Consent

Medical Treatment

Photography, Media, and Filming