Briars Rugby Registration 2017

Club Name*

Last years club name (if different to above)

Full Name*

First NameLast Name

Date of Birth*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState

Postcode

E-mail Address*

Mobile Number*

Work Number

Full Name*

Best Contact Number*

NSW Suburban Rugby Union definition: An Amateur is one who does not receive or agree to receive, either directly or indirectly, any remuneration or reward whatsoever (whether by match payments or expenses or otherwise) in respect to their participation as a player in the NSW Suburban Rugby Union.

Will you play in the NSW Suburban Rugby Union strictly as an amateur?*

YesNo

Have you held a professional Rugby Union contract in 2015 or 2016? (If yes, you are ineligible to play in the NSW Suburban Rugby Union in 2016)*

YesNo

Did you play in the Australian National Rugby Championship in 2015? (If yes, you are ineligible to play in the NSW Suburban Rugby Union in 2016)*

YesNo

Have you played in the Shute Shield (1st Grade) in 2015 or 2016? (If yes, you must apply to NSW Suburban Rugby for permission to register)*

YesNo

Were you last registered for Rugby overseas? (i.e. do you require a transfer?) (If yes, complete the form at the link: rugby.net.au/_uploads/res/132_8277.PDF)*

YesNo

Do you have a judiciary record in Rugby? (i.e. have you ever been suspended?) (Players with an unsatisfactory judiciary record may be refused registration)*

YesNo

REGISTRATION TERMS AND CONDITIONS

Unless otherwise stated, terms in this document shall have the same meaning as defined in the ARU Code of Conduct. A copy of the ARU Code of Conduct is available at: (http://www.rugby.com.au/rugbylink/PolicyRegister.aspx)

1. By completing this Registration Form, you (or if the participant is under 18 years of age, that participant’s parent or legal guardian on behalf of the participant) agree:i. The information you have provided is true, correct and accurate.ii. The information you have provided will be used and disclosed for the purposes specified in the Privacy Policy, including being used by your club and Member Union to administer the Game and provide rugby activities and rugby-related services. A copy of the ARU Privacy Policy is available at: http://www.rugby.com.au/PrivacyPolicy.aspx.iii. To comply with and abide by the rules and regulations which govern the Game and its authorised variations, including, World Rugby Laws of the Game and Regulations (www.worldrugby.org) , the ARU Code of Conduct By-Law, the ARU Policies (including ARU Anti-Doping Code and ARU Member Protection Policy) (http://www.rugby.com.au/rugbylink/PolicyRegister.aspx) and the competition rules governing sanctioned competitions and events.iv. You have fully disclosed any suspension you may be serving imposed by any sporting body, and will disclose any suspension imposed in the future.v. You must pay all fees, including but not limited to, registration fees.vi. The ARU, your Member Union, Rugby Body or Club may use your name or image in any form or medium for marketing, promotional and research activities.vii. The ARU may deregister you at any time by notice.

RISK AND LIABILITY

2. The Game and its variations can be hazardous and incidents may happen. To the extent permitted by law, by accepting these Terms of Registration, the participant and/or his/her parent or legal guardian assume the risks associated with participating in the Game and acknowledge this warning of the injury risks involved, and in doing so, waives all claims for liability against any participant and releases every participant from all liability, provided that such liability arises while the participant is participating in the Game.

3. ARU will hold the benefit of this release and waiver on trust for all participants. ARU makes no warranties regarding services associated with the Game or the fitness for purpose of materials provided.

INSURANCE

Registered participants of the Game are provided basic levels of cover under the ARU Insurance Plan for Sports Injury (Accident) cover, excluding cover for medical expenses where there is any Medicare Contribution (i.e. Medicare Gap). It is recommended that all participants consider Private Health and other Insurances as required for their individual circumstances, over and above the coverage provided under this Plan. Further information is available at www.gowgatessport.com.au/rugby.

I certify the information supplied above is true and correct and that I have read and agree to the Australian Rugby Union Registration Terms and Conditions listed above*

Yes

Registration Payment*

Seniors$300.00AUD

Colts (u/21's)$150.00AUD

Total $0.00AUD

Briars Rugby Registration 2017

Player Details

Emergency Contact

Amateur status

Playing History