Player Registration Primary Parent (You)Name* First Last Email* Enter Email Confirm Email Phone*Address Street Address Address Line 2 City County Post Code Secondary Parent (Optional)Name First Last Email Enter Email Confirm Email PhoneVolunteeringWe are a club entirely staffed by volunteers - we invite all parents to take an active part in the running of the club. If you are able to help, please select the areas you may be interested in below. Roles are not time intensive, full support and any training needed will be given. Thank you very much for any help you can offer. On the Pitch Coaching First Aid Team Manager Registrar Off the Pitch Sponsorship Recruitment School Rep Marketing Activities Catering Social Secretary Kit Sales Child DetailsName* First Last Date of Birth* SchoolGender*MaleFemaleNationality*EnglishScottishWelshAny medical issues we need to be aware of?Add Second Child? Yes Second Child DetailsName* First Last Date of Birth* SchoolGender*MaleFemaleNationality*EnglishScottishWelshAny medical issues we need to be aware of?Add Third Child? Yes Third Child DetailsName* First Last Date of Birth* SchoolGender*MaleFemaleNationality*EnglishScottishWelshAny medical issues we need to be aware of?Membership PaymentOur preferred Mamberhsip payment is via this website - Please use the link below (Opens in new window) This can be paid either with credit card or bank transfer. Please note the payment order number in the 'Membership Order #" box below Terms and Conditions for Junior Rugby PlayersI confirm that all the information given on the online membership system is correct. Chiswick RFC will not pass on your contact details to any third party other than the Rugby Football Union for player registration purposes. While every precaution is taken by Chiswick RFC to maintain a safe playing and training environment for its young players I accept that due to the nature of the sport that occasional injuries may occur and that Chiswick RFC can not be held responsible for these. I also accept that in the rare event of an injury occurring that treatment may be given by the club’s first aiders or appointed practitioner. I agree to Chiswick RFC and others working with its authority, full and free use of photographic images containing the image / likeness of my children whilst they are representing the club. I understand that these images may be used for promotional use and/or news purposes in printed/online publications or in any of the club online media channels. At no point will any individual personal data about a player be divulged. Please read our Photography and Video Policy for more details. By registering my child I give my permission for the registered Junior Rugby players to play Mini / Junior/ Youth rugby at Chiswick Rugby Football Club and agree that the named players shall be bound by the laws, regulations and codes of conduct of the Rugby Football Union, its Constituent Bodies and Chiswick RFC as they may be available on the respective websites of those bodies from time to time.Your NameDate Membership Order # This iframe contains the logic required to handle AJAX powered Gravity Forms.