COBRA Clubhouse, Cae Cobra, Meifod, Powys,SY22 6DA.

Tel : 01938 500526

COBRA RFCMembership Form 2021 -2022

We are inviting you to join us for the forthcoming 2021–2022 season.

We also hope to offer added benefits to all our club members – keep an eye on our website and our facebook page for more information……www.cobrarfc.co.uk

We hope you can be part of the COBRA family and look forward to welcoming you to the Club House on match days and throughout the season.

The 2021–2022 membership fees are as follows: -

Type of membership Please tick

Family Membership* £100.00

Senior Membership £120.00

Ladies Membership £60.00

2nd Team Membership £60.00

Youth Team Membership £60.00

Mini/Junior Membership £50.00

Non Playing Membership £50.00

*Covers playing and non playing members.

First Member

Name...............................................................................................

Address ........................................................................................

.............................................................................................................

Mobile Number......................................................................(essential to receive teamer notifications re matches and training)

Email...............................................................................................(essential to receive notifications from Junior Secretary)

Date Of Birth............................................................................

School............................................................................................

School Year (2021/2022).................................................

Third Member

Name...............................................................................................

Mobile Number......................................................................(essential to receive teamer notifications re matches and training)

Email...............................................................................................(essential to receive notifications from Junior Secretary)

Date Of Birth............................................................................

School............................................................................................

School Year (2021/2022).................................................

Fifth Member

Name...............................................................................................

Mobile Number......................................................................(essential to receive teamer notifications re matches and training)

Email...............................................................................................(essential to receive notifications from Junior Secretary)

Date Of Birth............................................................................

School............................................................................................

School Year (2021/2022).................................................

Our BACS details are as follows:COBRA LtdNatwest Plc53-81-0078514126Please use your name as the reference.

Has your Son/Daughter any medical conditions, disability or special needs that we should be made

aware of? if so please state:...................................................................................................................

Parents/Guardians of those Under 18

I* do / *do not consent to any photographs or videos taken during COBRA Junior RFC

I give permission in case of emergency for my knowledge for my child to receive medical treatment

without my direct consent

SIGNED PARENT/GUARDIAN........................................................... DATE..................................

PARENTAL CONSENT FORM

Second Member

Name...............................................................................................

Mobile Number......................................................................(essential to receive teamer notifications re matches and training)

Email...............................................................................................(essential to receive notifications from Junior Secretary)

Date Of Birth............................................................................

School............................................................................................

School Year (2021/2022).................................................

MEMBERSHIP DETAILS

First Member

Name...............................................................................................

Address ........................................................................................

.............................................................................................................

Mobile Number......................................................................(essential to receive teamer notifications re matches and training)

Email...............................................................................................(essential to receive notifications from Junior Secretary)

Date Of Birth............................................................................

School............................................................................................

School Year (2021/2022).................................................

Third Member

Name...............................................................................................

Mobile Number......................................................................(essential to receive teamer notifications re matches and training)

Email...............................................................................................(essential to receive notifications from Junior Secretary)

Date Of Birth............................................................................

School............................................................................................

School Year (2021/2022).................................................

Fourth Member

Name...............................................................................................

Mobile Number......................................................................(essential to receive teamer notifications re matches and training)

Email...............................................................................................(essential to receive notifications from Junior Secretary)

Date Of Birth............................................................................

School............................................................................................

School Year (2021/2022).................................................

Fifth Member

Name...............................................................................................

Mobile Number......................................................................(essential to receive teamer notifications re matches and training)

Email...............................................................................................(essential to receive notifications from Junior Secretary)

Date Of Birth............................................................................

School............................................................................................

School Year (2021/2022).................................................

Sixth Member

Name...............................................................................................

Mobile Number......................................................................(essential to receive teamer notifications re matches and training)

Email...............................................................................................(essential to receive notifications from Junior Secretary)

Date Of Birth............................................................................

School............................................................................................

School Year (2021/2022).................................................

At COBRA Rugby Club we take the privacy of our members' data seriously and will only use your personal information for the administration of your membership, the communication of information and the organisation of events. The information you provide in this form will be used solely for dealing with you as a member of COBRA Rugby Club. This information will be recorded in our membership database, which is stored online in compliance with the GDPR. Our membership data is shared with the WRU. Your personal data is not passed on by us for use by any other third party.