Serge Betsen Rugby - Registration Form and Child Information


Full Name   Date of Birth

School    Class   

Address Post Code


Player Email*   Player Phone*

*This is applicable to players who are allowed to get to SBR and leave on their own.



Parent/Guardian 1

Phone Email


Parent/Guardian 2

Phone Email


My child is authorised to leave the SBR activities on their own


No one other than the legal parent or guardian may pick up your child unless listed below. Please provide the names of any individuals that have permission to pick up your child. If there is someone besides a parent who might pick up your child in an emergency, please be sure to provide this authorization.

Name and telephone number



Parents grant SB Tchoua Consulting the authority to take care of their children. This grant of temporary authority shall begin as from the time the child leaves school and shall remain effective until the Serge Betsen Rugby session is terminated. SB Tchoua Consulting shall have the power to pick up children from school only if the parents have granted a written authorization to the school and SB Tchoua Consulting to the following emails :



Does your child have any of the following needs:

  • Medical requirement? (eg. asthma)
  • Dietary requirements?
  • Special education needs or disability?

If YES at any of the questions, please attach additional information.

In the event of my child requiring medical or surgical treatment, including the administration of local or general anaesthetics in any emergency during SBR activities, I hereby give my consent to such treatment as may be considered necessary by a registered medical practitioner.

Date: Full Name:



Photos and videos will be taken throughout the rugby sessions. Some photographs will be posted on our website, facebook, newsletter and for commercial purposes. Please let us know in writing if you do not wish your picture or the pictures of your children made public (




SB Tchoua Consulting Ltd - Serge Betsen Rugby will use the information you provide on this form to be in touch with you and to provide updates and marketing. You can change your mind at any time by clicking the unsubscribe link in the footer of any email you receive from us, or by contacting us at We will treat your information with respect, and by clicking below, you agree that we may process your information.

Can we get in touch by email only in accordance with these terms?





Registration will be complete upon receiving the payment.

Serge Betsen Rugby reserves the right to cancel an event when the number of registered participants is too low for educational reasons.


The undersigned hereby declare to have read, understood and accepted the content of the Registration Form, and the attached Terms and Conditions.

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Document name: Serge Betsen Rugby - Registration Form and Child Information
lock iconUnique Document ID: 25671dcba75eed5a127eb5573b38da0d7571a33b
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April 5, 2017 2:22 am BSTSerge Betsen Rugby - Registration Form and Child Information Uploaded by Helene CAUX Betsen - IP 2a02:c7d:b991:9700:6cc0:e6f2:20f3:88d1