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Serge Betsen Rugby - Registration Form and Child Information

THE PLAYER

Full Name Date of Birth

School Class

Address Post Code

Gendre MaleFemale

Player Email* Player Phone*

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

THE GUARDIANS AND PICK-UP

Parent/Guardian 1

Phone Email

Parent/Guardian 2

Phone Email

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

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

ESCORT SERVICES

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 :

For Lycée Français Charles de Gaulle : vie-scolaire-primaire@lyceefrancais.org.uk and contact@sergebetsenrugby.com
For La Petite Ecole Française : lapetiteecolefrancaise@gmail.com and contact@sergebetsenrugby.com

MEDICAL INFORMATION

Does your child have any of the following needs:

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

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:

MEDIA AUTHORISATION

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 (contact@sergebetsenrugby.com).

DATA POLICY

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 contact@sergebetsenrugby.com. 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? YesNo

PAYMENT INFORMATION

I will pay the full amount due

via SergeBetsenRugby.com

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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Your legal name

Your email address

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Timestamp

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April 5, 2017 2:22 am BST

Serge Betsen Rugby - Registration Form and Child Information Uploaded by Helene CAUX Betsen - contact@sergebetsenrugby.com IP 2a02:c7d:b991:9700:6cc0:e6f2:20f3:88d1