West of Scotland Junior Registration and Payment Form 2021/22
Child's Name
First Name
Last Name
Child's Date of Birth
Child's Address
Street Address
Street Address Line 2
City
State / Province
Post Code
Parent/Guardian's Full Name
First Name
Last Name
Parent/Guardian's Phone Number - Home
Parent/Guardian's Phone Number - Mobile
Parent/Guardian's E-Mail Address
Emergency Contact's Name
Emergency Contact's Phone Number - Home
Emergency Contact's Phone Number - Mobile
School Attending
Childs School Year
P1
P2
P3
P4
P5
P6
P7
S1
S2
S3
S4
Membership Type
Family Membership (2 x Adult and 1 up to 16)
Additional Child
Junior Playing Membership
Upgrade of Junior Playing Membership to Family
Micros
Membership Type (one selection must be selected)
prev
next
( X )
Family Membership - (2 Adults + 1 child U16)
£
200.00
GBP
Additional Child (added to Family Membership) -
£
50.00
GBP
Junior Playing Membership -
£
135.00
GBP
Micro Rugby Player
£
Free
GBP
Girls (U16)
£
135.00
GBP
Total
£
0.00
GBP
If you require an additional child to be added to your Family Membership could you please complete another form. Records are required for each individual child. Thank you.
Does you child have any medical conditions
YES
NO
If YES please provide details
Does you child have any allergies
YES
NO
If YES please provide details
Please click SUBMIT below to submit your Registration form and make payment. Payment is taken via PayPal - you do not need a PayPal account in order to make payment - just Credit or Debit card details.
Submit
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