Individual Membership

Please complete and submit this form to register an individual child player with the Academy. Please complete all fields.

The Individual Player subscribtion for the 2019/20 season is £130.

Click here to view our Terms & Conditions

Click here to view our Privacy Policy

Personal details

First name

Last name

Gender

Male Female

Date of birth:

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School year

School attending

Name of parent/guardian

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Contact details

Telephone

Mobile

Email address

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Address Details

Address

Address2

Address3

Parish or city

Postcode

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About your membership

Are you registering for the first time?

Yes

No

Are you renewing an existing member?

Yes

No

Do you play Rugby at school?

Yes

No

Does your parent/guardian give consent for your image to be used in photos to promote the club?

Yes

No

Do you have any medical requirments, allergies or dietary needs? Please provide details including any pain relief that can be given.

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Emergency contact details

Emergency contact name

Emergency contact mobile number

Emergency contact home number

Relationship to member

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I accept the Terms & Conditions

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Jersey Reds, Rue des Landes, St Peter JE3 7BG
Tel: 01534 499929

Jersey Reds are very grateful for the support of the Wooden Spoon charity who helped fund improvements to provide wheelchair access to the pavilion.