REGISTRATION FORM

Parent/Guardian Details

Siblings

They will be able to participate in the program together.

Terms and Conditions

The following outlines the Terms and Conditions associated enrolling yourself or your child in Connect Rugby League. Please read these Terms and Conditions carefully. These Terms and Conditions are subject to change

All parents/carers and their children attending must refrain from:

1. The use of offensive, obscene or derogatory language or actions to any participant, volunteer, coach, parent or carer.
2. Assaulting or acting with aggression to any person/s including staff, volunteers, parents and other players.
3. Behaving in a way contrary to the spirit of the game.

Photographs may be taken of the activities involved with this program. I consent to the Connect Rugby League, QRL, NRL, our sponsors and our photographer/s using the photographs or video for publicity and promotional purposes.

Insurance

The insurance coverage attached is our maximum coverage for this match. If you wish any extra coverage to the attached which is provided within your registration, it will be your personal responsibility to obtain this at your own cost. Submission of your registration confirms your agreement to our level of coverage for the match and that it is acceptable for yourself as a parent or guardian and/or your child. Thank you.

All players take the field at their own risk. Pre-existing injuries may not be covered at the discretion of the insurer.

We are covered by Gallagher, please download and review documents here:

▪ Combined Liability
▪ Sports Injury

Waiver

As Parent/Guardian or participant of the above mentioned child/ren or person, I consent for him/her to participate in the Connect Rugby League program and I understand that this is a community based d program facilitated at times by QRL and NRL staff. I am required to supervise, be responsible for and assist my child or any children of mine present if under 18 years at all times and for the duration of the program, if required.  All parents and participants are encouraged to seek medical advice for themselves or their children before playing to ensure they are fit and capable of participating in Connect Rugby league. It is the responsibility of the participant or parent/guardian to ensure our program is suitable for themselves or their child. I acknowledge that there are risks involved in body contact sport programs such as these; and I accept that the Connect Rugby league, Queensland Rugby League and National Rugby League (“NRL”) and its employees, board members, volunteers, players and agents will not be liable for any injuries or damages sustained by my child, myself, myself as a participant, or my child’s guardian in any way, in connection with and participation in, this program.

The personal information provided on this registration form, will be used by Connect Rugby League, Queensland Rugby League and NRL for general administration, communication within the running of this program and other matters of welfare relating to your yourself or your child’s participation in this program. The information will be stored securely and will not be provided to any third parties or used for any purposes other than those outlined.

Please note: As part of Connect Rugby League’s code of conduct, as we are working together to create a positive and supportive environment for our players, families and carers we would like to ensure we uphold a positive environment where we all communicate in a positive way to ensure the best physical, social and emotional experiences for all.

Anyone wishing to promote their own or another service or business at our sessions please contact Connect Rugby League to confirm prior as we will be moving forward in offering further opportunities with other community organisations and services and wish to ensure there is no conflict of interest.

We thank you.

By my eSignature below, I certify that I have read, fully understand and accept all terms of the foregoing statement and conditions listed in the agreement above. Please signify your acceptance by entering your full name in the box below along with your signature and date.

REGISTRATION FEES MUST BE PAID THREE BUSINESS DAYS PRIOR TO THE FIRST SESSION to cover insurance.
Please advise us if you need assistance.

All VIP Guests will be contacted with further instruction.

Payment Information
Payment to Connect Rugby League.
Bank: Suncorp Bank
BSB: 484-799
Acc: 610 961 868
For our reference please use your surname and then first name.

Please email copy of direct deposit to connectrugbyleague@gmail.com to confirm payment.