Junior Colts Membership Page

Sign Up Form

Please complete the following form to sign up for the Lymm Rugby Junior Colts 2017-18 season. Once completed, please pay subscription fee (see below) by cheque, cash or funds transfer.

Subscription fees must be paid by October 1st 2017. Any members joining later in the season must pay the subscription fee with-in 4 weeks of starting

Parent / Guardian Name (1)*

Parent / Guardian Name (2)*

Both the above-named parents are entitled to free membership of the Lymm RFC Supporters' Club which is part of Lymm Beechwood Limited.

Child / Player Name*

Child / Player DOB*

Child / Player School*

Medical Conditions *
In case of an emergency we need to know of any allergies or existing medical conditions your child may have. Please list anything here:


Home Phone Number

Email Address


£140* (1st child)
£70 (2nd child)
£30 (Additional children)
*£35 of the subscription will be passed on as a donation to The Lymm Grass Roots Clubhouse Appeal

Once you have completed this form, please make payments to the club in the following way:

Bank Transfer:
Acc: 70514799
Sort: 209148
Ref: Surname & Age Group

Cheques payable to LYMM RFC JUNIOR & MINI SECTION.
Ref on the back: Surname & Age Group.

Cash & Cheque: Please place in an envelope with surname & age group and hand to the club bar for the attention of Andy Leach.

If you are paying for more than 1 child, then a membership form needs to be completed for each child in each individual age group membership page e.g. Child 1 Age 7, complete Under 7 membership form. Child 2 Age 10 complete Under 10 membership form.
Payment however can be a single transaction (Bank Transfer, Cheque or cash) but reference both Age Groups e.g. Smith Under 7 & 10

Email andywleach@aol.com to advise of transfer.

DATA PROTECTION ACT: I acknowledge that I am aware of the purpose for which the data set out above is to be held, used or disclosed by the RFU and that I consent to the holding, use or disclosure of such data.

CODE OF CONDUCT: I acknowledge receipt of a copy of this document and agree to abide by its contents.

FIRST AID: I consent to first aid being given to my child in case of emergency.

PHOTOGRAPHY: I consent to the photographing/videoing and publication of images of my child under the RFU’s Policy and Procedures for the Protection of Young People in Rugby Union.

Form submitted/signed by*

If you wish to register manually, please download a copy of the membership form from here and when completed hand in to your Age Group Head Coach