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Please select the form you would like to complete

Please note that if you wish to complete the 'Junior Playing Member Form' then a parent or guardian will also be required to complete the 'Ordinary Member Form'

Junior Playing Member

Fields marked with a * are required

Senior Playing Member

Fields marked with a * are required

Ordinary Member

Fields marked with a * are required

Junior Playing Member (under 19 on 1st Jan of year of joining)

Given Name
Family Name
Gender
Date of Birth
IC / Passport Number
Nationality
Parent's Mobile Phone (1)
Parent's Mobile Phone (2)
Home Phone
Player's Email
Mother's Name
Father's Name
Parent's Email (1)
Parent's Email (2)
Player's Mobile Phone
Emergency Contact Name
Emergency Contact Phone

PARENT DECLARATION:

I, , the parent / guardian * of the above player give my consent to their membership of the Club and declare that:
a. The player will participate in the activities of the Club at their own risk
b. Neither myself, nor the player will hold the Club or any of its members or officers liable for:
(i) Any injury suffered by the player or by any other person; or
(ii) Any loss of, or damage to, any of the player's or any other person's property, in connection with the player's participation in the activities of the Club
c. The above information is true and accurate
d. The player will abide by the constitution of the Club and any bye-laws, rules or regulations issued by the Club from time to time
e. At Club training and events the Club attend, a parent / guardian will be present or will arrange with the parent / guardian of another player to be responsible for the player
f. The player acknowledges that the Club recommends the use of a mouth guard at all time
g. I agree that the club will use information provided in accordance with prevailing regulations on data protection & usage in Malaysia

* Delete as applicable

Date of Membership
21, November, 2017
Membership Number

KL Saracens Rugby Club
c/o Hartamas Regency 1, Unit 12-3-6, Persiaran Dutamas, 50480 Kuala Lumpur, Malaysia
www.kl-saracens.com

Ordinary Member (Parent / Guardian of Junior Playing Member)

Given Name
Family Name
Nationality
Email
Home Phone
Mobile Phone

MEMBER DECLARATION:

I, , declare that:
a. I will participate in the activities of the Club at my own risk
b. I will not hold the Club or any of its members or officers liable for:
(i) Any injury suffered by myself or by any other person; or
(ii) Any loss of, or damage to, any of any other person's property, in connection with the my participation in the activities of the Club
c. The above information is true and accurate
d. I will abide by the constitution of the Club and any bye-laws, rules or regulations issued by the Club from time to time
e. I agree that the club will use information provided in accordance with prevailing regulations on data protection & usage in Malaysia

Date of Membership
21, November, 2017
Membership Number

KL Saracens Rugby Club
c/o Hartamas Regency 1, Unit 12-3-6, Persiaran Dutamas, 50480 Kuala Lumpur, Malaysia
www.kl-saracens.com