Registration Form

Member's Details (Player)

Member's Details (Player)*

Member's Surname / Family Name*

Member's Date of Birth*

Select your age group* Select Under 5 Mixed (DOB 01/09/14 – 31/08/15) Under 6 Mixed (DOB 01/09/13 - 31/08/14) Under 7 Mixed (DOB 01/09/12 - 31/08/13) Under 8 Mixed (DOB 0109/11 - 31/08/12) Under 9 Mixed (DOB 01/09/10 - 31/08/11) Under 10 Mixed (DOB 01/09/09 - 31/08/10) Under 11 Boys (DOB 01/09/08 - 31/08/09) Under 12 Boys (DOB 01/09/07 - 31/08/08) Under 13 Boys (DOB 01/09/06 - 31/08/07) Under 14 Boys (DOB 01/09/05 - 31/08/06) Under 15 Boys (DOB 01/09/04 - 31/08/05) Under 16 Boys (DOB 01/09/03 - 31/08/04) Under 19 Boys (DOB 01/09/01 - 31/08/03) Under 12 Girls (DOB 01/09/07 - 31/08/11) Under 15 Girls (DOB 01/09/04 - 31/08/07) Under 19 Girls (DOB 01/09/01 - 31/08/04) Adults Touch (Above 16 Years Old)

Gender* Select Male Female

Nationality *

School

Member's UAE Residence ID Number
If you do not have a UAE Residence ID, please state 'in progress' *

Member's Passport Number*

Member's UAE Residence Visa Number
If you do not have a UAE Residence Visa, please state 'in progress'*

Existing Medical conditions

Does the Member suffer from any existing medical conditions that we should know about, such as any organ conditions like heart or kidney problems, or other ailments such as asthma or allergies etc?* Select Yes No

Details of Existing Medical Conditions
If you answered the provious question 'yes'

Member's Medical Insurance Declaration

Our club policy is for all members to hold private medical insurance valid in the UAE. By checking this box, I confirm that the Member has valid medical insurance for treatment from injuries that may arise from participating in sports programs with Warriors.*:

Member's Images for Advertising Purposes

I grant permission to Warriors to use the Player’s image or likeness or voice for the promotion of Warriors including but not limited to any photographs, live or recorded television, electronic transmission, video display, internet, radio, or any other transmission or reproduction. All photos and videos and recordings are the sole property of Warriors.*:

Parents' / Guardians' Details

Primary Contact - Parent / Guardian's Details

Primary Parent / Guardian's Full Name
The Primary Parent / Guardian will be the initial contact we use for communication.*

Primary Contact Mobile Number*

Primary Contact Email Address*

Can the Primary Contact help?

The club is run by volunteers, can you help by providing assistance in any form?
I would like to be a Coach First Aider or Age Group / Squad Manager I can help organise Club Events I can help with acquiring Club Sponsorship I can help on the Club Committee There are other ways I can help please contact me.

Second Contact - Parent / Guardian's Details

Second Parent / Guardian's Full Name*

Second Contact Mobile Number*

Second Contact Email Address*

Can the Secondary Contact help?

The club is run by volunteers, can you help by providing assistance in any form?
I would like to be a Coach First Aider or Age Group / Squad Manager I can help organise Club Events I can help with acquiring Club Sponsorship I can help on the Club Committee There are other ways I can help please contact me.

Membership Fees and Discounts

Warriors Rugby Membership Fees

Select the Member's age group fee band from below, which should correspond with the age group selected earlier on the form.* Select Tag Rugby Under 5 - Under 8: Fee AED 900 Junior Rugby Under 9 - Under 13: Fee AED 2000 Youth Rugby Under 14 - Under 16: Fee AED 2000 Girls Ripper Rugby Under 12 / Under 15: Fee AED 1700 Girls Contact Rugby Under 19: Fee AED 2000 Boys Under 19: Fee 1200 AED Adults Touch: Fee 900 AED

Sibling Discount Claimed

The first (oldest) member will pay the full membership rate and any subsequent sibling member is entitled to receive a discount of AED150 off their respective fee. Not available for U5 to U8 Select First / Oldest Member - No Sibling Discount Applies A Sibling Discount is due but I would like to donate it back to the club Sibling Member Discount of AED150 Claimed

Oldest Sibling's Details - Full Name

If you are claiming a Sibling Discount for this member, please enter the oldest member's Full Name so we can check it against our records. Remember, the oldest member pays full rate, only younger siblings of a full paying member may claim a Sibling Discount. Not available for U5-U8

How will you be paying your Fees that are due?* Select BY BANK TRANSFER - ACCOUNT NAME: Warriors Sports Trading LLC; IBAN: AE230400000352463710001; SWIFT: NRAKAEAK; BANK: RAKBANK; - Include the member name and age group in the transfer details field BY CHEQUE - MADE PAYABLE TO 'WARRIORS SPORTS TRADING LLC BY CASH

Indemnity and Waiver of Liability

Please read the below and confirm the terms at the end.*

I, the undersigned, fully understand that Activities (rugby, cricket, netball, football, basketball, commando fitness, dodgeball, hockey, boxing, birthday parties, and similar such sports and training activities) are physically, mentally, socially and emotionally demanding and potentially severe injuries, permanent paralysis, brain damage, or death, can occur from Activities or merely being in the same vicinity as Activities while not participating, and protective equipment does not prevent all injuries. Additional risks include being struck by errant or misdirected balls and bats, loss or damage of personal property, slipping, falling, falling objects, colliding with others or equipment, or suffering of any type of accident or illness. Further risks include that Warriors Sports Trading LLC, (Warriors), its’ staff, volunteers and independent contractors might be unaware of Player’s health or ability and might give incomplete warnings or instructions, and the equipment being used might malfunction. Activities entail both known and unanticipated risks that cannot be eliminated without jeopardizing the essential qualities of the Activities. All risks and dangers may be caused by Player’s own actions, or inactions, the actions or inactions of others participating in Activities, or the negligence of Warriors, its members, officers, directors, employees, agents, independent contractors, or other representatives, whether paid or volunteer. Being fully aware of these dangers and in consideration of being permitted to participate in Activities, Player (or if Player is a minor, then both Player and the parent or guardian signing on behalf of Player) does hereby release Warriors, its members, officers, directors, employees, attorneys, agents, independent contractors, affiliates, heirs, executors, successors, and assigns (collectively Releasees) from all liability of Releasees for any physical injury, death, illness, or damage to property that results, directly or indirectly from the use of Property by Player and Player’s guests or invitees in conducting such Activities. I further assume all risks of Player using the Property and engaging in Activities and agree to indemnify, save and hold Releasees harmless from any claims, loss, liability, attorneys’ fees, damage, or costs that Releasees (or any of them) may incur arising out of or related to the use of Property or engagement in Activities by Player or a guest or invitee of Player, whether caused by the negligence or breach of contract or strict liability of the Releasees or otherwise. This release and indemnification agreement includes any and all claims, demands, debts, contracts, costs, loss of services, expenses and compensation, actions, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that Player had or may have, arising from or in any way related to use of the Property or engagement in Activities by Player or Player’s guest or invitee. I acknowledge and agree Player has a personal duty and responsibility to learn and follow the safety guidelines established by Warriors staff and will make Warriors aware at any point if Player questions his knowledge of these guidelines, or his ability to participate. I declare, warrant and represent that Player’s participation in Activities is purely voluntary and Player elects to participate in spite of the risks and furthermore I assume the risk of any medical or physical or mental condition he may have. I grant permission to Warriors to use the Player’s image or likeness or voice for the promotion of Warriors including but not limited to any photographs, live or recorded television, electronic transmission, video display, internet, radio, or any other transmission or reproduction. All photos and videos and recordings are the sole property of Warriors. I confirm that Player is in good health, and has medical insurance and will provide coverage while he or she is on the Property. I fully understand that Warriors staff are not physicians or medical practitioners of any kind. With the above in mind, I release Warriors staff to render first aid to Player in the event of any perceived injury or illness, and if deemed necessary by Warriors staff to seek medical and/or dental help, including transportation by a Warriors staff member, or its representatives, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance for Player if Warriors staff deem this to be advisable and further consent to any x-ray, exam, and medical and/or dental or surgical diagnosis that is deemed necessary in case of emergency. I hereby release, discharge and covenant not to sue for any negligent medical and/or dental efforts expended on behalf of Player. Additionally, I hereby agree to individually provide for all possible future medical and/or dental expenses that may be incurred by Player as a result of any injury sustained while at the Property, whether or not participating in Activities. I will pay to Warriors all costs and expenses, including reasonable attorneys’ fees, incurred by Warriors in any action or proceeding or settlement, even without a suit having been filed, to which Warriors may be made a party by reason of Player’s use of the Property. Warriors may periodically send Player and me information about programs and events and promotions via Email at the address(es) provided above. Warriors will keep the Email address(es) private and not sell or share it with any other party without a court order. Player and me may unsubscribe to Email from Warriors at any time. The invalidity of any portion of this Agreement shall not affect the force or effect of its remaining portions. In this Agreement, any reference to a party includes that party’s parents, legal guardians, spouse, children, heirs, estate, executors, administrators, successors and assigns, and the singular includes the plural and the masculine includes the feminine.

I confirm I have read, understand and agree to the terms of the Indemnity and Waiver of Liability above*: