2016/17 APPLICATION FORM Under-18 Player in Adult Rugby (Male) CLUB PLAYERS ONLY COMPLETED FORM TO BE SUBMITTED TO SHONA STOTT, SCOTTISH RUGBY, BT MURRAYFIELD STADIUM, EDINBURGH, EH12 5PJ.

ALL SECTIONS OF THE FORM ARE COMPULSORY

PLAYER (please complete all fields and print clearly) Name:

Club:

Date of Birth:

Current Age: (only 17 yr olds can apply)

Height:

Weight:

Playing Position:

Competition: Premier League, National League, Regional League, Reserve, 7s, 10s (Please circle) Cleared last season: Yes / No

Senior Level to be Played: 1XV 2XV 3XV (Please circle)

Representative History: National/Regional U16/U18/U20 (Please circle) World Rugby Online Rugby Ready award date: (Please attach certificate) I have read and understood the Under-18 Player in Adult Rugby policy, have undergone the pre-application assessments, and completed the World Rugby online Rugby Ready test. I believe that my physical development, skill level experience and medical condition are sufficiently high that I am capable of competing safely with players in the proposed game/competition. I understand that I will be competing against older players and this may involve an increased level of injury risk. I am not aware of any medical reason why my application to move into senior rugby may not be safely approved. Signature: ________________________________ Print Name: ______________________________

Date: ______________________

COACH (please complete all fields and print clearly) This is the person who undertakes the pre-application assessment Name:

Online RugbyRight date:

Email:

UKCC Qualification (please circle)

Telephone:

Strength & Conditioning Qualifications:

[2] [3]

Other relevant qualifications (please note)

Did the player meet the pre-application assessment criteria? YES / NO (please circle) Coach Name :

Date:

Signature:

Qualification:

REASON FOR APPLICATION Please provide a brief statement giving the reasons for this application. How approval would assist in this player’s rugby development? -

How will the introduction to the senior game be managed? –

How much U18 rugby has the player played, last season/this season? –

Is the player on an S&C programme? How often does he go to the gym/week? Any other relevant information -

COACH TO ASSESS THE PLAYER AGAINST THE FOLLOWING CONSIDERATIONS. If the answer is NO to any of these considerations, then the player shall NOT be considered capable of competing safely with players in the proposed game/competition (with the exception of the last point).

Please Circle

Physical Development:

In your opinion does the player’s level of physical development allow the player to safely compete with players in the proposed game/competition?

YES

NO

Skill Level:

In your opinion is the player’s skill level comparable with other players in the proposed game/competition (including skills specific to their playing position and in relation to the game’s fundamentals e.g. tackle, pass, ruck, maul, scrum etc)?

YES

NO

YES

NO

YES

NO

YES

NO

Level of Experience:

In your opinion does the player have the experience to compete with other players in the senior rugby competition? The following factors are considered – representative/ pathway rugby; performance within his age group and; has the player trained with senior players in a controlled environment?.

Standard of Competition:

In your opinion is the standard of competition in the proposed game/competition suitable to allow the player to compete safely?

Medical condition:

Does the player have any history of serious injury while taking part in rugby? If yes, please give brief details.

Medical condition explanation:

COACH/TEACHER DECLARATION I have read and understood the Under-18 Player in Senior Rugby policy, and completed the online RugbyRight test. In my opinion, the player’s physical maturity, skill level experience and medical condition are sufficiently high that he is capable of competing safely with players in the proposed senior rugby competition. I have explained to the player and his parent or guardian that he will be competing against older players and this may involve an increased level of injury risk. Signature:

Date:

_______________________________________

Print Name: ________________________________

CLUB PRESIDENT (OR OTHER RELEVANT CLUB OFFICE BEARER) DECLARATION Please make sure that you are familiar and agree with the following: 

I have been provided with a copy of Scottish Rugby’s Under-18 Players in Senior Rugby policy;



The coach has explained to me that, in his/her opinion, the player’s physical development, skill level experience and medical condition is sufficiently high that he is capable of competing safely with players in senior rugby;



I am aware of the additional considerations for front row players;



It has been explained to me that the risk of injury may be increased by the player playing in the proposed senior rugby competition; and



I understand that rugby is a contact sport and, like all contact sports, players are exposed to risk of injury. I also understand that the level of risk may be heightened where a player participates in senior rugby in circumstances where the player’s physical development, skill level and experience are inferior to that of the players he will play against.

Signature:

Date:

_______________________________________

Print Name: ________________________________

PARENT/LEGAL GUARDIAN – Please discuss with the player parent or guardian prior to application Please make sure that you are familiar and agree with the following: 

I am a parent or legal guardian of the above-mentioned player;



I have been provided with a copy of Scottish Rugby’s Under-18 Players in Senior Rugby policy;



The coach has explained to me that in his/her opinion, the player’s physical development, skill level experience and medical condition is sufficiently high that he is capable of competing safely with players in senior rugby;



I am aware of the additional considerations for front row players;



It has been explained to me that the risk of injury may be increased by the player competing in the proposed senior rugby competition; and



I understand that rugby is a contact sport and, like all contact sports, players are exposed to risk of injury. I also understand that the level of risk may be heightened where a player participates in senior rugby in circumstances where the player’s physical development, skill level and experience are inferior to that of the players he or she will play against.

NO PARENT/GUARDIAN SIGNATURE REQUIRED

SCOTTISH RUGBY DECLARATION – (SRU Office use only) I confirm that:

a) The information submitted above complies with Scottish Rugby’s Under-18 Player in Senior Rugby policy. b) The player has been deemed capable of playing senior rugby by the relevant regional panel.

Signature: Notes:

Date: _________________

FRONT ROW EXCEPTION FORM – Under-18 Players in Adult Rugby (male players) COMPLETED FORM TO BE SUBMITTED TO SHONA STOTT, SCOTTISH RUGBY, BT MURRAYFIELD STADIUM, EDINBURGH, EH12 5PJ.

A player 17 years of age wishing to participate in adult rugby in the front row (prop or hooker) must also apply for approval from Scottish Rugby prior to participation in adult rugby. The player may not play in the front row in senior rugby (XVs, 10s or 7s) until his neck strength has been tested by a Scottish Rugby Union approved medical practitioner and Scottish Rugby approval has been received. The coach and player must comply with the Under-18 Players in Adult Rugby policy, and complete the Under-18 Players in Senior Rugby application form along with this Front Row Exception form. Medical studies support that players in the front row (prop or hooker) are exposed to a higher level of serious injury than players in other positions.

Playing experience and level Please enter the number of years’ experience playing in the front row: ___________________ Did you play in the front row last year? YES or NO (circle) If No, please state why not: _____________________________________________________________ Level of rugby played at in the front row (e.g. representative/pathway): ___________________________ School/club team: _______________________________________________________________________ Level of coaching and training received 1. Have you received any specialist front row coaching in the last two years? YES or NO (circle) If Yes please specify the details (e.g. what coaching, identify the coach and their level of qualification and experience etc): ____________________________________________________________________________ __________________________________________________________________________________________ 2.

Have you trained with senior players in the scrum? YES or NO (circle) If Yes, please specify the details: _________________________________________________________

Strength & Conditioning Do you undertake a regular strength program? YES or NO (circle) If Yes, how many times a week do you complete strength training? _________ per week How many years have you been completing a regular strength program? _______ years _______ months PLAYER I believe that my physical development, skill level and experience are sufficiently high that I am capable of competing safely in the front row with players in senior rugby. I understand that I will be competing against older players and this may involve an increased level of injury risk. Signature:

Date: ___________________________

Print Name: __________________________________ COACH In my opinion, the player’s physical development, skill level and experience is sufficiently high that the player is capable of competing safely in the front row with the players in the proposed senior rugby competition. I have explained to the player and his parent or guardian that the player will be competing against older players and this may involve an increased level of injury risk. Signature:

________________________________ Date: ___________________________

Print Name: ________________________________