Registration Form | Ridge Rugby Academy

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PLAYER REGISTRATION FORM

Section 1 - Player Information

Player First Name*

Player Last name*

Date of Birth*

Month

Day

Year

Age*

Gender*

Male

Female

Other

Section 2 - Parent/Guardian Information

Parent/Guardian Name*

Phone Number*

Email Address*

Section 3 - Emergency Contacts

Emergency Contact*

Emergency Contact Phone*

Section 4 - Address

Street Address*

City*

State*

Zip*

Section 5 - Rugby Experience

Experience Level*

Beginner (New to Rugby)

Intermediate

Advanced / Competitive

Previous Team / Club (if applicable)

Section 6 - CIPP/ID Information

CIPP Number (Rugby ID)*

Expiration Date*

Section 7 - Program Fees

Registration Type

Camps

Youth Camp - $TBD

Middle School Camp - $TBD

High School Camp - $TBD

Season Registration - $TBD

Add-Ons

Uniform Package - $TBD

Tournament Fees - $TBD

Equipment Fee - $TBD

Payment Method

Check (Mail to: PO Box 83, Sparta, MI 49345)

Cash

Venmo

Section 8 - Medical Information

Allergies or Medical Conditions*

None

Yes (please explain below)

Explanation

Section 9 - Waiver & Consent

Liability Waiver Agreement

I understand that participation in rugby includes inherent risks such as physical injury. I give permission for participation and agree to release and hold harmless Ridge Rugby Academy, its coaches, staff, and affiliates from any liability. I authorize emergency medical treatment if necessary.

I have read and agree to the waiver