Participant First Name *

Participant Last Name *

Participant Date of Birth: *

Participant Gender: *

Parent/Guardian 1 Relation *

Parent/Guardian 1 First Name *

Parent/Guardian 1 Last Name *

Parent/Guardian 1 Email *

Parent/Guardian 1 Primary Phone Number *

Parent/Guardian 1 Secondary Phone Number *

Parent/Guardian 2 Relation

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 email:

Parent/Guardian 2 Primary Phone Number:

Parent/Guardian 2 Secondary Phone Number:

What grade will the participant be in during September 2019? *

Participant T-Shirt Size *

Dietary restrictions *

List all allergies your child has: *

I understand that I will have to pay $65 by check made out to North Haven Rugby Club upon arrival to the first session. *

While every precaution is taken by North Haven Rugby to maintain a safe playing and training environment for its young players I accept that due to the nature of the sport that occasional injuries may occur and that will not be held responsible for these. I also accept that in the rare event of an injury occurring that treatment may be given by the club’s coaches who are trained in first aide. I agree to allow North Haven Rugby and others working with its authority, full and free use of photographic images containing the image / likeness of my children. I understand that these images may be used for promotional use, news, research and/or educational purposes in printed publications or on the club website. *