2019 North Haven Summer Youth Program
Event Timing: M/W From 6/24 - 7/31
Event Address: North Haven Recreation Fields
7 Linsley St, North Haven, CT 06473
Contact us:
Northhavenrugby@gmail.com
Or Northhavenrugby.com
* Required
Participant First Name
*
Your answer
Participant Last Name
*
Your answer
Participant Date of Birth:
*
MM
/
DD
/
YYYY
Participant Gender:
*
Female
Male
Other:
Parent/Guardian 1 Relation
*
Your answer
Parent/Guardian 1 First Name
*
Your answer
Parent/Guardian 1 Last Name
*
Your answer
Parent/Guardian 1 Email
*
Your answer
Parent/Guardian 1 Primary Phone Number
*
Your answer
Parent/Guardian 1 Secondary Phone Number
*
Your answer
Parent/Guardian 2 Relation
Your answer
Parent/Guardian 2 First Name
Your answer
Parent/Guardian 2 Last Name
Your answer
Parent/Guardian 2 email:
Your answer
Parent/Guardian 2 Primary Phone Number:
Your answer
Parent/Guardian 2 Secondary Phone Number:
Your answer
What grade will the participant be in during September 2019?
*
Fourth
Fifth
Sixth
Seventh
Eighth
Ninth
Participant T-Shirt Size
*
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Dietary restrictions
*
None
Vegetarian
Vegan
Kosher
Gluten-free
Other:
List all allergies your child has:
*
Your answer
I understand that I will have to pay $65 by check made out to North Haven Rugby Club upon arrival to the first session.
*
Yes
Required
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.
*
Yes
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms