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

Participant First Name *

Your answer

Participant Last Name *

Your answer

Participant Date of Birth: *

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

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