2019 Simsbury Rugby Summer Youth Program
Event Timing: Tues./Thurs From 6/25 - 8/1
Event Address: Simsbury High School Turf Field
34 Farms Village Rd, Simsbury, CT 06070
Contact us: simsburyrugbyboosters@gmail.com
Participant First Name *
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Participant Last Name *
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Participant Date of Birth: *
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Participant Gender: *
Parent/Guardian 1 Relation *
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Parent/Guardian 1 First Name *
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Parent/Guardian 1 Last Name *
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Parent/Guardian 1 Email *
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Parent/Guardian 1 Primary Phone Number *
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Parent/Guardian 1 Secondary Phone Number *
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Parent/Guardian 2 Relation
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Parent/Guardian 2 First Name
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Parent/Guardian 2 Last Name
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Parent/Guardian 2 email:
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Parent/Guardian 2 Primary Phone Number:
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Parent/Guardian 2 Secondary Phone Number:
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What grade will the participant be in during September 2019? *
Participant T-Shirt Size *
Dietary restrictions *
List all allergies your child has: *
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I understand that I will have to pay $75 by check made out to Simsbury Rugby Club upon arrival to the first session. *
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While every precaution is taken by Simsbury Rugby Club 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 Simsbury 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. *
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