U16 & U18 Talent ID Registration

Participant Information

Participant's Name *

First Name Last Name

Birthday *

Date

Gender *

Male Female Nonbinary

Height

Weight [lbs]

What team/club are you affiliated with?

What is your preferred/primary position? *

What is your secondary position?

Please list any rugby accolades, awards, and/or achievements you have earned

Championships, MVPs, select-side appearances, scholarships, etc.

I am planning to attend the following: *

April 10th - Boys April 10th - Girls April 16th - Girls Rugby WA Curtain Raiser Matches April 17th - Boys

Parent/Guardian Information

Name *

First Name Last Name

Cell Number *

E-mail *

example@example.com

Emergency Information

Emergency Contact's Name *

First Name Last Name

Relationship *

Phone Number *

Alt. Phone Number

Does the player have any allergies, chronic illness, asthma, or medical conditions coaches should be prepared for? If yes, please describe.

Informed Consent and Acknowledgement Recognizing the possibility of injury or illness, and in consideration for members of the Seattle Seawolves accepting my athlete as a player in rugby programs and activities of the Seattle Seawolves and its members (the "Program"), I consent to my athlete's participating in the Program. Further, I hereby release, discharge, and otherwise indemnify the Seattle Seawolves, its member organizations and sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the Program, against any claim by or on behalf of my athlete as a result of my athlete's participation in the Program.

Medical Release and Authorization As Parent and/or Guardian of the named participant, I hereby authorize the treatment by a qualified medical professional, of the minor child, in the event of a medical emergency. In the event of an emergency arising out of serious illness or significant accidental injury, I understand that every attempt will be made by the staff to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the the Seattle Seawolves and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Media Release and Authorization The Seattle Seawolves and Rugby Washington have my permission to use my or my child’s photograph or other media images such as videos publically to promote The Seattle Seawolve’s programs. I understand that the images and videos may be used in print publications, online publications, presentations, websites, and for social media purposes. I also understand and agree that no royalty, fee or other compensation shall become payable to me by reason of such use.

Confirmation BY ACKNOWLEDGING AND SUBMITTING THIS FORM, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Payment *

U16 & U18 Registration

$ 10.00

Total

$ 0.00

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

U16 & U18 Seawolves Talent ID Registration