ACT Junior Rugby Union Representative Player Registration Form
Name
First Name
Last Name
Gender
Please Select
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Age Grade
Under 12
Under 13 Boys
Under 14 Boys
Under 14 Girls
Under 15 Boys
Under 16 Boys
Under 16 Girls
Under 18 Girls
Rugby Club
Player Position
Player History
Please put any relevant player history including past representative squads and position in that squad
Jersey/Hoodie Size
eg. XS or L
Shorts Size
eg. XS or XXL
Socks Size
Please Select
Size 4-8
Size 7-9
Size 10-12
Size 12-14
Submit
Should be Empty: