Marvin Ridge Rugby Winter Registration 2024

Name

First NameMiddle Name

Name

Last NameSuffix

Date of Birth:*

MonthDayYear

School Attended:

Grade:*

Age as at Sept 1st, 2024:*

For Youth we will be U10, U12, U14 - that means 9 and under Sept 1 is U10, 11 and under Sept 1 is U12 and 13 and under Sept 1 is U14

Athlete's USA Rugby CIPP number:*

ALL PLAYERS NEED TO REGISTER DIRECTLY WITH USA RUGBY TO PRACTICE & PLAY.
This registration runs 12 months from Sept 1st 2024 to August 31st 2025 so will also cover Cardinals Spring seasons.

INSTRUCTIONS FOR REGISTERING WITH USA RUGBY:
- Go direct to Rugby Xplorer: https://auth.rugbyxplorer.com.au
- Returning Players - verify/update your details
- New Players - set up an account (SEE 'HOW TO' GUIDE ON WEBSITE)

REMEMBER:

- Select Charlotte Cardinals Rugby as your Club - this gives your athlete superior insurance to USA Rugbys.

- Pay $67.57 subscription directly to USA Rugby

- Enter USA Rugby ID/CIPP # above.

Gender:*

MaleFemaleOther

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Name:*

First NameLast Name

Parent phone number:*

Parent e-mail:*

example@example.com

Second optional e-mail:

example@example.com

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number

Jersey/T-shirt Size:*

Allergies/Medical Conditions/Medications? If yes, please describe.

REGISTRATION COST AND PAYMENT:

Registration is $325.00 for the Winter season. No charge for any U10 players.

This cost includes: Field rental for games and practices, game day jerseys and socks, custom fit mouthguard, warm up T-shirt or practice jersey (age dependant) all training equipment, referees, trainers/game day medic etc.

Scholarships and volunteer opportunities are available for players in need of financial assistance. Direct Message Coach Mitchell in confidence (704.698.7684) to discuss any support required - we are here to help young athletes.

Any player is welcome to try rugby. The athlete must be insured with USA Rugby to practice though, so the $67.57 to USA Rugby is non-refundable. If rugby is not for you, just let us know by Thanksgiving, and you will receive a full refund of the $325 Club Fee

Payment is via Zelle, Venmo or check - please indicate below which method of payment you have used.

Method of Payment:*

FOR ZELLE PAYMENTS PLEASE USE THE EMAIL:

marvinridgerugby@gmail.com

INFORMED CONSENT AND ACKNOWLEDGEMENT:

I ACKNOWLEDGE THAT BY SIGNING THIS DOCUMENT, I AM AGREEING TO RELEASE THE RELEASED PARTIES FROM LIABILITY. I HAVE THEREFORE BEEN ADVISED TO READ THIS DOCUMENT CAREFULLY BEFORE SIGNING IT.

I am the parent/legal guardian of the athlete (hereafter cited as “Athlete”) listed above. I give permission for the athlete to participate in all rugby camps/clinics/ tournaments/games/teams/leagues/practices/scrimmages.

Participation in the rugby activities, including but not limited to, warm-up, training, practice, games, clinics, travel, and social events, includes participation in a full-contact sport, requires good health and fitness and can be HAZARDOUS AND PRESENT POTENTIAL DANGER. The athlete is qualified to participate in the activities, and if at any time I deem the conditions to be unsafe or the athlete to be unfit to participate, it is my resposibility to immediately discontinue their further participation.

I fully understand that participation includes game play that involves risks and dangers and these risks and dangers may be caused by player action, inaction and/or the actions or inactions of others. I fully accept and assume all such risks and all responsibility of losses, costs, and damages incurred for such participation.

I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless all coaches, medical and training staff and personnel, agents, volunteers, officers, directors and other participants from all liability, claims, demands, losses, or damages on Player’s account caused or alleged to be caused in whole or in part by the negligence of the “Releasees” or otherwise, including negligent rescue operations and further agree that if, despite this release, I or anyone on my behalf makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE & HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE OR COSTS ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.

PHOTOGRAPHY RELEASE:

I also grant my authorization and consent for Marvin Ridge Rugby Club and/or affiliates to use any photos or videos of Player for any purpose including, but not limited to, promotional materials.

MEDICAL RELEASE AND AUTHORISATION:

I grant my authorization and consent for any Supervising Adult to administer general first aid treatment for any minor injuries or illnesses experienced by the Athlete. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Supervising Adult to summon any and all professional emergency personnel to attend, transport, and treat the participant and to issue consent for any X-Ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of, any physician, surgeon, dentist, hospital, or other medical professional or institution.

I agree to be responsible for any and all costs resulting from medical attention and/or treatment and I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless all coaches, medical and training staff and personnel, agents, volunteers, officers, directors, and other participants from all liability, claims demands, losses or damages on Athlete’s account.

It is understood that this authorization is given in advance of any such medical treatment, but is given to provide authority and power on the part of the Supervising Adult in the exercise of his or her best judgment upon the advice of any such medical or emergency personnel. The Consent to Medical Treatment of a Minor is effective at the time of consent by my signature.

I HAVE READ AND AGREE TO ALL OF THE ABOVE STATEMENTS.

PARENT/GUARDIAN NAME

PARENT/GUARDIAN SIGNATURE:

Date

MARVIN RIDGE RUGBY REGISTRATION