Girls Fall Clinic Registration

Rugby Washington is hosting 2 development clinics to kick off the Fall season! These camps will be lead by local women's players and coaches to prep athletes before they take the field this 7s season. No experience is necessary, however players who participate in these clinics will have some level of experience and/or already with a team for the Fall season.

Once you have filled out this committment to attend each clinic, you will receive additional logistic information including what to bring, who will be coaching, what skills will be highlighted, etc.

September 14th

What: Attack Focused Clinic

Where: Pat Ryan [1809 S 140th St, Seattle, WA 98168]

When: 10:00 AM - 12:30 PM

Who: U15 and High School Girls Players

September 21st

What: Defense/Contact Focused Clinic

Where: DeWilde Rugby Fields [7090 Dahlberg Rd, Ferndale, WA 98248]

When: 12:00 PM - 2:30 PM

Who: U15 and High School Girls Players

*This form is meant to provide availability and check attendance specifically for the two camps. It is different than registering for a team/club. You will still need to register with Rugby Xplorer if you are playing in the Fall. Please reach out to your home coaches/admins for assistance, if needed.*

Player Name*

First NameLast Name

Age*

Grade

Parent E-mail*

example@example.com

Player E-mail

Leave blank if none

Parent Number*

Address

Street Address

Street Address Line 2

City

Postal / Zip Code

How much experience does the player have in rugby?*

No Previous Experience1 Season2-3 Seasons3+ Seasons

Which Team/Club are you registered?*

If Other, please specify

I will be attending*

September 14th Camp at Pat RyanSeptember 21st Camp at DeWilde Rugby FieldsBoth Camps

Emergency Contact Information

Emergency Contact Name*

First NameLast Name

Emergency Contact Relation*

Emergency Contact Number*

Please explain any details of the player that would be important for coaches/staff to know in regards to player safety. Leave blank if none.

i.e: Severe allergies, medical conditions, no photos allowed, etc.

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Rugby Washington during the selected camp. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Rugby Washington and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of participating in selected camp sessions. There is a risk of being injured that is inherent in all sports activities. In case of injury to said child, I hereby waive all claims against Rugby Washington including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

Medical Release and Authorization As Parent and/or Guardian of the named player, I hereby authorize the treatment by a qualified professional, of the minor child, in the event of a medical emergency, which requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made 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 Rugby Washington 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, if required. 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.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, 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.