Panther Rugby Academy Sept. 2024 - Aug. 2025 Player Registration
Player's Name
*
First Name
Last Name
USA ID Number (from USA Rugby)
*
You must be a USA Rugby Member to participate in all PRA Events. If you do not have a current USA Rugby membership, then 1. Go to USARugby.org. 2. Click on MEMBERS at the top. 3. Click REGISTER. 4. Create an account with Rugby Xplorer. 5. Click on "Find a Club." 6. a. If you are a Youth/HS Player, enter: Panther Rugby Academy - U18 b. If you are a U23 Player (age 19-23), enter: At Large - College
Player Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Player Date of Birth
*
/
Month
/
Day
Year
Date
Email for registration confirmation and that you check often:
*
Player's Email
*
example@example.com
Player's Instagram ID
@exampleID
Player's Cell
*
Please enter a valid phone number.
Player's gender for the team they will play with:
*
Please Select
Male
Female
Adult Shirt Size / Jersey Size
*
Please Select
XS
S
M
L
XL
2XL
3XL
The above sizes are Adult Unisex
Adult Short Size
*
Please Select
XSmall
Small
Medium
Large
X Large
2XL
The above sizes are Adult Unisex
Weight in lbs.
*
Height
*
Example: 5' 7''
Rugby
Current Rugby Club
*
Rugby Club Coach's Name
*
Rugby Coach's Email
*
example@example.com
Years Played Rugby
*
Education
School Name
*
Grade
*
Please Select
4th
5th
6th
7th
8th
9th
10th
11th
12th
College Freshman
College Sophomore
College Junior
College Senior
N/A
What year will you graduate from High School
*
College player's input N/A
Parent/Guardian Information
Parent/Guardian 1 Name
*
First Name
Last Name
Parent/Guardian 1 Email
*
example@example.com
Parent/Guardian 1 Cell
*
Please enter a valid phone number.
Parent/Guardian 2
First Name
Last Name
Parent/Guardian 2 Email (please don't repeat above emails)
example@example.com
Parent/Guardian 2 Cell (please don't repeat above cell #'s)
Please enter a valid phone number.
Emergency Contact if different from Parent/Guardian 1 or 2
First Name
Last Name
Emergency Contact cell if different from Parent/Guardian 1 or 2
Please enter a valid phone number.
Insurance
If said participant is covered by any insurance company, please complete the following:
Medical Insurance Company
Medical Insurance Policy Holder
Medical Insurance Policy Number
Medical Insurance Group Number
Medical Insurance Phone Number
Medical History
If the answer to any of the following questions (below), is yes, please describe the problem and its implications for proper first aid treatment.
Does the player have any allergies that we need to be aware of?
*
Yes
NO
Please explain allergies:
Does the player have any other medical conditions that we need to be aware of?
*
Yes
No
Please Explain medical conditions:
I/We have read, understand and agree to comply with the Waivers as outlined above.
*
Yes
No
Player Signature
*
Parent/Guardian for participant under age 18 at the time of registration
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Submit
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