ACT Brumbies U16 Boys Open Trial Registration
Please use this form to register you or your child for the upcoming ACT Brumbies U16 Super Rugby Program. The open trial will be held on Saturday 19th of July at 1:00 PM, Brumbies HQ in Canberra and is open to all ACT&SNSW players born in either 2010 or 2011.
Name of Player
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent or Guardian Email
*
example@example.com
Emergency Contact
*
First Name
Last Name
Emergency Contact Number
*
Relationship of Emergency Contact
*
Rugby Club/School
*
Primary Playing Position
*
Please Select
Prop
Hooker
Lock
Flanker
No.8
Halfback
Flyhalf
Centre
Wing
Fullback
Secondary Playing Position
*
Please Select
Prop
Hooker
Lock
Flanker
No.8
Halfback
Flyhalf
Centre
Wing
Fullback
Relevant Representative History
*
Submit
Should be Empty: