Talent ID Camp

Giltinis Talent ID Camp

Ages 19-26
APPLICANT INFORMATION
Full Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth*

MonthDayYear
USA Rugby CIPP Number*
Height (feet/inches)*
Weight (pounds)*
Shirt Size
1st Choice Position
2nd Choice Position
Current Club/School
Current Coach's Name
Do you have health Insurance Coverage?*

YesNo
If 'yes' then please provide name of provider
Do you have any disabilites (learning or physical)?

YesNo
If yes, please describe (if comfortable)
EMERGENCY CONTACT INFORMATION
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
EDUCATION INFORMATION
High School or college*
Have you graduated high school/college?

YesNoCurrently attending
Discuss your goals, values and reasons for attending the Giltinis Talent Identification Camp
Camp Location

Camp Registration Fee*

Registration Fee$79.00

Enter coupon

Total $0.00

Proof of Vaccine (or need to show negative covid test within 48 hours of camp date)

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Giltinis Talent ID Camp