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?
If 'yes' then please provide name of provider
Do you have any disabilites (learning or physical)?
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?
Discuss your goals, values and reasons for attending the Giltinis Talent Identification Camp
Camp Location

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