Rugby Indiana New Team Application

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Welcome to Rugby Indiana. The Indiana Youth Rugby Foundation (dba “Rugby Indiana”) supports amateur athletics with a geographical preference for Indiana and with particular emphasis on youth rugby football as played by primary and secondary male and female students. The Foundation believes that youth rugby is uniquely suited to instill social skills including teamwork, fair play, self discipline, respect for authority, and individual leadership within a safe, enjoyable and competitive recreational sports experience.

Our mission is to promote sportsmanship, character development, leadership and physical fitness by providing an exciting, all-inclusive, team sport in a safe environment.

Rugby Indiana provides leadership, development capacity and expertise to all Youth/HS Rugby constituents. It is designed to foster the growth of Youth/HS Rugby in geographically and economically diverse communities. Our game development philosophy is to promote across Indiana a safe and educational rugby experience for all participants, age 5 to 18 (2-12) in recreational and competitive settings.

We appreciate your interest in creating a new Rugby team, this will be a rewarding experience for you and your team. Thank you for your contribution to the growth of the game and your dedication to your community’s youth. Please complete the following Team membership application.

If you have questions please contact Wayne Eells / WEells@RugbyIndiana.com / 317.727.8651

***Please complete this form to the best of your ability. We realize at the early stages of developing a new team that all the pieces are not in place yet. The listed roles and tasks are essential for the foundation of a successful club. Rugby Indiana exists to help you along the way in this process.

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Team Name:* This field is required.

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Club Declaration (Check all that apply)* This field is required.

Youth Non-Contact Rookie Rugby - Community (No travel): Grades 2-8, Coed

Youth Non-Contact Rookie Rugby Spring Travel Season: Grades 2-4, Coed

Youth Contact Rugby Spring Travel Season: Grades 5-6, Coed

Youth Contact Rugby Spring 7s Travel Season: Grades 7-8, Girls

Youth Contact Rugby Spring Travel Season: Grades 7-8, Boys

High School Tackle Rugby Spring 15s Travel Season: Grades 9-12, Girls

High School Tackle Rugby Spring 15s Travel Season: Grades 9-12 Boys

High School Tackle Rugby Fall 7s Travel Season: Grades 9-12 Girls

High School Tackle Rugby Fall 7s Travel Season: Grades 9-12 Boys

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Coaching Staff:

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Head Coach Name* This field is required.

First Name

Last Name

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Head Coach E-mail* This field is required.

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Head Coach Phone Number* This field is required.

Area Code

Phone Number

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Head Coach Previous Coaching Experience, Training & Certifications* This field is required.

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Assistant Coach Name

First Name

Last Name

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Assistant Coach E-mail

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Phone Number

Area Code

Phone Number

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Assistant Coach Previous Coaching Experience

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Team Officers

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President

First Name

Last Name

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President E-mail

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Treasurer

First Name

Last Name

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Treasurer E-mail

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Secretary

First Name

Last Name

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Secretary E-mail

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Are your coaches willing to complete WR/USA Rugby Level 1 Coach training?* This field is required.

Yes

No

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Are any of your coaches registered with USA Rugby as a coach?* This field is required.

Yes

No

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Have you identified a practice/game field?* This field is required.

Yes

No

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If yes, what is the location of the field?

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Have you established a relationship with your community school?* This field is required.

Yes

No

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Do you have access to Certified Athletic Trainers* This field is required.

Yes

No

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Have you identified someone willing to become certified as a referee?* This field is required.

Yes

No

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If yes, please list name.

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Have you identified volunteers willing to assist in recruiting players? Example: PE Demos, community clinics, after-school programs, club fairs* This field is required.

Yes

No

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Do you have a pre-season meeting scheduled. * This field is required.

Yes

No

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If yes, what is the date?

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What events do you have planned to promote rugby in your community?

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How do you plan to recruit new members to secure your club's future?

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What fundraisers do you have planned?

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What are your club's goals for the next 3 years?

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RUGBY INDIANA NONDISCRIMINATION POLICY
In compliance with the nondiscrimination laws of the United States and any state in the United States, Rugby Indiana shall conduct all its operations and programs without regards to age, sexual orientation, national origin, race,gender, political affiliation or religion. Accordingly, by applying for membership, you affirmatively certify that you adopt Rugby Indiana’s nondiscrimination policy in conducting all your operations and programs.
WAIVER OF ELIGIBILITY AND LIABILITY
The undersigned representative (accountable for entire applying organization) states: To the best of my knowledge and belief, every individual in our organization is eligible or will be eligible by the beginning of the competitive season under USA Rugby Guidelines (CIPP registered) to participate in this activity. To the best of my knowledge and belief, we as an organization are eligible or will be eligible by the beginning of the competitive season to participate in this activity under all USA Rugby Guidelines and Rugby Indiana policies. We agree to abide by all rules and regulations imposed by the International Rugby Board, USA Rugby, Rugby Indiana and the local hosts. We are aware that we may lose the privilege to participate in the activity in the event of any violation of the above mentioned statements.