Girls Rugby Intro Clinic Registration
Use this form to register for your upcoming Girls Rugby clinic. Questions? Please contact us at info@girlsrugbyinc.com.
Player Name
*
First Name
Last Name
Current Grade Level
*
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Other
Which clinic are you registering for? (Select all that apply)
*
PENNSYLVANIA - Sunday, August 4th - 2pm-4pm at Highspire Memorial Park
OREGON - Saturday, August 17th - 10am-11:30am at Roosevelt Park
T-Shirt Size
*
Youth Small
Youth Medium
Youth Large
Youth XL
Adult Small (Unisex)
Adult Medium (Unisex)
Adult Large (Unisex)
Adult XL (Unisex)
Adult 2XL (Unisex)
Please indicate your rugby experience (Select all that apply)
*
This is my first time! (I'm super excited!)
I've tried rugby before, but I've never played in an official program
I've played flag rugby before
I've played contact rugby before
Other
Parent/Guardian Name
*
First Name
Last Name
Contact Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
PARTICIPATION WAIVER
Participation Waiver - Please review our Participation Agreement prior to participation. Do you consent to waiver for the Girls Rugby event?
*
Yes, I consent
MEDIA RELEASE FORM
Media Release - Please review our Media Release prior to participation. Do you consent to this media release for the Girls Rugby event?
Yes, I consent
Additional Players
Please use this space to register additional players.
Player #2
First Name
Last Name
Player #2 Grade Level
Player #3
First Name
Last Name
Player #3 Grade Level
Player #4
First Name
Last Name
Player #4 Grade Level
Girls Rugby - Introductory Clinic Payment
Which clinics are you signing up for? (Select all that apply)
*
Sunday, March 10th - 4:00pm - 6:00pm
Please select only the option with the number of clinics and number of players you are registering
*
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( X )
1 Clinic Registration
$
10.00
Please select the number of players you are registering for just one clinic.
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
2 Clinic Registrations
$
20.00
Please select the number of players you are registering for two clinics.
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: