Girls Rugby PA Clinic Registration
Use this form to register for your upcoming Girls Rugby clinic. All clinics will be indoor and at Derry Township Community Center. Questions? Please contact us at pennsylvania@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
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
Girls Rugby PA - Winter Indoor Clinics
All clinics will be indoors at the Derry Township Community Center. Clinics will be 2 hours in length and are $20 per clinic per player to attend.
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 total number of clinics you plan to attend.
*
prev
next
( X )
$20 - 1 Clinic
$
20.00
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: