Rugby Bricks Clinic Form

1

Which area of your game are you MOST wanting to Improve at the Rugby Bricks Clinic?* This field is required.

Short & Long Passing Game

Place Kicking

Kicking out of Hand

Drop Kicking

Catching Skills

Footwork & Evasion Skills

2

Name* This field is required.

First Name

Last Name

3

BEST Email* This field is required.

example@example.com

4

Phone Number* This field is required.

Area Code

Phone Number

5

Emergency Contact + Number + Relationship to you* This field is required.

6

Age* This field is required.

7

What Level?* This field is required.

Saturday - High School

Sunday - Club

Sunday - College

8

Current Team* This field is required.

9

Primary Position* This field is required.

10

Where do you live? * This field is required.(gives me an idea of how far you'd have to travel to attend this clinic)

11

Do you follow Rugby Bricks on Social Media?* This field is required.

YESNO

12

Do you own a Rugby Bricks Kicking tee?* This field is required.

YESNO

13

What are you MOST looking forward to at the camp?* This field is required.

Getting World-Class Coaching

Passing Segment

Kicking Segment

All of it! Can't wait

14

Media Release* This field is required.I grant permission to Peter Breen (Rugby Bricks), Troy Hall, and associated partners to use photographs, video, and audio recordings of me/my child taken during the Rugby Bricks Camp at Clemson University for promotional use (e.g., website, social media, and marketing). I understand that no compensation is provided and all media becomes the property of Rugby Bricks and Troy Hall.

I agree to the Media Release

I do not agree to the media release

15

**IMPORTANT: PLEASE READ!**

To Maintain a World-Class learning environment, participants agree to:

Show good sportsmanship on and off the field
Respect coaches, teammates, referees, and opponents
Be positive rugby ambassadors
Bring full effort, a learning mindset, and a great attitude
Avoid disrespect, dangerous behavior, or poor conduct

Liability Waiver & Acknowledgment of Risk

I understand that rugby is a physical sport and carries the risk of injury. I voluntarily assume all risks related to participation and release Peter Breen (Rugby Bricks), Troy Hall, Clemson University, camp staff, and affiliates from any liability for injuries, accidents, or losses that may occur during or as a result of the camp. I confirm that I/my child is in good physical health and authorize staff to provide emergency medical care if needed.

16

Signature of Participant or Parent/Guardian (if under 18)* This field is required.

Clear