Fort Lauderdale Ruckus Rugby Club

Subscribe to our Newsletter

2017 Ruckus Rugby Summer/Fall Season Form HS & Youth

PLAYER INFORMATION

* First Name:

* Last Name:

FYRU/USA CIPP Number:

* Pant Size:

* Shirt Size:

City:

Street:

State:

Zip Code:

* Player's Cell Phone:

* Player's Email:

* Gender:

* Grade:

* Birthdate:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Medical Conditions/Allergies:

Insurance Carrier:

Policy #:

USA RUGBY Release of Liability Form (PLEASE PRINT, SIGN & RETURN TO US.)

World Rugby Concussion Guidance

World Rugby Laws & Code of Conduct

I/we acknowledge and confim that I/we have read the above Linked, World Rugby Laws & Code of Conduct and the Concussion Guidance. *

I/we Understand/Approve that my child/player will be photographed and filmed and potentially displayed on team related website, social media and promotional materials *

TWO MORE STEPS TO COMPLETE REGISTRATION:
(1) GO TO THE HOME PAGE & CLICK ON THE 2017 SUMMER/FALL PAYMENT LINK" TO PAY
(2) CLICK ON "FYRU / USA RUGBY REGISTRATION LINK" TO REGISTER WITH THE FL. FYRU / USA RUGBY CIPP REQUIREMENT FOR ALL PLAYERS PRIOR TO PLAYING. PLEASE REGISTER AS FORT LAUDERDALE RUCKUS RUGBY GIRLS/BOYS.

* indicates required fields

OUR SERVICES

LOCAL SPORTS

ELITE

2017 Ruckus Rugby Summer/Fall Season Form HS & Youth