Wellington Wizards Rugby Club - (Wellington, FL)

Subscribe to our Newsletter

2023-2024 Wizards Rugby Registation, CoC & Liability

PLAYER INFORMATION

* First Name:

* Last Name:

FYRU/USA Registration Entry Number:

* Shirt Size:

* Short Size:

Street:

City:

State:

Zip Code:

Cell Phone:

* Birthdate:

Email:

Gender:

* Grade:

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:

* Emergency Phone Contact:

* Medical Conditions/Allergies:

Insurance Carrier:

Policy #:

USA RUGBY Release of Liability Form (Please print, sign and return to us.)

World Rugby Concussion Guidance

World Rugby Laws & Code of Conduct

I/we agree with the above World of Rugby Laws & Code of Conduct *

I understand/approve that my child/player be will photographed and filmed and potentially displayed on Facebook, Wizards YouTube Channel etc. *

TWO MORE STEPS TO COMPLETE REGISTRATION:
(1) GO TO THE HOME PAGE & CLICK ON THE "2019 REGISTRATION PAYMENT LINK" TO PAY
(2) CLICK ON THE "FYRU/USA RUGBY REGISTRATION LINK" TO REGISTER WITH THE FYRU/USA RUGBY

* indicates required fields

MidTown Clinic of Chiropractic

3208 Lantana Road, Lake Worth, FL 33462
561-533-3884
www.corderochiropractic.com