The Rugby Coaching Academy


Academy Registration 2012



Junior & Mini or Senior Academy (select from drop down menu):

Name of Participant

Date of Birth
/ /

Home address:


Phone
/ /

Email

Shirt Size Required
small medium large

Insurance provider and policy number?

Details of existing medical conditions(allergies, asthma,
and anything considered relevent)


I understand and agree with the following (please check)
Participant has own health and accident insurance.
Registration is a committment to attend and pay in full. "No shows" will be charged in full. Payment can only be refunded in the event of RCA cancelling the course.
RCA is not responsible for valuables and although every care will be taken to ensure safety RCA cannot be held responsible for any personal injuries sustained.