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GLENDALE RAPTORS RUGBY
http://www.glendalerugby.com
Rugby Colorado TRY League Rugby Season
May 5 – June 27, 2015
TBD Tournaments July 11 & 18, 2015
The Glendale Raptors Rugby Club will have teams in Rugby Colorado’s TRY League in 2015. Players will be placed in different age groups
and ability levels.
Practice Days & Times: Tuesdays and Thursdays 5-6:30pm
Game Days & Times: Saturdays - May 23, May 30, June 6, June 13, June 20, June 27 @ 9am-4pm (not the entire time)
Cost per participant:
2015 fees includes full uniform (rugby jersey, shorts and socks), USA Rugby membership and liability insurance, and Rugby Colorado membership
Non-Contact Flag Rugby 5-7 years old - $160
Contact Tackle Rugby 8-15 years old - $175
*By completing Glendale Youth Rugby’s TRY League Rugby season registration forms and paying the membership fee, players will automatically receive USA Rugby’s
Accidental and Liability Insurance benefits and become registered members with USA Rugby. For information on USA Rugby insurance please visit http://usarugby.org/
insurance. Registration/insurance will remain valid through 8/31/2015.
Payments can be made online via Rugby Colorado's SportNgin website and information will be sent out when you register online.
Practice Location: Synthetic rugby pitch just south of the rugby stadium at 950 S. Birch St., Glendale, Colorado.
Paperwork and fee can be sent to: City of Glendale, Attn: Jenna Anderson, 950 S. Birch St., Glendale, CO 80246. Paperwork can be faxed in
to: 303-639-4611.
Questions? Contact Jenna Anderson at 303.639.4713 or [email protected].
The first and second page of this registration form MUST be completely filled out before any child can participate in their first
practice.
PLAYER & PARENT CODE OF CONDUCT
Glendale Raptors Rugby Club and Rugby Colorado expects all teams, coaches, players and parents to abide by the following code of conduct:
1.
Players who represent their teams are ambassadors of Glendale Rugby, Rugby Colorado, USA Rugby, as well of the game of rugby in
general. As such, each player is expected to be on good, responsible behavior at all times, both on and off the field.
2.
Players should not exhibit obnoxious, impolite or antisocial behavior (dangerous play) of any sort that would adversely affect the image of
the game as a serious and disciplined endeavor. This includes verbal abuse of opponents by coaches, players, parents or their supporters.
3.
A player or parent must not before, during or after a match under the jurisdiction of an affiliated Union or Society threaten or address a
referee or touch judge in insulting terms, or act in a provocative manger towards a fellow player, parent, spectator, referee or touch judge.
4.
Referees and touch judges must likewise treat coaches, players and parents with equal respect.
5.
All players, parents and supporters must respect the ground rules that are in effect at any particular match, such as prohibitions against
having alcohol on school grounds and in public parks.
6.
AT NO TIME WILL ALCOHOL OR DRUGS BE ALLOWED AT ANY HIGH SCHOOL OR YOUTH RUGBY MATCH EITHER BY
PLAYERS OR TEAM SUPPORTERS.
Violations of this Code of Conduct will be immediately addressed by the Rugby Colorado Disciplinary Committee. All sanctions by the Rugby Colorado
Disciplinary Committee will be enforced by the committee and appropriate coaching staff.
Team/Club Name: Glendale Raptors Rugby Club
Printed Parent Name ____________________________________________________
Parent Signature ________________________________________________________Date ______
Printed Player Name _____________________________________________________
Player Signature ________________________________________________________ Date ______
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Glendale Raptors Rugby TRY League Teams
May 5-June 27, 2015
GLENDALE RAPTORS RUGBY
Participation Agreement PLAYER’S NAME:__________________________________Age:________
The Undersigned understand that Rugby Football is a physical sport with the possibility of injury. With that knowledge, the Undersigned hereby accept the risks that accompany
participation in Rugby Football. The Undersigned agree that they will not hold the City of Glendale, the Glendale Raptors Rugby Football Club or any of its coaches, administrators,
officials, staff, representatives, employees, insurers, or re-insurers liable for any and all claims including, but not limited to, injury, sickness, disability, paralysis, or death; that may result
from participation in the sport of rugby or from participation in the Glendale Raptors Rugby Football Club and its 2015 TRY League Glendale Team.
RELEASE AND WAIVER OF LIABILITY: IN CONSIDERATION OF THE PLAYER’S RIGHT TO PARTICIPATE, THE UNDERSIGNED HEREBY RELEASE,
DISCHARGE, AND COVENANT NOT TO SUE the City of Glendale, the Glendale Raptors Rugby Football Club or any of its coaches, administrators, officials, staff,
representatives, employees, insurers, or re-insurers for any and all claims including, but not limited to, injury, sickness, disability, paralysis, or death; that may result from participation in
the sport of rugby or from participation in the Glendale Raptors Rugby Football Club and its 2015 TRY League Glendale Team.
THE UNDERSIGNED AGREE THAT THIS RELEASE IS BINDING AND EFFECTIVE AS TO THEMSELVES AS WELL AS TO THEIR PERSONAL
REPRESENTATIVES, ESTATES, ASSIGNS, HEIRS, AND NEXT OF KIN AND THAT IT APPLIES TO ANY AND ALL LOSS OR DAMAGE INCLUDING, BUT NOT
LIMITED TO, INJURY, DISABILITY OR DEATH.
I give permission for the coaches and/or organizers of the Glendale Raptors Rugby Football Club Youth Programs to act as a guardian to my child in the case that my child is in need
of medical assistance and I can not be reached.
The Undersigned understand that by signing this release they are giving up substantial rights they would otherwise have to recover damages for losses and they agree that they are doing
so voluntarily and without inducement, threat, or duress. The Undersigned agree that they had the opportunity to seek legal advice before signing this release and have either done so,
or have voluntarily elected not to and waive this opportunity.
I hereby give permission for the City of Glendale, Infinity Park, and the Glendale Raptors Rugby Football Club to use photographic or video images of my child for marketing and/or
promotional purposes only.
I understand and will pay the program fee by my child’s third practice. Refunds before the first game are given a $20 administrative fee. Refunds are not given after the first game.
Parent/Guardian Signature: ___________________________________
Date: ________________
Glendale Representative Initials: __________ Date: ____________
Glendale Raptors Rugby Football Club Youth Medical Release Form
Hospitals often can not treat or care for children without consent from parents or legal guardians. Complete this form in the
event your child must be attended to by medical personnel and you can not be immediately contacted to obtain consent.
Consent to Medical Care and Treatment of Minor Children
I, __________________________, the natural parent or legal guardian of (minor child) __________________________
authorize and consent to medical, surgical and hospital care, treatment and procedures to be performed for my child by a
licensed physician or hospital when deemed immediately necessary or advisable by the physician to safeguard my child’s
health and I can not be contacted. I wave my right of informed consent to medical treatment.
Parent/Guardian Signature: _________________________________ Date: ____________
Athlete Medical Information
Player Name: ____________________________
Date of Birth: ______________________
Allergies: _______________ Medications: __________________ Dietary Restrictions:__________________
Past Concussions (list year and how they happened):_______________________________________
Medical Conditions staff should be aware of:____________________________________________
Primary Phone #: ______________________
Secondary Phone #: ______________________
Insurance Company: _____________________________________________________________
Group #: _____________________________
Membership #: __________________________
Employer: _____________________________________________________________________
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Glendale Raptors Rugby TRY League Teams
May 5-June 27, 2015
GLENDALE RAPTORS Rugby rugby colorado TRY LEAGUE Season
May 5-­‐June 27, 2015
Player Registra8on Form
First Name:
Last Name:
Middle Name
Gender: Male or Female
DOB (mm/dd/yyyy):
Returning Player? YES or NO
E-­‐mail:
Would you like to be in the player/team directory sent
Address 1:
out to your child's respec8ve teammates? YES or NO
City:
State:
Zip Code:
City:
State:
Zip Code:
Area Code Only: ( )
Phone Number:
Address 2:
Level: Co-ed U8 flag / Co-ed U10 tackle / Boys U12 tackle / Girls U12 Tackle / Boys U13 tackle / Boys U14 tackle / Boys U16 tackle / Girls M.S.Tackle
Current School:
Current Grade: (As of May 1)
Height: (in) / Weight: (lbs)
Parent/Guardian Name
Primary #
Email Address:
Alt #
Parent/Guardian Name
Primary #
Email Address:
Alt #
Parent/Guardian Name
Primary #
Email Address:
Alt #
Emergency Contact Name
Primary #
UNIFORMS -­‐ CIRCLE or STRIKETHROUGH ONE
JERSEY SIZE: Youth Sml / Youth Med / Youth Large / Adult Small / Adult Med / Adult Large / Adult X Large SHORT SIZE: Youth Sml 26 / Youth Med 28 / Youth Lg 30 / Adult Sml 32 / Adult Med 34 / Adult Lg 36 **Refunds before the first game are given with a $20.00 administra8ve fee. **Refunds are not given acer the first game.
I would be interested in: Coaching / Assistant Coaching / Refereeing I know someone who may be interested in: Playing / Coaching / Refereeing
Name:
Phone #:
Email:
DATE SUBMITTED: _________________________________