|
***
Is this
info New
for this
player
or an
Update
to
previous
information?
|
|
Name of member who referred you, if any:
|
|
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|
***
First
Name
*** Last Name
|
|
Street
|
|
City
ST
Zip
|
|
Neighborhood
Country
|
|
Phones: enter
all phone numbers
on this form
as a
10 digit entry, no spaces, parentheses, dashes, etc.
e.g.
enter
(123)
456-7890
as
1234567890 |
|
Home Phone
Mobile Phone
Fax Number
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|
Work Phone
Work
Extension
|
|
Email
Want
email?
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Preferred Contact Method
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BIO INFORMATION
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|
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Employer
Job
Descr/Title
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|
Hometown Birthdate
(mm/dd/yyyy) |
|
Nickname
Nationality
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Marital
Status
If "Married", Spouse's Name
|
|
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Use keywords to describe hobbies, interests, skills, etc. separate with
commas
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|
Your Interests
|
|
Spouse Interests
|
|
Children
|
|
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|
Use this area to add any other information you choose related to your contact
information, interests and abilities off of the pitch, management exp., etc. |
|
|
|
|
RUGBY BIO INFORMATION |
|
Gender
Experience
Year Began
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|
Comfortable as a Forward?
Comfortable as a Back?
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|
1st Preferred/Experienced Position |
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|
2nd Preferred/Experienced Position |
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3rd Preferred/Experienced Position |
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|
4th Preferred/Experienced Position |
|
|
Height
ft in
Weight (lbs)
CIPP#
|
|
Use this area to add any other information you choose related to your playing
experience, abilities, recognition ON the pitch, etc. |
|
|
|
|
SAFETY AND EMERGENCY INFORMATION |
|
All information in the following sections, like all of the information from
this form, is to be used for the intended purposes of communication and safety
and is not in any way collected or assembled or sold. |
|
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|
Emergency Contact #1 Name
(relationship
in
parentheses) |
|
Home Phone
Cell Phone
Work Phone
|
|
Emergency Contact #2 Name
(relationship
in
parentheses) |
|
Home Phone
Cell Phone
Work Phone
|
|
PARENT
-
GUARDIAN
INFORMATION
must be
completed
if you
are a
minor |
|
|
|
MOTHER /
GUARDIAN 1 |
|
Name
Home
Work
|
|
Street
Email |
|
City, ST, Zip
|
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|
FATHER/
/
GUARDIAN
2 |
|
Name
Home
Work
|
|
Street
Email |
|
City, ST, Zip
|
|
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|
PHOTOS Include
a
Portrait
photo
and an
Action
photo.
Please
keep
size of
graphic
files
under 75
KB each. |
|
|
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|
Portrait |
|
|
Action |
|
|
|
|
|
Thanks for taking the time to automate
registration with your club, saving everyone time and positively affecting club
organization, management, and communication!
After
clicking
the
Register
button
the
data
will
be
submitted
to
the
club
at
the
top
of
the
page. |
