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Company

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Name*

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Email*

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Address*

Street Address Address Line 2 City Province Postal Code

Membership Type*

Player Membership

Supporter

Number of Player Registrations*

Player Name

Gender

Date of Birth

DD slash MM slash YYYY

School

(if applicable)

Relationship to player

Membership Type

Medical Conditions/Allergies

2. Player Name

2. Gender

2. Date of Birth

DD slash MM slash YYYY

2. School

(if applicable)

2. Relationship to player

2. Membership Type

Medical Conditions/Allergies

3. Player Name

3. Gender

3. Date of Birth

DD slash MM slash YYYY

3. School

(if applicable)

3. Relationship to player

3. Membership Type

Medical Conditions/Allergies

Name

First Last

Phone

Supporter Options*

I would like to purchase Supporter Apparel

I would like to make a donation

Both apparel and donation

Password*

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Terms & Conditions*

I, the parent/guardian, agree that my child and I will abide by the rules of Deep South Junior Rugby.*

I understand the nature of rugby and accept the risks involved.*

I hereby release, discharge, and indemnify Deep South Junior Rugby and its coaches.*

I consent to photographs and videos of my child being used for promotional purposes.

Consent*

I agree to the privacy policy.

Signature*

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