Premier Rugby Academy
Registration
2017-18

 
PARTICIPANT INFORMATION
Last Name * (* indicates required field)
First Name *
Male/Female *
Current Grade *
Birthdate * (Month/dd/yyyy) (ie: May/19/2002)
PRIMARY PARENT CONTACT INFORMATION
Primary Parent Contact Name *
Primary Contact Telephone *
Primary Contact Email *
Primary Contact Home Phone
Primary Contact Work Phone
Primary Contact Cell Phone
Address *
City *
Postal Code *
OTHER PARENT CONTACT INFORMATION
Other Parent Contact Name
Other Parent Contact Telephone
Other Parent Contact Email
Other Parent Contact Home Phone
Other Parent Contact Work Phone
Other Parent Contact Cell Phone
Address (If different from above)
City
Postal Code
ADDITIONAL INFORMATION
Student's Current School *
School Location * ie: West Vancouver, North Vancouver, etc.
School Attending this September *
Name of school if "Other" selected above
Current Rugby Experience * Beginner, Intermediate, Advanced
Years of Rugby Experience * 1, 2, 3, 4, 5, etc.
Current Position * Forward, Back, etc.
Where Played * Club or Representative
2015-2016 Capilano RFC member?
Coach *
Coach Phone *
Coach Email *
Please submit the following information via .pdf .doc or. rtf.
(use the "Browse" button to attach the file from your computer
)

1. Athletic goals: Tell us your athletic goals and let us know what you hope to accomplish by participating in the Premier Rugby Academy.
2. Athletic Achievements over the past three years. (Tell us about some of your experiences in this sport or any other area you have had success (sport or other).
3. A statement indicating why you would be a good candidate for the Premier Rugby Academy.
4. Please ensure you provide (scan) a copy of the most recent report card to dnelson@wvschools.ca.

* Attach document here:

Please click "Submit Registration" button only ONCE and wait...