First Name: *

Last Name: *

Email: *

Telephone Number: *

Childs Name: *

Childs Date of Birth: *

Emergency Contact Name: *

Emergency Contact Telephone Number: *

Unique Pick up password: *

Medical Information: *

Allergies or Dietary requirements: *

Do you allow us consent to administer first aid: * Yes No

Photo consent?: * Yes No

Which date would you like to attend?: * Thursday 29th August - Rugby (Attack) Friday 30th August - Rugby (Defence)