REGISTRATION FORM PLEASE FILL OUT THE BELOW FORM TO SIGN UP YOUR CHILD TO PARTICIPATE IN HIGHLANDERS RUGBY Select Team * Please Select which Team your player is Registering for Rookie (Ages 10 & Under) Junior (Ages 12 & Under Middle School (Ages 14 & Under) High School Girls High School Boys Select Season Please Select Which Season you are Register for High School Fall 7s - $200 High School Winter/Spring - $250 Youth Spring - $150 Player Name * First Name Last Name Player Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Player Phone Number Only Required For High School Players (###) ### #### Player Email Only Required For High School Players Player Date of Birth * MM DD YYYY Player's Grade at School * Parent/Guardian Name 1 * First Name Last Name Parent/Guardian 1 Phone Number * (###) ### #### Parent/Guardian 1 Email * Parent/Guardian Name 2 First Name Last Name Parent/Guardian 2: Phone Number (###) ### #### Parent/Guardian 2: Email USA RUGBY RULES ACKNOWLEDGEMENT * USA RUGBY RULES ACKNOWLEDGEMENT 1. I understand and agree to abide by all International Rugby Board, USA Rugby, territorial and local area union rules and regulations, including the arbiter procedures therein, for any dispute regarding my eligibility or right to participate in, USA Rugby-sponsored and USA Rugby-sanctioned activities and even set forth in the Bylaws of USA Rugby, as they are amended on a periodic basis, which I understand are available on the USA Rugby website ( www.usarugby.org ). 2. I affirm that I am not suspended or banned from play or participation by any club, local area union, territorial union, or national union and I authorize USA Rugby to verify my citizenship status with the appropriate governmental agencies. 3. I am aware that USA Rugby has the right to revoke my membership registration and therefore my eligibility to play or coach, in the event of any violation of the aforementioned statement. I HAVE READ THIS ACKNOWLEDGMENT AND FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY CHECKING BELOW BOX. IN CONSIDERATION FOR THE PRIVILEGE OF PARTICIPATION IN USA RUGBY ACTIVITIES, I FURTHER REPRESENT THAT I AM AT LEAST 18 YEARS OF AGE OR, IF I AM UNDER THE AGE OF 18, THAT MY PARENT/ GUARDIAN HAS SIGNED THIS FORM IN THE SECTION BELOW. CONSENT OF PARENT/GUARDIAN FOR PARTICIPANTS UNDER 18 I REPRESENT THAT I AM THE PARENT/GUARDIAN OF THE UNDERSIGNED PARTICIPANT, WHO IS UNDER 18 YEARS OF AGE. I CHECK THE BOX BELOW THIS DOCUMENT VOLUNTARILY AND WITH FULL UNDERSTANDING OF ITS TERMS AND LEGAL SIGNIFICANCE. I ATTEST THAT, IF I AM THE SOL PARENT/GUARDIAN SIGNING BELOW, MY SIGNATURE IS SUFFICIENT TO CONSENT TO THE PARTICIPATION OF THE MINOR IN THE ACTIVITIES AND TO ENTER INTO THIS AGREEMENT ON BEHALF OF THE MINOR. PROVIDE NAME OF MINOR ***PLEASE CHECK THE BOX BELOW CONFIRMING YOU*** All clubs are required to maintain the agreed waivers & releases in their possession for a minimum of three (3) years and provide to USA Rugby at any time upon request. For more information about USA Rugby's Liability Insurance protection, please visit: www.usarugby.org . I REPRESENT THAT I AM THE PARENT/GUARDIAN OF PARTICIPANT, WHO IS UNDER 18 YEARS OF AGE. I AGREE TO THIS DOCUMENT VOLUNTARILY AND WITH FULL UNDERSTANDING OF ITS TERMS AND LEGAL SIGNIFICANCE. I ATTEST THAT, IF I AM THE SOLE PARENT/GUARDIAN SIGNING BELOW, MY SIGNATURE IS SUFFICIENT TO CONSENT TO THE PARTICIPATION OF THE MINOR IN THE ACTIVITIES AND TO ENTER IN TO THIS AGREEMENT ON BEHALF OF THE MINOR.MINOR HIGHLANDERS RUGBY GENERAL CODE OF CONDUCT * HIGHLANDERS RUGBY GENERAL CODE OF CONDUCT This code establishes the basic contract for behavior on this team, for both coaches and players. Once a player joins the team, he or she has made a commitment to abide by these rules 1. Grades are a player's primary concern. Player’s grades will not fall because a player is playing Rugby. If your school has other requirements these will apply. 2. Use of controlled substances (alcohol, other drugs, cigarettes for minors, etc.) will not be tolerated. 3. No bullying or coercive behavior will be tolerated. 4. Racist, sexist, and bigoted jokes and statements will not be tolerated. 5. Obscene or profane language, as determined by the coaches, will not be tolerated. 6. No player will be allowed to participate in contact practices or games without a mouthpiece. 7. No player will be allowed to participate in contact practices or games without a suitably qualified or experienced Coach. 8. Fighting on the pitch will not be tolerated. If a fight appears to be starting, teammates will pull the offending player to a safe area. Fighting will get a player suspended from the league for a period of time determined by coaches and/or the disciplinary committee. 9. Offenses may result in temporary or permanent suspension from the league at the discretion of the coach or a disciplinary committee appointed by the Board of North Carolina Youth Rugby . 10. Rugby Activities are those approved by the head coach, and when a coach is present at the activity i.e. practices, games (set-up, competition, and clean-up), approved social activities and fundraisers. If no coach is present, it is not a team-sanctioned activity, even if it starts as one. 11. No player or coach will show disrespect to any other player, coach or referee. 12. No player will be dropped from the squad for lack of athletic ability. 13. Players will not be allowed to play without the following: (a) Picture identification, (b) CIPP registration, (c) Medical waiver/permission form, (d) When requested, verification from school of student status. Unless a player is over eighteen on September 1 st 2021, parents/guardians must sign these forms. 14. Players will wear the proper uniform to practice and games. At games, exposed boxer shorts or non white or black lycra shorts are unacceptable. 15. Good manners are expected on and off the field, especially when a player is wearing clothing identifying him or her as a Rugby player for Highlanders Rugby. Respect for the Referee is required by the laws for the players and expected by the club for the spectators (back talk, disrespectful behavior, or assault, either verbal or physical, will not be tolerated). 16. As a club, all players are expected to assist whenever possible. This includes setting up the fields, after game socials, and fundraisers. 17. The home team shall arrange an after game social. Players from both teams shall attend. 18. If a player is severely injured, a Coach, or someone designated by a Coach, will take him or her to the hospital. An adult, generally a Coach, will remain with the player until either the player is released, or the parents arrive. 19. Parents shall abide by the following Code for Parents: a. Remember, young people are involved in rugby for their enjoyment, not yours. b. Always encourage your child to play by the Laws of the Game. c. Teach young children that honest endeavor is as important as winning, so that the result of each game is accepted without disappointment. d. Help young people work towards skill improvement and good sportsmanship. e. Set a good example by applauding good play on both sides. f. Never ridicule, humiliate, or shout at young players for making a mistake or losing a match. Encourage them through recognizing the positive aspects of their play. g. Do not place emphasis on winning at all costs h. Do not force an unwilling child to participate in the playing of rugby. If the child is to play, he or she will do so in good time. There are other aspects of rugby other than playing which are equally fulfilling. i. Support all efforts to remove verbal and physical abuse from rugby. j. As a spectator, do not use profane language or harass referees, coaches, or players. k. Do not publicly question the referee’s judgment and never their honesty. l. Recognize the value and importance of volunteer referees and coaches. They give of their time and resources to provide recreational activities for young people. m. Encourage in your child an appreciation of mutual respect for teammates and opponents. BOTH MYSELF AND MY CHILD HAVE READ, UNDERSTAND AND AGREE TO THE CODE OF CONDUCT AS SET FORTH ABOVE Medical Wavier and Parental Permission * Parental Permission, Waiver, Release, and Authorization to Consent to Medical Treatment for Minor** 1. The Player, and his or her custodial parent(s) and/or legal guardian(s) (together referred to as the “Undersigned”), hereby consent to the Player’s participation in Rugby with the Youth Team (the “Team”) of North Carolina Youth Rugby. The Undersigned understand and agree that participation includes, but is not limited to, practice sessions, games, meetings, functions, parties, fund raising, and the like, and transportation to and from these activities. The Undersigned further understand and agree that transportation will generally be via automobiles and that the drivers will include adults, other Players, and fellow students. The Undersigned understand there is the potential for some drivers to be underinsured, or uninsured and the Undersigned agree to supplement their insurance to provide for sufficient underinsured or uninsured coverage to compensate for any losses resulting from injury or death in connection with a transportation mishap and the Undersigned otherwise waive claims against any driver beyond his or her insurance coverage as well as against any North Carolina Youth Rugby coach and staff and against USA Rugby, their designated Local Area Union or Territorial Union.. 2. The Undersigned understand and agree that the Team is not sponsored by any school within any of the school districts, and as such, these institutions and their administrators and officials are not responsible or liable for injury, sickness, disability, paralysis, or death that may result from the Player’s participation with the Team and all claims against said entities and individuals are waived. 3. The Undersigned understand that there are no salaried coaches or administrators assisting the Team. They are all volunteers. 4. The Undersigned understand that Players on the Team may include individuals 19 years of age and under, and that the Team will only compete against other youth teams. The Player agrees to provide the Team with proof of age with a copy of identification with a photograph. 5. The Undersigned understand that Rugby is a physical, full contact sport with the possibility of injury, minor or major, always present. The Undersigned hereby accept the risks that accompany participation in Rugby. The Undersigned agree that they will not hold North Carolina Youth Rugby, any coach and staff, USA Rugby, their designated Local Area Union or Territorial Union Team officials and administrators responsible for injury, sickness, disability, paralysis, or death that may result from participation with the Team and all claims resulting from such participation are waived. As such: 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 coaches, officials, and/or administrators of the Team, North Carolina Youth Rugby, USA Rugby, their designated Local Area Union or Territorial Union, all schools and districts within North Carolina, and sponsors and workers. THE UNDERSIGNED AGREE THAT THIS RELEASE IS BINDING AND EFFECTIVE AS TO THEMSELVES AS WELL AS TO THEIR PERSONAL REPRESENTATIVES, ASSIGNS, HEIRS, AND NEXT OF KIN AND THAT IT APPLIES TO ANY AND ALL LOSS OR DAMAGE CLAIMED ON ACCOUNT OF INJURY, DISABILITY OR DEATH, WHETHER CAUSED BY THE NEGLIGENCE OF THE ABOVE REFERRED TO ENTITIES, ORGANIZATIONS OR INDIVIDUALS OR OTHERWISE. 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. 6. The Undersigned understand that there may not be a trainer at the Team’s games or practice session. 7. The Undersigned understand and agree that the Youth Code of Conduct will bind the Player, while a member of the Team. 8. The Undersigned understand and agree to be solely responsible for the following: a. To see that the Player has had a Physical to determine that he/she is able and fit to play Rugby b. To see that the Player has appropriate medical insurance and has done the following: i. Completed and signed the authorization to consent to medical treatment ii. Provided the Team with proof of insurance c. To see that the Player wears a mouthpiece during all practices and games d. To see that the Player abides by all Team rules and instructions e. To see that the Player does not allow rugby to interfere with school requirements f. To see that the Player maintains a law abiding personal life in accordance with all applicable laws and regulations. 9. The Undersigned agree to accept all responsibility, including medical and financial, for participation; to pay the annual fee that covers registration, union dues, field and equipment, training aids, etc. The Undersigned understand that each Player must play in a regulation uniform that consists of a jersey, shorts, socks, and approved shoes. We have read and understand and agree to the information and waiver and release of liability as set forth above: I REPRESENT THAT I AM THE PARENT/GUARDIAN OF PARTICIPANT, WHO IS UNDER 18 YEARS OF AGE. I AGREE TO THIS DOCUMENT VOLUNTARILY AND WITH FULL UNDERSTANDING OF ITS TERMS AND LEGAL SIGNIFICANCE. I ATTEST THAT, IF I AM THE SOLE PARENT/GUARDIAN SIGNING BELOW, MY SIGNATURE IS SUFFICIENT TO CONSENT TO THE PARTICIPATION OF THE MINOR IN THE ACTIVITIES AND TO ENTER IN TO THIS AGREEMENT ON BEHALF OF THE MINOR.MINOR Addtional Comment or notes Please add any additional comments or notes we should be aware of. IE allergies or medical conditions Thank you for registering with Highlanders Rugby. Please reach out to us if you have any questions. A member of our team will be in will email you shortly with information in regards to payment. Cheers!
