Child's (player's) full name
*
First Name
Last Name
Date of birth
*
MM
DD
YYYY
Name of school
*
Avi Cenna International School
Chrisland Schools, Opebi
Corona School, Gbagada
Corona School, Ikoyi
Corona School, Agbara
Day Waterman College, Abeokuta
Temple Schools
Class
*
Year 3 - 6
Year 7 - 9
Year 10 - 13
Does the Player have any chronic medical illnesses (diabetes, asthma, exercise asthma, kidney problems, etc.)?
*
Yes
No
Don't know
If 'Yes' please state below
Is the Player presently taking any medications or pills?
*
Yes
No
Don't know
Does the Player have any allergies (medicine, bees or other stinging insects, latex etc)?
*
Yes
No
Don't know
Has the Player had extreme fatigue (been really tired) associated with exercise (different from other children)?
*
Yes
No
Don't know
Parent/Guardian full name
*
First Name
Last Name
Parent/Guardian email
*
Home address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Parent/Guardian phone number
*
Country
(###)
###
####
Emergency contact
*
Country
(###)
###
####
Relationship to child (player)
*
PARENT/GUARDIAN PLEDGE
*
As a parent, I acknowledge that I am a role model. I will remember that school athletics is an extension of the classroom, offering learning experiences for my child. I must show respect for all players, coaches, spectators, and support groups. I will participate in cheers that support, encourage, and uplift the teams involved. I understand the spirit of fair play and the good sportsmanship expected by our school. I hereby accept my responsibility to be a model of good sportsmanship that comes with being the parent of a Player
REQUEST FOR PERMISSION
*
We, the Player’s parent/legal custodian, give our consent for the above-named Player to represent his/her school in the ARS.
MEDICAL AUTHORIZATION
*
As the parent or legal custodian of this Player, I grant permission for treatment deemed necessary for a condition arising during or affecting participation in rugby, including medical or surgical treatment recommended by a medical doctor. I understand that every effort will be made to contact me before treatment. Also, permission is granted to release medical information to the school and athletic trainer or first responder.
RISK OF INJURY
*
We acknowledge and understand that there is a risk of injury involved in athletic participation. We understand that the Player will be under the supervision and direction of a coach. We agree to follow the rules of the sport and the instructions of the coach to reduce the risk of injury to the Player and other athletes. However, we acknowledge and understand that neither the coach can eliminate the risk of injury in sports. Injuries may and do occur. We freely, knowingly, and willfully accept and assume the risk of injury that might occur from participation in the ARS.
PARENTAL PERMISSION
*
I understand that additional questions or specific circumstances should be directed to my child's school coach, ARS, or head of school. I certify as a parent or legal custodian that the home address on this form is my sole bona fide domicile, and I will notify the head of the school immediately of any change in domicile since such a move may alter the eligibility status of my Player.
Full name
*
First Name
Last Name
Date
*
MM
DD
YYYY
