All players must be members of RugbyPA and have a valid CIPP.

Then, fill out the forms below to finish registering with our team.

Registration/Medical Form
Name *
Address *
Birth Date *
Birth Date
Name of your school followed by current grade level
Home/Cell Phone Number *
Home/Cell Phone Number
First & Last Name(s)
Policy Number, Policy Holder, Insurance Company, Contact Info
Policy Number, Policy Holder, Insurance Company, Contact Info
Name, Relationship, Phone Number
In connection with my (our) daughters participation In PA United Girls Rugby, I (we) authorize and consent to medical, surgical and hospital care, treatment and procedures to be performed for my child by a licensed physician or hospital when deemed necessary or advisable by the physicians to safeguard my child's health and I (we) cannot be contacted. I (we) waive our right of informed consent to treatment. I (we) waive all claims against the above referred adults, physicians, hospitals and their employees, ambulatory care, etc. in connection with the decision for immediate care. This form must be filled out and signed by both the parents and players.

Code of Conduct
All players need to comply with the following Code of Conduct: 1. Show good character. Be honest, caring, trusting, considerate, unselfish and a credit to myself, my family and my country. 2. Respect myself, teammates, coaches, officials, opponent and the game. 3. Follow the rules at all times. 4. Build and maintain a high level of fitness and game preparedness. 5. Give my best effort at all times. 6. Work hard towards team goals, and help teammates reach those goals. 7. NO tobacco, alcohol or illegal drug use. 8. Not engage in any criminal conduct, including, but not limited to laws governing the possession, provision and use of drugs and or alcohol. Violations of the code of conduct can result in one or more of the following: 1. PERMANENT DISMISSAL and sent home immediately. 2. SUSPENSION. The player may continue to practice bu twill not be allowed to play for a specific period of time or games. 3. COMMUNITY SERVICE. The player will complete a determined number of hours in a community service project. I understand that my participation in PA United Girls Rugby Club is depended upon my signature on this document and by my actions at all matches and team functions. By signing, I pledge to uphold the spirit of this Code which offers general guide to my behavior and conduct. I acknowledge that I have the right to a hearing if my opportunity to compete is denied for any reason or if I am charged with any violation of the Code. That hearing will be with in 24 hours of any alleged violations. the hearing committee will include the Head Coach, Assistant Coach and Team Manager. The decision of the committee will be final. By digitally signing this document, I agree to the terms written above.
Player Name *
Player Name

Acknowledgment, Waiver and Release from Liability Agreement
Waiver and Release: In consideration for being allowed to participate in any way in any PA United Girls Rugby and related events and activities, the undersigned: Agree that prior to participating, they will inspect the facilities and equipment to be used and if they believe anything to be unsafe, they will immediately advise their coach or supervisor of such condition(s) and refuse to participate. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inaction or negligence but the actions, inaction or negligence of others, rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time. Assume all foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death. Release, waive, discharge and covenant not to sue PA United Girls RFC, its affiliated clubs, their respective administrators, directors, agents, coaches and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, referees, and if applicable, owners and lessors of premises used to conduct the event, all of which hereinafter referred to as "releasees", from any and all liability to each of the undersigned, his or her heirs and next of kin from any and all claims, demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise. MEDIA WAIVER Additionally, I hereby authorize and give my full consent to PA United Girls RFC to copyright and/or publish any and all photographs, videotapes, film, web casts/podcasts, and any other form of visual/audio communications in which I appear while attending any PA United Girls RFC events and activities. I further agree that PA United Girls RFC may transfer, use or cause to be used, these above mentioned communications for any exhibitions, public displays, publications, commercials, art and advertising purposes, and television programs without limitations or reservations. By digitally Signing this document, I agree to the terms listed above.
Player Name *
Player Name
Parent/Guardian Name *
Parent/Guardian Name