Player Name:  _________________________________   DOB:  _______________
Player Email:  ___________________________________________ Age:  _______
Home Phone:  _________________________________
Player Cell Phone:  ___________________________________
Parent Cell(s):        ______________________          _______________________
Parent Email(s):   __________________________   _________________________
Home Address: _________________________________________
                             _________________________________________
Emergency Contacts (name/phone):  ____________________________________
			                                  ____________________________________
High School:  _________________________________________
Year:          Freshman          Sophomore          Junior          Senior

*Shirt:   S   M   L   XL   ___XL    	*Waist:   28   30   32   34   36   38   other: _____
I understand the costs and agree to register with Michigan Youth Rugby Association($80) and pay the team fees($70) in a timely manner.
If you want to play but need financial assistance, please contact Coach Varney. We may be able to work out partial support.
Check Box Indicating I have received read, understand and agree to the Portage Muskies’ Code of Conduct.

__________________________ 	           __________________________
           Student Signature                        	           Parent Signature