Participants Full Name

School                                                                                                                       Grade

Nickname

Date of Birth

Home Phone Number

Cell Phone Number

E-mail

Address

City, State  Zip

Primary Position

Secondary Position

Height

Weight

Years Played

Shirt Size (S, M, L, XL)

CIPP Number (must have current CIPP certification)

Emergency Contact

Relationship to Participant

Home Phone Number

Cell Phone Number

Address

Physician's Name

Phone Number

Insurance Company

Policy Number

Group Number

Allergies, Medications, and/or Special Health Considerations

The cost is $ 135.00 per participant, $ 98.00 for commuters, and that includes a Friday night dinner, Friday overnight accommodations (University housing), Saturday breakfast, Saturday lunch, Camp apparel, and a Rugby experience she will never forget!  All participants must have current CIPP certification.

Please complete and mail the Player Profile/Registration Form with a check or money order (made payable to GVSU Rugby) before the 5th of July, 2008.  Registration after that date will include a $ 50.00 late fee.  Upon acceptance to the Camp participants will receive a confirmation e-mail with Camp information including directions to the Camp.

REFUND POLICY:

A written request for a Cancellation must be received prior to the 25th of June, 2008, to qualify for a refund.  Requests received before the 25th of June, 2008,

are assessed a fee of $ 50.00 per person.  No refunds are issued for late requests.  No refunds are issued to participants who are dismissed from the Camp for

inappropriate behavior.