How to Enroll by Mail:  Mail the completed Enrollment Form with payment to: *Enrollment is not complete until payment is received | Please Print Clearly

Ohio State University Rugby Skills Camp, 2045 Brofford Drive, Columbus, OH 43235

Fax:  614-761-8051  |  Additional Mandatory Ohio State University Waiver

Participant's Name:

Address:

E-mail:

  Phone:

  CIPP #:

School attending:

  Grade:

  Current Team:

Birth Date:

____ /____ /_____

  Position:

   Height:

  Weight:

Please describe if you have any physical limitations or are on medication:

Emergency Contact(s):

                   Relationship:

         Phone 1:

  Phone 2:

Medical Insurance Information (photocopy of Insurance Card, both sides, is acceptable):

    Company:

  Policy #:

  Group #:

     Phone:

  Fax:

I am the legal Parent/Guardian of:

I have read, understood, and agree to the terms and conditions of this application and I am signing this release on behalf of said minor.

Signature of Parent:

Notification and Confirmation:

Upon acceptance into Camp participants will be sent a CONFIRMATION, with a list of recomended Camp items, and directions to the Camp

Questions?  Contact Coach Tom Rooney, rooney@osurugby.com, 614-325-1515