Florida Atlantic University Men’s Rugby Club
All information with ** will be kept confidential and will not be released except to the university when needed.
1). Name:_________________________________________________
2). **Mailing Address (where you receive your mail):
______________________________________________
______________________________________________
3). **e-mail:___________________________________________
4). **Phone:___________________________________________
5). Hometown_______________________6). **SS#:___________________
7). **Date of Birth:___________________________, age now ________
8). Expected year of Graduation:______ 9). Major__________________
10). Nuber of Credits:_______ 11.) Date First Enrolled in College__________
12). Height:_______Weight:_______Shirt size______Position(if known):___________
13). **Parents Name:___________________________________________
14). **Parents Address:________________________________
_________________________________
14). **In case of emergency contact: ______________________________ph#______________
15). **Relation of emergency contact:_______________________
16). **If you are taking any medications provide
18). I understand that I am responsible for reading the players page on the web site and checking my e-mail daily for club info.
Signature____________________________________
note: This information must be on file before player can play in an official match.