Season Commitment

DO NOT SUBMIT THIS FORM UNTIL:

• You have completed registration at USA Rugby

• If you require a 50% waiver as a full time student, are unemployed, and/or experiencing financial hardship, you must contact the Rebellion Club President

Name
Address
7 digits

I have reviewed the Rebellion Policies document *

Clear Signature
Signature

Health Insurance

No Known Allergens

Emergency Contact

Name

Payment

Payment
** with special permission from the President