ECLIPSE RUGBY FOOTBALL CLUB

Player Registration

September 9, 2024

Full Name

USA Rugby CIPP#

Date of Birth

YYYY-MM-DD

Player Age

Address

Player Contact Number

Player Email Address

Player School

Player Grade

Player Weight

Player Height

Parent/Guardian Name

Parent/Guardian Contact Number

ECLIPSE REGISTRATION FEES

Youth Registration Fee $150.00

-High School Registration Fee $150.00

Payment by Zelle 480-688-3659 to Chris Gray-

If you have any questions, please contact Chris Gray at 480-688-3659