SPRING AFTERSCHOOL RUGBY REGISTRATION

Spring After School Rugby

  • Participants Information
  • Parental/Guardian's Information
  • Athlete Medical Information
  • Finishing Up

Questions? Contact Alexandra (Andie) Hammon by email or by calling 303-639-4713

Athlete Information

Please tell us about your athlete.


Parental/Guardian Information

Please provide your details below.




Athlete Medical Information

Please complete the following medical information for your athlete.


Glendale Youth Rugby Participation Agreement

The Undersigned understand that rugby football is a physical sport with the possibility of injury. With that knowledge, the Undersigned hereby accept the risks that accompany participation in rugby football.

The Undersigned agree that they will not hold the City of Glendale, the Glendale Youth Rugby or any of its coaches, administrators, officials, staff, representatives, employees, insurers, or re-insurers liable for any and all claims including, but not limited to, injury, sickness, disability, paralysis, or death; that may result from participation in the sport of rugby or from participation in Glendale Youth Rugby and its 2022 Winter Indoor Rugby Program.

RELEASE AND WAIVER OF LIABILITY: IN CONSIDERATION OF THE PLAYER’S RIGHT TO PARTICIPATE, THE UNDERSIGNED HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the City of Glendale, Glendale Youth Rugby or any of its coaches, administrators, officials, staff, representatives, employees, insurers, or re-insurers for any and all claims including, but not limited to, injury, sickness, disability, paralysis, or death; that may result from participation in the sport of rugby or from participation in Glendale Youth Rugby and its 2023 Spring After School program.

THE UNDERSIGNED AGREE THAT THIS RELEASE IS BINDING AND EFFECTIVE AS TO THEMSELVES AS WELL AS TO THEIR PERSONAL REPRESENTATIVES, ESTATES, ASSIGNS, HEIRS, AND NEXT OF KIN AND THAT IT APPLIES TO ANY AND ALL LOSS OR DAMAGE INCLUDING, BUT NOT LIMITED TO, INJURY, DISABILITY OR DEATH.

I give permission for the coaches and/or organizers of Glendale Youth Rugby to act as a guardian to my child in the case that my child is in need of medical assistance and I can not be reached.

The Undersigned understands that by signing this release they are giving up substantial rights they would otherwise have to recover damages for losses and they agree that they are doing so voluntarily and without inducement, threat, or duress. The Undersigned agrees that they had the opportunity to seek legal advice before signing this release and have either done so or had voluntarily elected not to and waive this opportunity.

I hereby give permission for the City of Glendale, Infinity Park, and Glendale Youth Rugby to use photographic or video images of my child for marketing and/or promotional purposes only.

I will pay the program fee by my child’s second practice. Refunds after practice has started are given a $10 administrative fee.


Glendale Youth Rugby Medical Release

Hospitals often cannot treat or care for children without consent from parents or legal guardians. Complete this form in the event your child must be attended to by medical personnel and you cannot be immediately contacted to obtain consent.

Consent to Medical Care and Treatment of Minor Children

I, the natural parent or legal guardian of the rugby participant (minor child), authorize and consent to medical, surgical and hospital care, treatment and procedures to be performed for my child by a licensed physician, hospital, ATC or PT when deemed immediately necessary or advisable by the medical professional to safeguard my child’s health. I wave my right of informed consent to medical treatment.


Glendale Youth Rugby Covid-19 Waiver and Consent

In consideration of being allowed to participate in the Glendale Youth Rugby Program and related events and activities, the undersigned acknowledges, accepts, and agrees that:

While Glendale Youth Rugby is taking reasonable steps to follow local, state, and federal guidance intended to promote public health and limit the spread of infection from communicable diseases including but not limited to MRSA, influenza, and COVID 19, Glendale Youth Rugby cannot possibly eliminate all risk of exposure associated with participation in the program.

Participation in the program necessarily includes possible exposure to and illness from infectious diseases, including but not limited to MRSA, influenza, and COVID 19 and this document has served to provide me clear and unambiguous notice of the existence of the particular risks related to communicable or infectious diseases that are associated with participation in the program.
While rules requiring social distancing, facial covering, and other public health measures may reduce this risk, the risk of serious illness and death does exist; and I, , the natural parent or legal guardian of (minor child) KNOWLINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or other program participants, and I assume full responsibility for my participation.

I, , the natural parent or legal guardian of (minor child) willingly agree to comply with all of Glendale Youth Rugby's rules, requirements and guidance regarding Glendale Youth Rugby public health measures related to infectious diseases as a condition of participation in the program. If, however, I notice in my minor child or observe in others, any unusual or significant hazard during my presence or participation I will remove them from participation and bring such information to the attention of the nearest official immediately. I understand that this obligation requires me to remove my child from participation in the program if they are experiencing symptoms of an infectious disease.

I, , the natural parent or legal guardian of (minor child) , and on behalf of my heirs, successors, assigns, and personal representatives, hereby agree to indemnify and hold harmless and release and forever discharge Glendale Youth Rugby, the City of Glendale, and their trustees, officers, employees, agents, and representatives (collectively, "Releasees"), from any and all liability and all claims and causes of action whatsoever for any damages to or loss of property, personal illness, or injury (including death) caused by, deriving from or associated with participation in the program.

If any provision of this agreement is held by a court of competent jurisdiction to be invalid or unenforceable, then such provision shall be enforced to the maximum extent permissible so as to affect the intent of this agreement, and the remainder of this agreement shall continue in full force and effect.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I FURTHER UNDERSTAND AND AGREE THAT THIS AGREEMENT MAY SUPPLEMENT, AND DOES NOT REPLACE ANY OTHER WAIVER OR ASSUMPTION OF RISK DOCUMENTS THAT I MAY ALSO SIGN IN CONSIDERATION OF BEING ALLOWED TO PARTICIPATE IN THE PROGRAM.

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF EVENT)

This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward, including the risks of presence and participation and their personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to their release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child's/ward's presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE to the fullest extent provided by law.


USA Rugby Release of Liability

I ACKNOWLEDGE THAT BY SIGNING THIS DOCUMENT, I AM AGREEING TO RELEASE THE RELEASED PARTIES FROM LIABILITY. I HAVE THEREFORE BEEN ADVISED TO READ THIS DOCUMENT CAREFULLY BEFORE SIGNING IT.

This Participation Agreement and Waiver and Release of Liability is entered into by the undersigned "Participant" in favor of USA Rugby, its member unions, clubs, organizations, affiliates, partners, sponsors, vendors, directors, officers, employees, volunteers, members, agents, contractors, contracted entities and facilities and the owners and lessors thereof, (hereinafter referred to as "USA Rugby" or collectively as the "Released Parties").

I understand that participation in USA Rugby activities is a privilege but not a right. In consideration for the privilege of participation in USA Rugby activities, I and my Parent/Guardian, if applicable, acknowledge and agree as follows:
1. Participation in the activities of USA Rugby, including but not limited to warm-up, training, practice, games, clinics, travel, and social events (referred to herein as the "Activities"), includes participation in a full-contact sport, requires good health and fitness and can be HAZARDOUS AND PRESENT A DANGER TO ME. I believe I am qualified to participate in the Activities, and if at any time I believe the conditions to be unsafe, I will immediately discontinue further participation in the Activities

2. Participation in Activities exposes me to RISKS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH. Risks may arise out of contact and/or participation with other participants, spectators, equipment, field, facility and/or fixed objects; falls, collisions, rough play, and other mishaps; exposure to adverse weather conditions and/or high altitude; flaws and defects in equipment and facilities; irregular field conditions; and negligent field maintenance, negligent officiating, negligent coaching and negligent participation. Risks may be caused by my own actions, or inaction, the actions or inaction of others participants, the condition of the facilities in which the Activities take place, and/or THE NEGLIGENCE OF THE "RELEASED PARTIES." There may be other risks and social and economic losses either not known to me or not readily foreseeable at this time.

3. Assumption of the Risks. I CONSENT TO PARTICIPATION IN THE ACTIVITIES AND FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES incurred as a result of such participation.

4. Waiver and Release of Liability. In consideration for the privilege of my participation in the Activities, I hereby RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS RELEASED PARTIES from any and all liability, demands, losses, medical expenses, lost opportunities, damages or attorneys fees and costs stemming from any or all claims for negligence, expressed or implied warranty, contribution, and indemnity, and/or claims of negligent rescue operations, first aid, and emergency care, to the broadest extent permitted by applicable law, including C.R.S. 13-22-107 if I am a Minor, suffered by me and incurred on my account with respect to my personal injury and other injury or harm, disability, and/or death, or property damage, arising directly or indirectly from my participation in Activities, as caused or alleged to be caused in whole or in part by the Released Parties or any of them, and further agree that if, despite this Release, I or any other person makes a claim on my behalf against any of the Released Parties, unless, and to the extent, prohibited by law, I AND MY PARENT/GUARDIAN, IF APPLICABLE, WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASED PARTIES FROM ANY LIABILITY, LITIGATION EXPENSES, ATTORNEY FEES, LOSSES, DAMAGES OR COSTS ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM, WHETHER ASSERTED BY ME, MY PARENT/GUARDIAN, IF APPLICABLE, OR ANOTHER PERSON.

5. Governing Law, Venue and Jurisdiction: I understand and agree that this document is intended to be as broad and inclusive as permitted under applicable law and shall be governed by Colorado law. In the event of a dispute, the exclusive venue and jurisdiction for any lawsuit arising out of such dispute shall be the state court of Boulder County, or the federal courts located in Denver, Colorado.

6. Severability: If any provision of this document is determined to be invalid for any reason, such invalidity shall not affect the validity of any of the other provisions, which other provisions shall remain in full force and effect as if this document had been executed with the invalid provision eliminated.

7. Privacy Policy: I hereby certify that I have completely read and agreed to the USA Rugby Privacy Policy, currently residing on the USA Rugby website (https://www.usa.rugby/privacy-policy/).

I HEREBY CERTIFY THAT I HAVE COMPLETELY READ AND UNDERSTAND THIS AGREEMENT AND ITS TERMS. PRIOR TO SIGNING THIS AGREEMENT, I HAVE HAD THE OPPORTUNITY TO ASK ANY QUESTIONS ABOUT THIS AGREEMENT. I AM AWARE, BY SIGNING THIS AGREEMENT, THAT I ASSUME ALL RISKS AND WAIVE AND RELEASE CERTAIN RIGHTS THAT I AND EACH OF MY HEIRS, NEXT OF KIN, FAMILY, RELATIVES, GUARDIANS, CONSERVATORS, EXECUTORS, ADMINISTRATORS, TRUSTEES AND ASSIGNS MAY HAVE AGAINST RELEASED PARTIES. THIS RELEASE SHALL BE EFFECTIVE AND BINDING UPON ME. I FURTHER REPRESENT THAT I AM AT LEAST 18 YEARS OF AGE OR, IF I AM UNDER THE AGE OF 18, THAT MY PARENT OR GUARDIAN HAS SIGNED THIS FORM IN THE "CONSENT" SECTION BELOW.

I, a prospective or current member of USA Rugby, agree to abide by and be bound by the applicable Bylaws, disciplinary regulations, rules, regulations, Code of Conduct, competition rules of USA Rugby, as well as the safe sport rules, policies and procedures promulgated by the U.S. Center for Safe Sport, as they may be amended from time to time. I agree to be subject to the jurisdiction of the U.S. Center for Safe Sport and agree that any sanctions imposed by the Center extend to my participation in all USA Rugby events or activities, or events and activities of other NGBs, and may be posted publicly and include information regarding the misconduct involved.

I understand and agree that the USA Rugby Anti-Doping Rules and U.S. Anti-Doping Agency Protocol for Olympic and Paralympic Movement Testing (USADA Protocol) and all other policies and rules adopted by USA Rugby, USADA, and the USOC apply to me and that it is my responsibility to comply with those rules. I agree to submit to drug testing at any time and understand that the use of methods or substances prohibited by the applicable anti- doping rules would make me subject to penalties including, but not limited to, disqualification and suspension. If it is determined that I may have committed a doping violation, I agree to submit to the results management authority and processes of USADA, including arbitration under the USADA Protocol, or to the results management authority of USA Rugby and/or my national federation, if applicable or referred by USADA.


USA Rugby Rules Acknowledgement

1. I understand and agree to abide by all World Rugby Board, USA Rugby, territorial and local area union rules and regulations, including the arbitration procedures therein, for any dispute regarding my eligibility or right to participate in, USA Rugby-sponsored and USA Rugby-sanctioned activities and events, as set forth in the Bylaws of USA Rugby, as they are amended on a periodic basis, which I understand are available on the USA Rugby website (www.usarugby.org).

2. I affirm that I am not suspended or banned from play or participation by any club, local area union, territorial union, or national union, and I authorize USA Rugby to verify my citizenship status with the appropriate governmental agencies.

3. I am aware that USA Rugby has the right to revoke my membership registration and therefore my eligibility to play or coach, in the event of any violation of the aforementioned statement.

I HAVE READ THIS ACKNOWLEDGMENT AND FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. IN CONSIDERATION FOR THE PRIVILEGE OF PARTICIPATION IN USA RUGBY ACTIVITIES, I FURTHER REPRESENT THAT I AM AT LEAST 18 YEARS OF AGE OR, IF I AM UNDER THE AGE OF 18, THAT MY PARENT/ GUARDIAN HAS SIGNED THIS FORM IN THE SECTION BELOW.


USA Rugby Covid 19 Release

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact, but the virus can also live on surfaces. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people and the engagement in contact activities such as sport. Individual states and communities are making decisions as to what they believe the appropriate level of personal interaction in their jurisdiction should be in accordance with the local health guidelines. USA Rugby directs all potential players, participants, officials and spectators to follow the advice, regulations and rules associated with their individual locales rules and regulations. Rugby matches, trainings and events held which violate these local rules and regulations will be deemed to be unsanctioned events and thus prohibited gatherings for USA Rugby insurance and certification purposes.

At sanctioned events, USA Rugby (“USAR”) has directed that preventative measures to reduce the spread of COVID-19 be put into place; however, USAR cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending USAR sanctioned events could increase your risk and your child(ren)’s risk of contracting COVID-19. By checking the acknowledgement below you are in agreement with the following statement:

I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending USAR sanctioned matches, trainings or events (“Events”) and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Events may result from the actions, omissions, or negligence of myself and others, including, but not limited to, USAR or local rugby employees, volunteers, players and participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my or my child(ren)’s attendance at USAR Events or participation in USAR programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless USAR, its employees, directors, managers, attorneys, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of USAR, its employees, directors, managers, attorneys, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Event.

I further warrant that neither I nor, my children have tested positive for the COVID-19 infection / virus, nor are we experiencing symptoms associated with COVID-19. Should we test positive or become symptomatic, we hereby understand that our attendance at any USAR Events are prohibited.


Consent of Parent/Guardian for Participants Under 18

I REPRESENT THAT I AM THE PARENT/GUARDIAN OF THE UNDERSIGNED PARTICIPANT, WHO IS UNDER 18 YEARS OF AGE. I SIGN THIS DOCUMENT VOLUNTARILY AND WITH FULL UNDERSTANDING OF ITS TERMS AND LEGAL SIGNIFICANCE. I ATTEST THAT, IF I AM THE SOLE PARENT/GUARDIAN SIGNING BELOW, MY SIGNATURE IS SUFFICIENT TO CONSENT TO THE PARTICIPATION OF THE MINOR IN THE ACTIVITIES AND TO ENTER INTO THIS AGREEMENT ON BEHALF OF THE MINOR.

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