WINTER INDOOR RUGBY REGISTRATION

  • 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 2022 Winter Indoor Rugby 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.

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