Your First Name *

Your Last Name *

Your Email Address *

Your Contact Telephone Number *

Child's Gender * Child's First Name *

Child's Last Name *

Child's Date of Birth (dd/mm/yyyy) *

Media Usage — Safeguarding is of the utmost importance to Rugby Stars. Please tick this box only if you are happy to give consent for visual and audio recordings to be taken of your child and used by Rugby Stars for promotional purposes

Child's Medical Conditions * (if relevant). If none, please type "None"

How did you hear about Rugby Stars? * Word of mouth/Facebook/Google etc