Registration Form

Welcome to the online registration for the 2017 Berkeley Rhinos season. Registration fee is $175, and includes a team T-shirt. Rugby shorts and black knee high socks are required and available for purchase below. You will be able to pay online using PayPal or pay with a check.

Player Information
  First Name*
Middle Initial
Last Name*
  Player Email
Home Phone*
Player Cell Phone
  Mailing Address*
  City*
State*
Zip*
  Birthdate MM-DD-YY*
Gender
  School*
Grade*
GPA* (last semester)
  Height
Weight
Waist Size (32,34,..)
  Rugby Experience (club, year)
Preferred Rugby Position
  Team
Select Team
T-Shirt Size*
Shirt included with registration
Rugby Shorts
$20 additional each
Socks $5/pair additional

Parent/Guardian Information
  Parent1 Name*
Parent1 email*
Parent1 phone*
  Parent1 Cell
  Parent2 Name
Parent2 email
Parent2 phone
  Parent2 Cell

Volunteer
  All families are expected to sign up to bring food for at least one home game. The Club Volunteer Coordinator will contact you with your assigned date.

I am willing to be in charge of organizing food and beverage for a Home Game:
January February March April (Returning parents - kindly sign up to be an organizer)

I am willing to bring food and/or beverage for a Home Game:
January February March April

For other parent/family volunteer assignments, please check the following:

I am interested in fundraising for the Rhinos. Here are my initial thoughts:
My company matches cash donations:

I am willing to contribute food or beverage to an end of season Team Barbeque, usually in April.

I am available to drive a car pool to away games. My car will hold players.

I am willing to be a side-line monitor for a game in
January February March April

I am available to drive to the Kick Off Tournament on Sat. Jan 21, 2017 or Sun. Jan 22, 2017. (Final date to be determined.)
My car will hold players.

Medical Information
  Medical Issues
List all important health information (allergic reaction, previous conditions, etc.)
  Emergency Contact Name*
Emergency Contact Phone*
 
  Emergency Doctor*
Doctor Phone*
 
  Health Plan Company*
Health Plan Number*
 

Authorization to Participate
  My child, being registered on this form, has my permission to participate in any and all home and away practices, scrimmages, matches, tournaments and tours, and all other activities related to his participation in this sport, including the transportation to and from such events, regardless of the mode, method or means, and any type of accommodations related to such activities.

I fully understand that my child is to abide by all the rules, regulations and requirements governing his conduct during these activities. Any violation of these rules, regulations or requirements may result in his being sent home at or by his own means of transportation and expense.

Berkeley Rhinos Libability Release

I fully understand that I hold harmless and indemnify the RHINOS, its officers, agents, employees, coaches, trainers, managers, and all other participants acting in any capacity on behalf of the RHINOS, and all other participants, including opposing players and touring side hosting families, from any injury or death related to any and all participation in these activities.

 
  • 1. PERMISSION TO PARTICIPATE: I, the parent/guardian of the above named participant hereby acknowledge that my child is in good general health and I give my approval for my child to participate in any and all RHINOS national, regional, league/conference, association and team/squad activities, including transportation to and from the activities by a licensed driver with proof of insurance.
  • 2. WAIVER: I acknowledge that I am fully aware of the potential dangers of participation in any sport and I fully understand the participation in rugby may result in SERIOUS INJURIES, PARALYSIS, PERMANENT DISABILITY AND/OR DEATH. Furthermore, I fully acknowledge and understand that protective equipment does not prevent all participant injuries, and therefore I do hereby waive, release, absolve, indemnify, and agree to hold harmless the local, league, regional and national rugby organizations and any and all organizers, sponsors, supervisors, coaches, trainers, managers, RHINOS Board Members, participants, and persons transporting the above named participant to and from activities, from any claim arising out of any injury to my/our child whether the result of negligence or for any other cause.
  • 3. EMERGENCY MEDICAL AUTHORIZATION: I hereby grant my permission for any and all emergency medical/dental treatment and/or first aid to be administered to my child/participant, including authorizing any medical treatment facility/hospital to administer emergency treatment, for any illness/injury/accident resulting from participation in any and all RHINOS activities.
  • 4. SCHOLASTIC VERIFICATION: I hereby stipulate that my child is scholastically fit and that my child is currently enrolled and attending school, and that my child will maintain a minimum, and current, 2.0 GPA during participation with the RHINOS.
  • 5. ADULT CODE OF CONDUCT: In order to uphold the goals of the RHINOS and ensure that all participants have the benefit of a safe and fun learning environment, all parents, guardians and other adults and attendees at RHINOS events, including but not limited to practices, competitions, social events, tours, tournaments, and banquets, must behave accordingly in a respectful, courteous and sportsmanlike manner at all times.
  • 6. ELGIBILITY: I understand that my child must meet the RHINOS requirements in order to participate in any and all RHINOS programs and events.
  • 7. RULES AND REGULATIONS: I hereby understand and acknowledge that as a parent/guardian of a RHINOS participant it is my responsibility to comply with all the rules and regulations adopted by the RHINOS. Non-compliance with any rules and regulations may be cause for discipline and/or dismissal of my child/the participant, myself, and/or any spectators or other persons affiliated with the undersigned and the above named participant.

By my signature below, I hereby stipulate that I have read, fully understand and voluntarily agree to all of the above:
Signature
  Name of person completing this form:


By clicking here I am signing the Authorization to Particpate, Libability Release and Authorization for Medical Treatment.

I understand the registration is not complete until payment has been received, the USA Rugby Release of Libability has been signed and returned, a copy of the student ID card has been submitted, and a player photo is taken.

  Berkeley Rhinos is a non profit. Please consider adding a donation to your registration to help us cover the admisistrative costs of the program.
$25 $50 $75 $100 $200 donation

  Payment:
I would like to pay online
I would like to pay with a check sent to 2931 Magnolia St, Berkeley, CA 94705