Name *

First Name

Last Name

Name of Child *

First Name

Last Name

Age category *

3 - 5

6 - 9

10 - 12

Phone *

(###)

###

####

Photo Release Permission Slip *

As the Parent or Guardian, I hereby consent to the use of photographs/videotape taken during the Elk Valley Rookie Rugby Camp, for publicity and/or promotional purposes (including publications, presentation or broadcast via newspaper, internet or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.

Yes, I give consent for Elk Valley Rugby Club to photograph my child.

No, I do not give permission to Elk Valley Rugby Club to photograph my child.

T-Shirt Size *

Youth S

Youth M

Youth L

Youth XL