Green Bay Leprechaun Rugby
6396 County Rd R
Denmark, WI 54208
 
www.gbleprechaunrugby.com
 
gbleprechaunrugby@gmail.com
 
 

2020 Green Bay Leprechaun Registration

Registration Fees Dues include, socks, shorts and use of a team jersey throughout the season. *
You must also register with USA Rugby under:

Green Bay Leprechaun Rugby Football Club

Join USA Rugby 

Family Information

Medical Information

In connection with my (our) child’s participation in the North East Wisconsin Youth Rugby program, I (we) authorize any accompanying adult bringing in my(our) child to your treatment facility to consent to any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment , and hospital care to be rendered to the minor under the general or special supervision, and on the advise of any physician or surgeon who is licensed to practice when the need for such treatment is immediate, and when efforts to contact me(us) are unsuccessful. 

 I (we) understand that I (we) assume all liabilities and expenses to the above. I (we)  waive all claims against the above referred to adult, physicians, hospitals and their employees, ambulatory care, etc. in connection with the decisions for such immediate care.

Scholarships

RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT

RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT
1. Player, and his custodial parent(s) and/or legal guardian(s) (together referred to as the “Undersigned”) hereby consent to Player’s participation with the Green Bay Rugby Football Club, Inc and the NE Wisconsin Rugby Foundation, Inc. as well as the North East Wisconsin Youth Rugby Corp. The Undersigned understand and agree that participation includes, but is not limited to, practice sessions, games, functions, parties, fundraising, and the like, and transportation to and from these activities. The Undersigned further understand and agree that transportation will usually be via private automobile and that drivers will include adults, other players, and students. 

The Undersigned understand that some drivers may be underinsured or uninsured and the
Undersigned agree to supplement their insurance to provide for sufficient underinsured or
uninsured coverage to compensate for any losses resulting from injury or death in connection with
a transportation mishap and the Undersigned otherwise waive claims against any Green Bay Rugby Football Club, Inc and the NE Wisconsin Rugby Foundation, Inc. as well as any North East Wisconsin Youth Rugby Corp. volunteer or staff. 

2. The Undersigned understand and agree that the team is not sponsored by any area high school nor
the area school districts, and as such, these institutions and their administrators and officials are not responsible or liable for injury, sickness, disability, paralysis or death that may result from Player’s participation with the team and all claims against said entities are waived.

3. The Undersigned understand that there are no salaried coaches or administrators assisting the
team. All of those who help are volunteers.

4. The Undersigned understand that rugby is an exciting, rough, physical contact sport and that as
with all sports the possibility of injury, be it serious or minor, always exists. The Undersigned hereby agree that they will not hold the Team coaching staff and Wisconsin Rugby Union and its officials and administrators responsible for injury, sickness, disability, paralysis or death that may
result from participation with the Team and all claims arising form such participation are waived.
5. RELEASE AND WAIVER OF LIABILITY: IN CONSIDERATION OF PLAYER’S RIGHT TO PARTICIPATE, THE UNDERSIGNED HEREBY RELEASE, DISCHARGE AND COVENANT NOT TO SUE the coaches, officials, and/or administrators of the Team, Green Bay Rugby Football Club, Inc,NE Wisconsin Rugby Foundation, Inc, North East Wisconsin Youth Rugby Corp. area high schools, school districts, municipal Park Departments and sponsors and workers. THE UNDERSIGNED AGREE THAT THIS RELEASE IS BINDING AND EFFECTIVE AS TO THEMSELVES AS WELL AS TO THEIR PERSONAL REPRESENTATIVES, ASSIGNS, HEIRS AND NEXT OF KIN AND THAT IT APPLIES TO ANY AND ALL LOSS OR DAMAGE CLAIMED ON ACCOUNT INJURY, DISABILITY OR DEATH, WHETHER CAUSED BY THE NEGLIGENCE OF THE ABOVE REFERRED ENTITIES, ORGANIZATIONS OR INDIVIDUALS OR OTHERWISE. The Undersigned under stand 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 agree that they have had the opportunity to seek legal advice and have either done so or voluntarily elected no to and waive this opportunity. 
 
6. The Undersigned understand that there may not be a medical physician or trainer at the Teams
games or practice sessions.
7. The Undersigned understand and agree to be solely responsible for the following:
a) To see that Player has a physical to determine that he is able and fit to play rugby;
b) To see that Player has appropriate medical insurance;
c) To see that Player wears a mouthpiece during ALL practices and games;
d) To see that Player abides by all rules and instructions;
e) To see that Player avoids the use of alcohol, tobacco, and/or controlled substance without proper prescription; and
f) To see that Player keeps his personal life clean and in accordance with laws and regulations
 
8. The Undersigned understand and agree to accept all responsibility, including medical and
financial, for participation. The Undersigned understands that each player must play in a
regulation jersey(provided for use by the team), socks, shorts and approved shoes.
We have read and understand and agree to the information and waiver and release of liability as set forth above.
I have read and agree to the RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT *