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Academy Application Fall HRM 2019
Keltics Academy
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* Indicates required question
Name
*
Your answer
Date of Birth
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Clothing size T-shirt (mens)
Choose
XS
Small
Medium
Large
XL
2XL
3XL
Clothing size shorts (mens)
Choose
XS
Small
Medium
Large
XL
2XL
3XL
Clothing size shorts (womens)
Choose
10
12
14
16
18
20
Health Card Number
*
Your answer
Health Card Expiry Date
*
Your answer
Emergency Contact #1 (Name, Relationship, Phone #, Email)
*
Your answer
Emergency Contact #2 (Name, Relationship, Phone #, Email)
*
Your answer
Medical Conditions and/or Medications
*
Your answer
Past or Current Injuries
*
Your answer
Allergies
*
Your answer
Dietary Requirements
*
Not Applicable
Celiac Disease
Lactose Intolerant
Vegetarian
Vegan
Other:
Preference of S&C training times / Days (please read carefully)
Wednesday/ Friday 5:45am-7am
Wednesday/ Friday 6:45am-8am
Last team played for?
Your answer
Are you currently insured through Rugby Canada via club or provincial team
Yes
No
Clear selection
Reason for applying to be involved in the Academy
Your answer
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