Academy Application Fall 2019
Keltics Academy
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Name *
Date of Birth *
Email *
Phone Number *
Clothing size T-shirt (Mens sizing)
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Clothing size Shorts (mens)
Clothing size Shorts (Womens)
Health Card Number *
Health Card Expiry Date *
Emergency Contact #1 (Name, Relationship, Phone #, Email) *
Emergency Contact #2 (Name, Relationship, Phone #, Email) *
Medical Conditions and/or Medications *
Past or Current Injuries *
Allergies *
Dietary Requirements *
Preference of training days
Preference of training times
Are you currently Insured with Rugby Canada? (through club or provincial )
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Last team played for?
Reason for applying to be involved in the Keltics Academy
What sessions are you looking to be involved in?
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