Contact information

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Contact information

2020-2021 Rugby Canada Development Academy Application.
Application to be completed by October 2nd, 2020
Any question- contact Sandro Fiorino via email Sfiorino@rugby.ca

Name *

Email *

Date of Birth *

YYYY

Address *

Phone number

Name Parent/Guardian #1 *

Name Parent/Guardian #1 Email Address *

Name Parent/Guardian # 2

Name Parent/Guardian #2 Email Address

What are your rugby aspirations?

Why do you want to be a part of the Rugby Canada Development Academy?

What Rugby 7s Representative teams have you played on in the past 3 years? Please provide the name of all your coaches - (7s)

What Rugby 15s Representative teams have you played on in the past 3 years? Please provide the name of all your coaches - (15s)

What are your preferred positions in Rugby 7s & 15s?

Rugby Team / Club / Organizations you are currently a part of?

Primary Rugby Coach(es) Name & Email

Are you currently participating in any Rugby Academy?

Are you presently registered with your club, Rugby Ontario or Rugby Canada?

Yes

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What grade will you be entering in September 2020?

What post-secondary education are you pursuing for Sept 2021 ( if applicable)

Are you currently playing other sports? If yes, at what level and list any notable accomplishments.

Name & Email of Secondary Sport Coach

Have you ever attended an RBC Training Ground event? (when/where?)

Please provide us with any testing data you have achieved over the last 18 months. This should include the type of test, results, where you were tested, and by whom. (possible data could include 10m sprint, 40m sprint, Bronco test, Beep Test, other).

Which Testing Combine will you attend?

October 3rd Central Ontario Toronto

October 4th Eastern Ontario Ottawa

October 10th Western Ontario Brantford

Not available for any of the above dates

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Applicant Height

Applicants Weight

Current/Past Physical Health History ( list any major or relevant past physical injuries or medical conditions. Date of occurrence, is it resolved/ongoing? What treatment was done?) Please note, providing an in-depth health history as well as a physicians

Allergies/Anaphylaxis: (Please indicate if you carry an EpiPen or an inhaler).

Current/Past Mental Health History (Please list any major or relevant past mental health concerns or conditions. Date of occurrence, is it resolved/ongoing? What treatment was done?)

Number of concussions: Diagnosed & Undiagnosed

Who is the person you would say knows you best?

Parent

Sibling

Friend

Other

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If something in your house breaks, what is the first thing you do?

1. try to fix it on my own

2. call a professional

3. call a friend/family member

4. try to ignore it

Clear selection

What do you prefer?

1. a book

2. a movie

3. a theatre play

Clear selection

4. What is your favorite game when you were a child?

1. hide and seek

2. playing sports

3. puzzle/board games

4. playing with toys/dolls

5. playing with friends

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The school dance is next week, how are you going to prepare?

One month to go and I already got my outfit, shoes, and I have my travel arrangements to and from.

One month to go, don’t really need to worry about it. I think I have something in my closet I can wear. As for driving, I know one of our parents/someone will do it so I am not even worried.

I could care less about the dance, i’d rather chill at home with friends.

I could care less about the dance, i’d rather chill at home alone.

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Personal Reference #1 Name

Reference #1 Relationship to Applicant

Reference #1 Email

If you have a link to an applicants highlight video, please provide it here:

Submit

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