Sign up here

Child's name:*
Child's DOB:*
Parent/Carer name:*
Phone number:*
-
E-mail:*
Address:
Which Sense Rugby Location would you like to sign up for:
Do you have any specific goals you would like us to work on with your child?
Any tips to help your child feel comfortable enough to participate? Please let us know if you have any strategies that you know usually works in group situations.
Any relevant diagnoses or medical history?
Are there any activities you would prefer your child does not participate in?
How would you like to pay?
Funding used, if applicable
Upload a File:
Credit Card Name:
Credit Card Number:
Expiry Date:
CVV:
Do we have permission to use your child's photos on our social media pages?
I give permission for my child or ward to participate in the Sense Rugby program. While I understand the efforts made by Sense Rugby Pty Ltd to minimize the possibility of injury, I understand that there will remain some degree of risk inherent in participation in the program. Please type your name in the box.