Kansas City Northland Youth League Registration

Registration for
Mid-America Youth Rugby League

Please complete the following:
1. Submit Registration to Mid-America Youth Rugby
2. Register for National Membership through USA Rugby
3. Visit our league store for Uniform

Rugby skills will be taught to all children at the beginning of each league session for ~30 minutes. Following the skills we will begin the flag games until 7:30. Tackle players will then get with their teams, warm up on tackle and play 30-45 minutes of games.

K-8th Grade - Flag ONLY - Coed Teams
3rd-8th Grade - Flag and Tackle - Coed Teams

Location:
Hodge Park Rugby Field
96 Reinking Road, Kansas City, MO 64157
(back past tree line on the rugby pitch)

Dates:
Summer Dates: July 11th - August 15th

Time:
6-7:30pm Flag
7:30-8:30pm Tackle

* Indicates required field

Child's Name *

First

Last

Gender *

Boy Girl

Address *

Line 1

Line 2

City

State

Zip Code

Country

Child's Birthday Month *

Day *

Year *

Child's School *

Child's Grade from 2021-2022 School Year *

Medical Insurance, Policy Holder & Policy Number *

Guardian #1 Name *

First

Last

Address Same as Player *

Yes

Address *

Line 1

Line 2

City

State

Zip Code

Country

Choose One *

Home Cell Work

Phone Number *

Email *

Guardian #2 Name *

First

Last

Address Same as Child *

Yes

Address *

Line 1

Line 2

City

State

Zip Code

Country

Choose One *

Home Cell Work

Phone Number *

Email *

Would either parent be interested in going to a short class to learn the basics of rugby to help coach a youth team? *

Yes No

Please list names of players you would like to be grouped with: *

How did you hear about us? *

Release Forms

USA RUGBY (MINOR) PARTICIPATION AGREEMENT AND WAIVER AND RELEASE OF LIABILITY
Participation in the activities of USA Rugby, including but not limited to warm-up, training, practice, games, clinics, travel, and social events (referred to herein as the “Activities”), includes participation in a full-contact sport, requires good health and fitness and can be HAZARDOUS AND PRESENT A DANGER TO PARTICIPANT. Participant and Parent or Guardian believe the Participant is qualified to participate in Activities, and if at any time the Participant, Parent or Guardian believe conditions to be unsafe, he/she will immediately discontinue further participation in the Activities. Participation in Activities exposes Participant to RISKS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH. Risks may arise out of contact and/or participation with other participants, spectators, equipment, field, facility and/or fixed objects; falls, collisions, rough play, and other mishaps; exposure to adverse weather conditions and/or high altitude; flaws and defects in equipment and facilities; irregular field conditions; and negligent field maintenance, negligent officiating, negligent coaching and negligent participation. Risks may be caused by the Participant’s own actions, or inaction, the actions or inaction of others participants, the condition of the facilities in which the Activities take place, and/or THE NEGLIGENCE OF THE “RELEASEES.” Some Risks cannot be predicted or controlled. There may be other risks and social and economic losses either not known to me or not readily foreseeable at this time.

Assumption of the Risks. I CONSENT TO PARTICIPATION IN THE ACTIVITIES AND FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES incurred as a result of such participation.

Waiver and Release of Liability. In consideration for the privilege of the Participant’s participation in the Activities, each undersigned hereby RELEASES, DISCHARGES, COVENANTS NOT TO SUE, AND AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS RELEASEES from any and all liability, demands, losses, medical expenses, lost opportunities, damages or attorneys fees and costs stemming from any or all claims for negligence, expressed or implied warranty, contribution, and indemnity, and/or claims of negligent rescue operations, first aid, and emergency care, to the broadest extent permitted by applicable law, including C.R.S. § 13-22-107, suffered by the Participant, Parent or Guardian or incurred on his/her account with respect to the Participant’s personal injury and other injury or harm, disability, and/or death, or property damage, arising directly or indirectly from the Participant’s participation in Activities, as caused or alleged to be caused in whole or in part by the Releasees or any of them, and further agrees that if, despite this release, the Participant or any other person makes a claim on the Participant’s behalf against any of the Releasees, THE UNDERSIGNED WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LIABILITY, LITIGATION EXPENSES, ATTORNEY FEES, LOSSES, DAMAGES OR COSTS ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM, WHETHER ASSERTED BY THE UNDERSIGNED, THE PARTICIPANT, OR ANOTHER PERSON.

Governing Law, Venue and Jurisdiction: The undersigned understands and agrees that this document is intended to be as broad and inclusive as permitted under applicable law and shall be governed by Colorado law. In the event of a dispute, the exclusive venue and jurisdiction for any lawsuit arising out of such dispute shall be the state court of Boulder County, or the federal courts located in Denver, Colorado.

Severability: If any provision of this document is determined to be invalid for any reason, such invalidity shall not affect the validity of any of the other provisions, which other provisions shall remain in full force and effect as if this document had been executed with the invalid provision eliminated.

THE PARENT AND/OR GUARDIAN HEREBY CERTIFY THAT PARTICIPANT IS UNDER 18 YEARS OLD, THAT I HAVE COMPLETELY READ AND UNDERSTAND THIS AGREEMENT AND ITS TERMS. THAT PRIOR TO THIS AGREEMENT, I HAVE HAD THE OPPORTUNITY TO ASK ANY QUESTIONS ABOUT THIS AGREEMENT. I AM AWARE, BY SIGNING THIS AGREEMENT I ASSUME ALL RISKS AND WAIVE AND RELEASE CERTAIN RIGHTS THAT I AND EACH OF MY HEIRS, NEXT OF KIN, FAMILY, RELATIVES, GUARDIANS, CONSERVATORS, EXECUTORS, ADMINISTRATORS, TRUSTEES AND ASSIGNS MAY HAVE AGAINST RELEASEES.

Parent's Initials *

USA RUGBY (MINOR) RULES ACKNOWLEDGEMENT
The Minor will abide by all International Rugby Board, USA Rugby, territorial and local area union rules and regulations, including the arbitration procedures therein, for any dispute regarding the Minor’s eligibility or right to participate in, USA Rugby-sponsored and –sanctioned activities and events, as set forth in the Bylaws of USA Rugby, as they are amended on a periodic basis, which are available on the USA Rugby web site (www.usarugby.org).

I affirm that the Minor is not suspended or banned from play or participation by any club, local area union, territorial union, or national union, and I authorize USA Rugby to verify the Minor’s citizenship status with the appropriate governmental agencies.

I am aware that USA Rugby has the right to revoke the Minor’s CIPP enrollment, and therefore his/her eligibility to play or coach, in the event of any violation of the aforementioned statement.

Parent's Initials *

MID-AMERICA YOUTH RUGBY PARENTAL WAIVER AND CONSENT
As the parent or legal guardian I hereby give my full consent and approval for my child to participate as a member of Mid-America Youth Rugby in practice, games and various camps.

I understand that there are certain risks inherent in playing the sport of rugby, and I am willing to assume these risks on behalf of my child. I hereby certify that my child is healthy and has no physical or mental disabilities or infirmities that would restrict full participation in these activities.

In addition to giving my full consent for my child’s participation, I do hereby waive, release and hold harmless Mid-America Youth Rugby, coaches, sponsors, supervisors and trainers for any injury that may be suffered by my child in the normal course of participation in the activities incidental thereto, whether the result of negligence or any other cause.

I also give permission for my child to be transported to practice, games or events by a parent, guardian, and/or member of the team or coach of Mid-America Youth Rugby. If I am not able to be reached immediately, I authorize a member of the Mid-America Youth Rugby's staff to see that my child is provided any necessary medical treatment and to provide my medical insurance information to the health care provider.

I hereby grant Mid-America Youth Rugby, or its assignees, permission to use my child's image for educational, promotional, fundraising and general public relations purposes.

Parent's Initials *

I agree to receiving marketing and promotional materials

1. Submit Registration Paperwork

2. Register with USA Rugby - Click Here

Follow the instructions below to get register with USA Rugby
1. Insert the following information
Type: Youth & High School
Region: Missouri Rugby
Club Name: Mid-America Youth
Scroll to the bottom:
* If playing FLAG ONLY - Choose Non-Contact Player $15
* If playing FLAG AND TACKLE - Choose Youth Player $40
2. Click Register
3. Create Login
4. Complete Registration and Payment

(All players must be CIPP registered with USA Rugby in order to play - if you played with Heartland Youth Rugby in Kansas, you may have already completed this step and do not need to do it again)

Visit our League Store for payment including registration and uniform!

3. League Store