contact us

Use the form on the right to contact us.

You can edit the text in this area, and change where the contact form on the right submits to, by entering edit mode using the modes on the bottom right.

Use the form on the right to contact us.

You can edit the text in this area, and change where the contact form on the right submits to, by entering edit mode using the modes on the bottom right.

 
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 ©2013 US Collegiate Development LLC. The shield logo and Jakl logo are trademarks of US Collegiate Development LLC.

9 Reservoir Road
Hanover, NH 03755
USA

(321) 480-3429

Staff Agreement

Contact Information
Name *
Name
Best Phone *
Best Phone
Mailing Address *
Mailing Address
Team Level *
Please check all that apply
Role
Participant Type *
Please check all that apply
Date of 1st Session participating *
Date of 1st Session participating
please indicate the first date of service
Date of last Session participating *
Date of last Session participating
please indicate the last date of service
Agreements / Waivers:
(check each box)
I HAVE READ AND AGREE TO: *
Registered with USA Rugby? *
Participants should be registered with the national governing body, USA Rugby
I am SafeSport certified *
I AGREE: *
Last Name, First Name
Emergency Contact Phone 1 *
Emergency Contact Phone 1
Emergency Contact Phone 2 *
Emergency Contact Phone 2
ACKNOWLEDGEMENT: *
MEDIA RELEASE: *
I agree to this electronic signature. Type "/" then full legal name, then "/" again:
Date *
Date