Please complete the following form to register for the clinic below:  


City: Van, Henry & Smith Clinic, BC
Association: BC Rugby / Rugby Canada
Date & Time: Dec 2/13 @ 5:30 pm-Dec 2/13 @ 9:30 pm
Location: Fortius, 3713 Kensington Ave, Burnaby BC
Contact: Andrew Smith
Cost: $150.00


* Player First Name:
* Player Last Name:
* Parent Name:
* Parent Phone:
* Parent email:
* Emergency Contact:
* Emergency Contact Phone:
* Player Grade:
* Player years of rugby experience:
* Agree to Waiver?:   click here to read waiver

* required



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email: dhopkins@rugbycanada.ca Voice: 250-418-8998