Berkley High School Rugby Football Club

Forms from the Parent Meeting...

C.I.P.P. Forms...

These forms are required by USA Rugby, we must mail them to Colorado by the end of February. If we do not have at least 15 of these forms turned in along with a $50 check (made out to BHS Rugby, we will write one check to USA Rugby) from each of the teams (boys and girls) then we will not be able to field a team this year. Thus, it is vital that these forms be turned in before vacation begins on Feb. 20, 2003. Coaches have forms, or they can be downloaded from the following site...

http://www.usarugby.org/membership/forms/registration/2003cipp.pdf

Berkley High Physicals...

The physical forms can be obtained from the Athletic Office, or at practice.

*If this is your first sports physical (since April 15, 2002) then both sides of the form MUST be filled out completely.

* If you have already had a physical (since April 15, 2002) then the Student and Parent or Guardian Consent Form (on the opposite side of physical form) must be filled out along with the Medical Treatment Consent.

*Please include a copy of your health insurance card with the physical, so that if treatment is needed it is available in the coach's file.

Parent Driver and Media release forms...

This form is crucial for our teams to be able to get to away games. We need all parents who think they might be able to drive even to just one game to turn this form. Players will NOT be allowed to drive themselves or others to away games, this is a school regulation. We will keep these forms on file so that when we leave for a game we merely need to pull the forms of our drivers for that particular game and submit copies to the school. The form can be received via emailing bhsrugby@comcast.net or by highlighting the form below, and choosing Print Selection under your Browser's File and Print menus.

School District of the City of Berkley
2211 Oakshire- Berkley, MI 48072
(248) 544-5800

Volunteer Driver Certificate

District Functions: Berkley High School Girls and Boys Rugby Club

Supervisor of Function: Dan White, Dave Skidmore, David Liedel

I. I have a valid Michigan Driver's license (copy attached):

Number: _____________________________

Expiration Date: ____________________

II. My vehicle is covered by liablility Michigan no-fault insurance (copy attached):

Company: _____________________________

Policy No.: __________________________

Expiration Date: _____________________

III. Description of Car:

Model: _______________________________

Year: ______________________________

No. of Passengers: __________________
(excluding driver)

______________________________ ________
Signature Date

Phone: ________________ ________________
Home Work

________________________________________

We also need the Media release forms turned in so that we know which athlete's parents have allowed their game pictures to appear in any newspaper articles or on the website. This form needs to be turned in even if you do not want your child's picture or name to be used. The Media form can be printed from this site, just highlight and choose Print the Selection in the browser's File menu. The forms are also available via email at: bhsrugby@comcast.net

Media and Website Release Form

I agree to allow the Berkley High School Rugby Club to post photographs of my child ____________________________
playing rugby on the club website. I also agree that any interested media sources (i.e. "The Mirror" newspapers) may photograph and interview my child for any articles or sports briefs.

______________________ Parent Signature

_____________ Date

If you do not want your child to be included in any of the above mentioned postings please sign below.

_______________________ Parent Signature

______________ Date

Email us
bhsrugby@comcast.net

USA Rugby Forms

C.I.P.P. Forms