Lloyd & Steyn Rugby Academy

Step 1

Parent / Guardian

Parent / Guardian Full Name *

Relationship

Mobile Number *

Email Address *

Residential Address

Emergency Contact

Emergency Mobile

Step 2

Athlete

Athlete Full Name *

Athlete Email / Gmail

Date of Birth

Gender

School

Grade

Primary Position

Secondary Position

Step 3

Programme & Service

Training Programme *

Pathway Level *

Service *

Step 4

Medical Information

Medical Alert / Condition

Allergies

Medication

Current Injury

Participation Status

Restrictions

Medical Aid

Member Number

Step 5

Consent & Declaration

Signed By *

Media Consent

I confirm that the information supplied is accurate and I consent to Lloyd & Steyn Rugby Academy using it for registration, coaching, safety and academy administration. I understand that this application is subject to academy approval.

Academy Management Portal

Opening secure portal

Apply to join Lloyd & Steyn

Parent / Guardian

Athlete

Programme & Service

Medical Information

Consent & Declaration