Player Registration – WRL Invitational Wheelchair League

First Names *

Surname *

Street Address *

Apartment, suite, etc

City

County

Postal Code

Country

Date of Birth *

Birthplace *

Email Address (parents or guardian's if aged 17 or under) *

Phone Number (parents or guardian's if aged 17 or under) *

Team Registering for *

Role in Club - Please tick all that apply *

PlayerCoachFirst AiderVolunteer

Name of School (if at school)

For Wheelchair or PDRL registration only (or please leave as able body)

Player profile picture *

No file chosen

Please upload a profile picture of yourself, preferably in the shirt or leisurewear of your registered club. It is preferred that the name of the file uploaded is the name of the player and club.

Parent / Guardian name (if you are under 18)

Relationship (e.g. mother, father etc)

Wales Rugby League (WRL)