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Please provide the first name of at least one of the student's parents.​​​
Please provide the last name for the parent(s) listed above.​​​
Please provide a contact email for at least one of the student's parents.​
Rugby Clinic - January 4, 11, 18, 25. 9 a.m. - 11 a.m.​​​, Sportsplex, 90 Ridge Rd, North Tonawanda, NY​​

After you click submit on this form, you will be brought to a payment page to complete your payment.

If there is any additional information we should know about this participant, please add it here.​​