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KHAOS Elite Rugby Clinic – Piacenza

Registration Form

3 – 5 July 2026

  • Rugby Piacenza 1931, Via Guglielmo Taverna 2, 29121 Piacenza (PC), Italy
  • 9:30AM - 16:00PM each day
1
Participant Details
2
Parent / Guardian Details
3
Payment
Participant Information
Full Name *
Age *
Current Rugby Club *
Primary Position *
Playing Experience (years) *
Date of Birth *
Gender *
T-Shirt Size *
Dietary Requirements *
Allergies *
Medical Conditions *
Current Injuries or Recent Surgeries *
Medication Currently Taken *
Parent / Guardian Information
Parent / Guardian Full Name *
Mobile Number *
Email Address *
Relationship to Player *
Secondary Emergency Contact Number
Home Address *
Emergency Contact
If different from parent / guardian
Emergency Contact Name
Relationship to Player
Contact Number
Please make your payment
Pay now via Wise - 1 Day
Pay now via Wise - 2 Days
Pay now via Wise - 3 Days
Payment Confirmation *
Which day/s will you be attending?