Register Now - Waitakere Rugby League Academy

Name(Required)

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Preferred Name (if applicable)

Date of Birth(Required)

Please remember that your child has to be born from 2011 or later. 13 years or older.

Gender(Required)

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Primary Position(Required)

Secondary Position(Required)

Age Grade(Required)

Club(Required)

Primary Phone Number / Mobile(Required)

Secondary Phone Number / Home

Address(Required)

Street Address Suburb City ZIP / Postal Code

Email(Required)

Emergency Contact Name(Required)

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Do you have any medical conditions?(Required)

Please detail your medical conditions(Required)

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WRLA July School Holiday Clinic 2025