Rising Stars Registration

RISING STARS REGISTRATION Form

1st & 2nd graders

$50 registration fee is required at the submission of this form.

* Indicates required field

CHILD'S NAME *

AGE *

BIRTHDATE *

TSHIRT SIZE *

GENDER *

GRADE *

SCHOOL *

Allergies/Medical/Emotional/Special Needs *

Parent/Guardian Name *

Parent/Guardian Email *

Parent Phone *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Name *

Emergency Contact Phone *

Names of those authorized to pick up your child *

How did you hear about RPA? *

ATTENTION: When you click "submit," you will be led to a page where you will pay the $50 deposit. Please do not click submit until you are ready to do so!

Submit