Youth Team Registration Form

100 Higginson Ave • Lincoln, RI 02865 • 401.727.1704 • questions@rhodeislandrockgym.com

Please fill out this form so that we can best the needs of your group.

If you have question, please contact Kris at 401.727.1704

Child's Name:

Age

Birthday:

Parent or Guardian Name:

Mom's Home Phone Number:

Mom's Cell Phone Number:

Dad's Home Phone Number

Dad's Cell Phone Number

Emergency Contact Name

Relationship

Emergency Contact Phone #

I wish to register my child for:

Electronic Signature
Please check this box to verify that you have read the description of the teams and certify that the above information is correct and accurate.
 

Message / Additional Request or Questions


 

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