YOUTH RRC REGISTRATION

Please complete the individual registration form below and press register.
 You will be taken to the payment option page.
Thank you!

 * denotes required fields

ACTIVITY: *

Please enter the RRC activity you are registering for in the field:

CHILD’S NAME: *

GENDER: *

AGE/GRADE: *

T-SHIRT SIZE: *
To Select Size Click Arrow

Sorry NO shirts for COOKING or TUMBLING/GYMNASTICS!

PARENT’S NAME: *

ADDRESS: *

CITY: *

STATE: *

ZIP: *

PHONE: (PRIMARY) *

PHONE: (ALTERNATE)

EMERGENCY CONTACT NAME: *

EMERGENCY CONTACT PHONE: *

EMAIL

COACH/ASSIST

COACHES T-SHIRT

Mail Payment to:

Russell Recreation Commission

701 Fairway Dr., P.O. Box 382

Russell, Kansas 67665

Phone: Office--785-483-6966 Cell--785-483-7712

Fax: 785-483-4331

Copyright © Russell Recreation Commission, All Rights Reserved 2012