MPACT GIRLS / ROYAL RANGERS REGISTRATION

Parent/Guardian Full Name *
2nd Parent/Guardian Full Name
Address *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Email *
Phone # *
Is this a cell phone?
If a cell phone, can you receive text messages?
Alternative Phone #
Child 1 Full Name
Child 1 Preferred Name
Child 1 Birth Date
Child 1 Gender
Child 1 Age
Child 1 Grade
Child 2 Full Name
Child 2 Preferred Name
Child 2 Birth Date
Child 2 Gender
Child 2 Age
Child 2 Grade
Child 3 Full Name
Child 3 Preferred Name
Child 3 Birth Date
Child 3 Gender
Child 3 Age
Child 3 Grade
Please list important information we should be aware of concerning your child(ren) (medications, food allergies, physical restrictions, etc.)
Do you consent for your child(ren) to be included in photos, videos and/or print materials? *
Additional Comments

    To register additional children, you will be returned to this page after clicking Register. Order t-shirts for your child(ren) below.