Diamond Valley: Program Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please provide an email address to receive a copy of the registration.

Email *

Athlete's First & Last Name *

Check session(s) registering:

>> Grassroots (8 - 13yrs)

>> Academy (12 - 16yrs)

GR Fall : Mon, Sept 22 @ 6:00 - 7:30pm ($125)

Acad Fall: Mon, Sept 22 @ 7:30 - 9:00pm ($150)

GR Winter : Mon, Nov 3 @ 6:00 - 7:30pm ($125)

Acad Winter : Mon, Nov 3 @ 7:30 - 9:00pm ($150)

Required

Athlete Gender *

Female

Male

Required

Athlete's Birthday *

YYYY

Current School Attending

Allergies & Heath Concerns (if any)

Mailing Address (Please include City & Postal Code) *

Parent Name(s) *

Parent Email(s) *

Parent Contact Number(s) *

Emergency Contact Name (should the primary parent not be reachable) *

Emergency Contact Number *

Relationship to athlete (emergency contact) *

Media Release Consent *

I have read the Media Release Consent and fully understand the contents and meaning of the release. I understand that I am free to contact Rampage, with any concerns regarding the release.

Required

Waiver & Release of Liability *

I confirm that I have read and fully understand the Waiver and Release of Liability.

Required

Almost finished with the registration.

Don't forget to click on the submit button.

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms