RHS 2017 Summer Bridge Registration
100 Participants Max - Deadline is Wednesday, May 31, 2017
Student Name
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Middle School Currently Attending:
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Parent/Guardian #1 Name
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Parent/Guardian #1 Contact Number
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Parent/Guardian #1 Email
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Home Address, City, Zip Code
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Parent/Guardian #2 Name
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Parent/Guardian #2 Contact Number
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Are there any medical conditions we should be aware?
Required
If yes, please identify:
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Emergency Person Name
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Emergency Person Contact Number
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In case of emergency, please identify: Hospital and Location
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