Develop 2018-2019 R.U.F.F. Registration Form
Member First/Last Name:
Your answer
Member Ethinicity:
(check all that apply)
Street Address:
Your answer
City/ Town:
Your answer
Zip Code:
Your answer
Member school (2018 - 2019)
Your answer
Member grade (2018-2019 school year)
Your answer
Member birthday mm/dd/yyyy:
MM
/
DD
/
YYYY
Member contact number:
Your answer
Member e-mail address:
Your answer
Does member receive free or reduced lunch?
Mother's name:
Your answer
Mother's contact number:
Your answer
Mother's e-mail address:
Your answer
Father's name:
Your answer
Father's contact number:
Your answer
Father's e-mail address:
Your answer
Other Emergency Contact:(name and contact information)
Your answer
Insurance Company/ policy #/ Group#:
Your answer
Allergies:
Your answer
Meds:
Your answer
Past Surgeries:
Your answer
Additional Medical hx:
Your answer
Doctor name/ phone number:
Your answer
Member T-Shirt Size:
(size for 2018-2019)
Submit
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