Rose Park Sports Association

Athlete's Full Name:

Athlete's Gender:

Female
Male
Other

Athlete's Race/Ethnicity

Age As Of July 1, 2021:

6
7
8
9
10
11
12
13
14-16
17-18

Birthday: MM/DD/YYYY

School Attending:

Current Grade:

Sport Registering For:

Spring Tackle Football
Rose Park Panthers Football (tackle) FALL
Basketball WINTER/SPRING
Spring/ Winter Conditioning
Panther Cheer

Parent/Guardian(s) Full Name(s):

Address:

Parent/Guardian(s) Full Email(s):

Parent/Guardian(s) Phone Number(s):

Emergency Contact Name/Number (if unable to contact parent/guardian):

I have read and understand RPSA Release (linked below), including a media release for promotional/or grant/fundraising purposes.

Yes, I agree and my child will participate.
No, I do not agree and my child will not participate.