Winter Academy Registration

Parent/Guardian Information

First Name

Last Name

Phone

Player Information

Player's First Name

Player's Last Name

Gender

Male

Female

Birth Date

Please select the group you are registering this player for below:

Product

U10 Coed (Ages 7-9)$350

U12 Boys (Ages 10-12)$350

U12 Girls (Ages 10-12)$350

Additional Parent/Guardian Contact (Optional)

First Name

Last Name

Phone

Emergency Contact Information

Full Name

Relationship to Player

Phone

Medical Info & Waiver

Player's Health Insurance Policy

Provider

Policy Number

Allergies or Other

Please provide us with any allergies this player has or medical information our staff should be aware of?

Click Here to Read & Review: Participation Waiver Agreement, Terms & Conditions

By checking this box you confirm that you have read, accept and agree to the Rising Star Academy participation waiver agreement, terms and conditions.

Winter Academy Registration

Parent/Guardian Information

Player Information

Emergency Contact Information

Medical Info & Waiver

Questions? success@risingstaracademy.us