Rocky's Girls (Grades 4-5 Registration)
Volleyball & Mentoring Program (Fridays- 7/10; 7/17; 7/24; 7/31; 8/7)
Participant Name
*
First Name
Last Name
Participant Grade (Current School Year)
*
Please Select
1
2
3
4
5
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Additional Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Liability:I give permission for my child to participate in the Rocky's Girls Program. In the event of an emergency, I authorize staff to seek medical treatment for my child if I cannot be reached.I understand that participation involves normal activity-related risks and release Rocky's Girls, Brockton Public Schools, and the City of Brockton from liability for injuries that may occur during program participation.
*
Agree
Photo & Media Release: I give permission for my daughter to be photographed or recorded during Rocky's Girls activities. I understand that these photos and videos may be used by Rocky's Girls and Brockton Public Schools for promotional, educational, or informational purposes, including social media, websites, and publications, without compensation.
*
Yes, I give permission.
No, I do not give permission.
Submit
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