Name: River City Soap Box Derby: June 2019
Start: 2019-06-08T00:00:00-04:00
End: 2019-06-08T23:59:59-04:00

Please fill all the required fields below:

Name*
First Last
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Allergies or Medical Condition?
Male/Female:*
Date of Birth:*
Current School:*
Grade:*
Parent's Info & Terms
Parent's Name:
First Last
Home Phone:
Cell Phone:*
Email:*
Photograph Terms*
- Yes, I do accept the terms
By checking this box below, I am aware photographs and videos will be taken and used for marketing including the use of social media for this program. I have proper authorization for each student attending to be photographed or videoed. If you have questions, please email us at soapboxderby@letsgrowsteam.org or call 800.332.7147
Authorization & Emergency Info
Authorized pick up person:
The following person(s) are authorized to pick up my child. Please be aware that anyone picking up your child MUST have a photo ID.
Authorized pick up person phone:
Emergency contact name:
First Last
Emergency contact phone:
PLEASE SUBMIT YOUR REGISTRATION

Racer Clinics – 27th April – D.A. Turner YMCA

Parent's Info & Terms