EmailMe Form - FREE TEEN MEMBERSHIP PRE-REGISTRATION

Teen's Name *
First Last
Parent/Guardian Name *
First Last
Teen Date of Birth *
MM / DD / YYYY
Male/Female *
Email *
Phone *
### - ### - ####
Your teen will be able to use either the Harrisonburg or Bridgewater locations. Which location will you bring him or her in to register? *
Harrisonburg
Bridgewater
School *
Health restrictions *
I have read rules & regulations.
I understand that to complete registration process; parent/guardian, teen and proof of age must be shown to staff. This is only pre-registering your teen. Registration must be completed at either club location in person by parent/guardian and teen.