Located on the corner of 6th and Orange St. Below Richland chiropractic clinic Richland Center, WI.
Youth Archery Registration Form 2012
________________________________________________________
Class Dates: Jan,- 21, 28th Feb,- 4, 11, 18, 25th March, 3th.
Class Time: Saturdays 11:00am – 12:30 pm. Ages 17 and under only!
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Return this portion of form and $20.00 (checks payable to RCAC)
Youth Name:____________________________________Age:_______________
Address:__________________________________________________________
Phone:______________________________Cell:__________________________
Email :____________________________________________________________
Cost: $20.00 per Archer, includes T-shirt and donation for club Expenses.
Please circle T-shirt size: Youth S M L Adult S M L XL
Youth Archery Instruction Waiver of Responsibility
I am aware that participating in this youth Archery program may result in serious injury / death. I am willing to accept and assume all responsibilities for
any loss / damages / injuries that may occur. In addition, I release the Richland Archery Club INC. affiliates, sponsors and organizers from any liability. In
the event of injury, I give my permission for trained persons in charge to seek medical attention for my child. I approve that photos be taken of my child
and utilized for the RCAC website and/or newspaper articles.
Parent/ Guardian Signature:_________________________________________________________________
Date:_______________________
NOTE: Classes fill fast, first come basis. Sending registration does NOT guarantee spot.( Fees refunded)
Mail completed Form to: John Cler 465 East 8th ST. Richland Center, WI 53581
Youth Archery Registration Form 2012
________________________________________________________
Class Dates: Jan,- 21, 28th Feb,- 4, 11, 18, 25th March, 3th.
Class Time: Saturdays 11:00am – 12:30 pm. Ages 17 and under only!
--------------------------------------------------------------------------------------------------------------------------------------------------
Return this portion of form and $20.00 (checks payable to RCAC)
Youth Name:____________________________________Age:_______________
Address:__________________________________________________________
Phone:______________________________Cell:__________________________
Email :____________________________________________________________
Cost: $20.00 per Archer, includes T-shirt and donation for club Expenses.
Please circle T-shirt size: Youth S M L Adult S M L XL
Youth Archery Instruction Waiver of Responsibility
I am aware that participating in this youth Archery program may result in serious injury / death. I am willing to accept and assume all responsibilities for
any loss / damages / injuries that may occur. In addition, I release the Richland Archery Club INC. affiliates, sponsors and organizers from any liability. In
the event of injury, I give my permission for trained persons in charge to seek medical attention for my child. I approve that photos be taken of my child
and utilized for the RCAC website and/or newspaper articles.
Parent/ Guardian Signature:_________________________________________________________________
Date:_______________________
NOTE: Classes fill fast, first come basis. Sending registration does NOT guarantee spot.( Fees refunded)
Mail completed Form to: John Cler 465 East 8th ST. Richland Center, WI 53581
