Royal Rangers Registration

Is this your first time in Royal Rangers?

Yes
No

How long have you been in a Royal Ranger Program?

Boy's Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Personal Information

Date of Birth

Shirt Size

Grade

Boys Date of Salvation

Attends church at

Father's Name

First

Last

Mother's Name

First

Last

Royal Ranger Group (Select one)

Ranger Kids (Grades K - 2)
Discovery Rangers (Grades 3- 5)

Emergency Medical Information

Family Doctor's Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Doctor's Phone

Is your child allergic to penicillin?

Yes
No

Date of last Tetanus shot (if known)

Medications - Please list

Other Allergies, Medical Problems and/or Learning Disabilities

Signature of Parent or Guardian for Medical Permission

In case of emergency and I cannot be located, I authorize the Royal Rangers to secure emergency medical care for my child. I hereby give the Royal Ranger Staff permission to render first aid, take my child to the hospital in an emergency, and permission for a physician to give or order any necessary treatment.

Signature of Parent or Guardian

Today's Date

RR Charter yearly cost

Price: $ 20.00

Personal Information

Emergency Medical Information

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