RR2TR / AT&T Digital Experience – Ruff Ryders to the Rescue

Ruff Ryders to the Rescue/AT&T Digital Experience

Registration

Child's Name *

First

Last

Parent's Name *

First

Last

Address *

Address Line 1

City

State

Phone *

Age Range

Email *

Gender *

Attendance

Technology Courses *

Desired Location *

Additional Information

Health Issues/Physical Limitations *

Emergency Contact Name *

Emergency Contact Phone

Disclaimer and Signature

I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that false or misleading information may be result in cancellation of support.

Name