JUNIOR REGISTRATION

Athlete's Name *
Athlete's Name
Athlete's Home Address *
Athlete's Home Address
Athlete's Cell Phone
Athlete's Cell Phone
Athlete's Birthdate *
Athlete's Birthdate
Gender *
Expected Graduation *
Parent/Guardian #1 Name *
Parent/Guardian #1 Name
Parent/Guardian #1 Cell Phone *
Parent/Guardian #1 Cell Phone
Parent/Guardian #2 Name
Parent/Guardian #2 Name
Parent/Guardian #2 Cell Phone
Parent/Guardian #2 Cell Phone
Head of the Ohio Pittsburgh, PA *
October 6 & 7
Head of the Schuykill Philadelphia, PA *
October 27 & 28
Head of the Occoquan, Fairfax Station, VA *
November 3 & 4

Checks should be made payable to Pittsburgh Rowing Club and mailed to 200 Mingo Road, Wexford, PA 15090.  Bring completed forms with you on the first day of practice.