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Roanoke-Benson Recreation Assoc.

P.O. Box 621
Roanoke, IL 61561

RBRA 2016 VOLLEYBALL PROGRAM
3RD – 5TH GRADE
First Name: __________________________ Last Name: _________________
Current Grade: ______Address: _______________________Phone:____________________
Circle Shirt Size:

Youth: (6-8) (10-12) (14-16)
Adult: (Small) (Medium) (Large) (X-Large)

FEE:

$50
Registration is March 5th 1:00-2:00, in the high school gym. Registration can also
be mailed to the RBRA. A late registration fee of $10 applies after March 12th.
Registration is closed after March 16h.

DATES:

Program will start right after spring break and last for 4-6 weeks. Dates to be
determined soon.

GOAL:

The goal of this league to teach girls the basic fundamentals of volleyball and to
HAVE FUN!!

VOLUNTEERS:

Volunteers are needed to make this program a success for the kids!!! Looking
for volunteers willing to help with practices and coach during games. Please let
us know if you are willing to help.

**KNEE PADS OPTIONAL**
Any questions please call Norm Weldon at 309-261-3639
**This registration form and the fee are required prior to participation and serves as a permission slip for each player
to participate in the RBRA volleyball program. All participants are responsible for their own health insurance
coverage. In case of an emergency, I give permission for my child to be given any necessary medical attention by a
qualified and licensed medical doctor.**

Emergency contact: Name: _______________________ Phone: _________ or _____________
Parent / Guardian Signature: _____________________ Date: _________
E-mail: ______________________

RBRA Board of Directors:
Chad Martin, Jonathan Weber, Norm Weldon, Vince Hummel, Dirk Norman
Jesse Martin, Dawn Alford, Leslie Cargill, Brian Reifsteck