RRDA Registration

 

This is for parents or guardians to register. After registration, you will be asked to login, using your email address, and then register your students.

If you are an adult student, you will be asked to fill out both sections. Please use 'Same' for the relationship.

 

Register Parent/Guardian:

First Name*   Last Name*   Relationship to Student*
   
Email*   Password*   Re-Enter Password*
   
Passwords do not match!
Home Phone*   Cell Phone   Work Phone
   
Street*   City*   State*
   
Job Title   Employer   Zip Code*
   
Emergency Contact First Name   Emergency Contact Last Name   Emergency Contact Phone
   
Preferred Hospital   Physician   Physician Phone
   
Insurance   Insurance Policy No.   Insurance Phone
   
* - Required Field