Registration

Youth ages 7-17 who live in the city of Roseville can register for RPAL membership. Membership is $40 per child and valid for one year. The membership fee covers all RPAL programs.

Complete the form below to begin the membership process. Please be advised that membership is not active until a payment is made.

Visit our Programs page to see how you get involved!

Roseville Police Activities League Registration

Child Information

Child First Name*

Child Last Name*

Child's Birthday*

Gender*

Male

Female

School*

Grade*

Ethnicity*

African American

American Indian

Asian

Caucasian

East Indian

Latino

Pacific Islander

Other

Health Insurance Carrier*

Health Insurance Policy Number*

Does your child have a food allergy?*

Yes

No

If yes, what is the allergy?

Chronic illness, medical conditions or other relevant information:

Which program(s) is your child interested in?

Boxing

Taekwondo

Homework Help

After-school Classes

Summer Program

Parent Information

Parent First Name*

Parent Last Name*

Email*

Phone*

Country/Region*

Address*

City*

Zip / Postal code*

Household Size*

Monthly Household Income*

How did you hear about us?

The Roseville Police Activities League

916-772-7725

110 Corporation Yard Road

Roseville, CA 95678

info@rosevillepal.com

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