Request edit access
CSCR Junior Research Summer 2019
Registration form
Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Grade Level entering in the fall
If your student has participated with us in the past, you can enter just the information we wouldn't have from prior registrations, or that has changed.
Current School/s or Collaborative
Your answer
Parent/s, Guardians, Backups Names
Your answer
Phone numbers
Your answer
Any allergies, conditions or situations you'd like us to be aware of?
Your answer
Primary Care Physician name, and office.
Your answer
Click the dates you plan to attend or skip to the bottom.
Monday July 8
Tuesday July 9
Wednesday July 10
Thursday July 11
Friday July 12
Thursday July 18 (staff is not available July 15-17)
Friday July 19
Monday July 22
Tuesday July 23
Wednesday July 24
Thursday July 25
Friday July 26
Monday July 29
Tuesday July 30
Wednesday July 31
Thursday August 1
Friday August 2
Monday August 5
Tuesday August 6
Wednesday August 7
Thursday August 8
Friday August 9
Monday August 12
Tuesday August 13
Wednesday August 14
Thursday August 15
Friday August 16
If you've had it with filling in forms, and would prefer to just provide a description of the days between July 8 and August 17 you'd like to attend you can do so here.
Your answer
I want more... and might be interested in...
I hereby give permission for my child to participate in all CSCR activities including transportation. In the event of an emergency, I as the parent or guardian, understand every effort will be made to contact me/us, using the phone numbers and emails above, while prioritizing getting 911 services. In the event we cannot be reached, I/we hereby give permission to the physician selected to secure proper medical treatment which may include hospitalization, anesthesia, surgery or injection of medication for my/our children. I/we do for my child, myself, and our personal representatives, family, heirs and assigns, knowingly and freely waive all claims against and release and discharge CSCR and its officers, directors, agents, employees and volunteers from any and all liability, loss, damage and expense which may result from participation in CSCR programs. CSCR reserves the right to photograph CSCR participants for publicity purposes. *
Thank you! Susan prefers email susangbryant@yahoo.com for non-urgent arrangements and registration questions. Please add her phone number 857-231-1768 to your contacts. If you need us while on an expedition, please both text and call repetitively (since otherwise we would be disregarding calls when with students). Our location will always be on the log-out sheet, next to the door at CSCR. Please count up the number of sessions your registered for and multiply by $32.50. If this form is for the second student, multiply by $27.50 instead. Write a check to CSCR with Junior Program in the memo line or use the "other donation" amount on our payment form at http://ccscr.org/OnlineDonationsForm.aspx to jump to paypal. And then be sure to click the submit button below -- or it won't enter.
Once again no professional IT consultants were harmed in the making of this document, so please let me know if it doesn't work, or if you have expertise to lend.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service