SCRC Kick-off Registration
Please fill out one per child
Email address *
Child’s First and Last Name *
Your answer
Child’s Birth Date
MM
/
DD
/
YYYY
Current school grade of your child *
Your answer
Parent/Guardian Names *
Your answer
Parent/caregiver's cell phone *
Your answer
Emergency Contact Name/ Relationship to child *
Your answer
Emergency Contact Phone Number *
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
List additional adults that have permission to pick up your child. (Only primary care-givers listed above or people listed below will have permission to pick up your child)
Your answer
List any food alergies of which we should be made aware.
Your answer
List any other important items you would like us to know about your child.
Your answer
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