CSCR Junior Research Registration for 2019
Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Grade Level -- if you already filled this in for summer or fall you can skip down to the dates.
Current School 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
Tuesday 3:30-5:30, January 8, 2019
Tuesday 3:30-5:30, January 15
Tuesday 3:30-5:30, January 22
Tuesday 3:30-5:30, January 29
Tuesday 3:30-5:30, February 12
Tuesday 3:30-5:30, February 19 (during school vacation so depending on interest)
Tuesday 3:30-5:30, February 26
Tuesday 3:30-5:30, March 5
Tuesday 3:30-5:30, March 12
Tuesday 3:30-5:30, March 19
Tuesday 3:30-5:30, March 26
Tuesday 3:30-5:30, April 2
Tuesday 3:30-5:30, April 9
Tuesday 3:30-5:30, April 16 (depending on interest during school vacation -- low tide mud)
Tuesday 3:30-5:30, April 23
Tuesday 3:30-5:30, April 30
Tuesday 3:30-5:30, May 7
Tuesday 3:30-5:30, May 14
Tuesday 3:30-5:30, May 28
Tuesday 3:30-5:30, June 4
Tuesday 3:30-5:30, June 11
Tuesday 3:30-5:30, June 18
Tuesday 3:30-5:30, June 25
Tuesday 3:30-5:30, July 2
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 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 you 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 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.
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