CSCR Middle Schoolers school-year 2020
Registration form
Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Graduation Year/Grade Level
Instructions:
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
Mailing Street Address
Your answer
City
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 days you plan to attend:
Winter Tuesdays 3:45-5:45 pm ($32.50 per day, and $27.50 for the second friend or family member)
If you know of dates that you'll miss or have other notes or questions put them here.
Your answer
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, unless noted otherwise below. *
Pay by the session at $32.50 each, and $27.50 for the second friend or family member. New kids are welcome any time. Write a check to CSCR with "Junior Program" in the memo line or use the "make payment" button below. And be sure to click the submit button on this form 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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