CSCR Middle Schoolers school-year 2020
Student First Name
Student Last Name
Graduation Year/Grade Level
2026 (Currently 6th)
2025 (Currently 7th)
2024 (Currently 8th)
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
Parent/s, Guardians, Backups Names
Mailing Street Address
Any allergies, conditions or situations you'd like us to be aware of?
Primary Care Physician name, and office.
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)
Attending Feb. 4, 2020
Attending Feb. 11, 2020
Attending Feb. 18, 2020
Attending Feb. 25, 2020
Can't make Tuesdays, but would do Fridays if offered.
If you know of dates that you'll miss or have other notes or questions put them here.
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.
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