CSCR Middle Schoolers school-year 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 days you plan to attend:
Fall Tuesdays 3:45-5:45 pm
Fall Fridays 3:30-5:30 pm
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. *
Thank you! Susan prefers email for non-urgent arrangements and registration questions. For the best in emergency communications, please add Susan's phone number 857-231-1768 to your contacts, and send her a text with your and your kid's name. 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. For this Fall we are experimenting with block pricing, and charging $145 through Nov. 8, 2019. 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 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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