RCAP MESBELLE Student Form

RCAP MESBELLE Student Form

Thank you for taking the time to invest in your children’s future! Please fill out all blanks below to register student information
Name of Guardian *

First NameLast Name
Emergency Contact ?*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Emergency Number *
Please enter a valid phone number.
E-mail*
example@example.com
Preferred Contact Method*

CallTextEmail
Name of Student *

First NameLast Name
Date Of Birth of Student *
Grade Level *
Current School *
Any Allergies or Medical Conditions?*
Medications or Special Accommodations *
Commute to 2820 Main Street Dallas, Texas?*

Yes I will be available to Pick-Up & Drop Off

Will Student Be Available For All Dates? *

Photo & Video Consent I give permission for my child to be photographed and/or recorded during the RCAP program for promotional, parental and documentation purposes only.
YesNo
Liability Waiver & Permission I understand that my child will participate in RCAP activities under adult supervision. I release the organizers, staff, and volunteers from liability for any injury or accident that may occur during the program. If a student those get injured or other through our environments we will be responsible of taking care of the situation. Please Confirm
YesNo
📬 Would you like to receive updates about future programs or events?
YesNo
Any special message or questions you would like to let ask or need us to know?
Should be Empty:

Photo & Video Consent I give permission for my child to be photographed and/or recorded during the RCAP program for promotional, parental and documentation purposes only.