Scouts
K-6th
at RICMS
2024 Fall Intersession
Student's Name
*
First Name
Last Name
Student's Grade
*
Please Select
K
1
2
3
4
5
6
Age
*
Please Select
5
6
7
8
9
10
11
12
School
*
Please Select
Rock Island Academy
Frances Willard
Earl Hanson
Rock Island Center for Math and Science
Ridgewood
Thomas Jefferson
Longfellow
Eugene Field
Denkmann
Gender
*
Please Select
Male
Female
Primary Parent/Guardian Name
*
First Name
Last Name
Parent Birthdate
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Email Address
*
example@example.com
Primary Phone Number
*
Please enter a valid phone number.
Secondary Phone Number
*
Please enter a valid phone number.
What allergies does Student have?
*
Photo Release
Spring Forward may photograph your child for means of publication purposes. The photographs could be used in publication to create positive press for the organization. Photos might also be used in various brochures describing and promoting the program in a positive way. In no way will the photos be used in any illegal misrepresentation of your child. Spring Forward does take pictures of the programs and participants during the normal course of programming, special events, as well as any function pertaining to Spring Forward. By choosing 'yes' below you agree to allow Spring Forward or its agent to take pictures of your child and use them for publicity.
Does Spring Forward have permission to take photographs and/or video of your child during camp activities?
*
Yes
No
Submit
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