Break Programming Sign Up

1
Parent Name
First Name
Last Name
2
Your Email
example@example.com
3
Are your children already registered for programs at R CITY?They must be registered for R CITY programs to participate. Complete registration at rcitycdc.org/programs.
YESNO
4
Permissions: In consideration for being allowed to participate in this Activity, I release from liability River City Community Church, River City Community Development Center, and their staff AND VOLUNTEERS from any and all claims, which may result from my child’s participation in this Activity or any events incidental to this Activity.* This field is required.I have read and understand that by clicking the box below, I give my permission for the children listed on this form to participate.
Yes, I understand and consent.
5
Write the NAME and AGE of the children who will be attending:* This field is required.Example: John, 8
6
Which days are you planning to bring your child/children?
0Monday, June 15, 10:30 AM-1:30 PM
Tuesday, June 16, 10:30 AM-1:30 PM
Wednesday, June 17, 10:30 AM-1:30 PM
Thursday, June 18, 10:30 AM-1:30 PM
7
Have you completed a CPS Safe Haven form this year?All K-4th grade will already have this form completed. If you don't have one yet, we will send it to you.
Please Select
Please Select
Yes, for all my children
Yes, for some of my children
I'm not sure
No
8
Any allergies or special needs or considerations you want to share?
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: