Crescent Scouts Registration Form
Parent & Child Information
Parent's Full Name
*
First Name
Last Name
Parent's Email
*
example@example.com
Parent's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How Many Children Are You Registering?
*
Please Select
1
2
3
4
5
Child 1 Information
Child 1 Full Name
*
First Name
Last Name
Child 1 Age
*
Child 1 Current Grade Level
*
Child 1 Shirt Size
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Child 1 Allergies or Medical Conditions
*
Child 2 Information
Child 2 Full Name
*
First Name
Last Name
Child 2 Age
*
Child 2 Current Grade Level
*
Child 2 Shirt Size
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Child 2 Allergies or Medical Conditions
*
Child 3 Information
Child 3 Full Name
*
First Name
Last Name
Child 3 Age
*
Child 3 Current Grade Level
*
Child 3 Shirt Size
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Child 3 Allergies or Medical Conditions
*
Child 4 Information
Child 4 Full Name
*
First Name
Last Name
Child 4 Age
*
Child 4 Current Grade Level
*
Child 4 Shirt Size
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Child 4 Allergies or Medical Conditions
*
Child 5 Information
Child 5 Full Name
*
First Name
Last Name
Child 5 Age
*
Child 5 Current Grade Level
*
Child 5 Shirt Size
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Child 5 Allergies or Medical Conditions
*
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Emergency Contact Name
*
First Name
Last Name
Emergency Contact Relationship to Child
*
Please Select
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Older Sibling
Family Friend
Godparent
Other
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Primary Care Physician's Name
First Name
Last Name
Primary Care Physician's Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Health Insurance Details
Provider Name and policy number to expedite medical care if needed
Medical Treatment Authorization
Do you grant permission for Crescent Scouts leadership to seek emergency medical attention for your child if necessary?
*
Yes, I authorize medical treatment for my child in case of an emergency.
No, I do not authorize medical treatment for my child. (I understand that this may limit participation in certain activities.)
Liability Waiver
By checking the box below, you acknowledge and accept the inherent risks associated with scouting activities and release Crescent Scouts and its leaders from any liability.
*
I acknowledge and accept the liability waiver for Crescent Scouts activities.
Photo/Media Release
Do you consent to Crescent Scouts using photos/videos of your child in promotional materials, social media, or program-related publications?
*
Yes, I give permission for my child’s image to be used in Crescent Scouts promotional materials.
No, I do not consent to my child’s image being used in promotional materials.
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Authorized Pickup Person #1
*
Authorized Pickup Person #1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized Pickup Person #2 (Optional)
Authorized Pickup Person #2 Phone Number (Optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized Pickup Person #3 (Optional)
Authorized Pickup Person #3 Phone Number (Optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Special Needs/ Accommodations Needed for Child/ren (if any)
*
Behavioral Concerns (if any)
*
Which activities interest your child? (Select all that apply)
*
Sports & Fitness (Basketball, Soccer, Running, etc.)
Martial Arts & Self-Defense
STEM (Science, Technology, Engineering, Math)
Robotics & Coding
Arts & Crafts (Drawing, Painting, DIY Projects)
Music & Performing Arts (Singing, Dancing, Acting)
Outdoor Adventures (Camping, Hiking, Survival Skills)
Cooking & Baking
Leadership & Public Speaking
Book Club & Reading Activities
Money Management & Entrepreneurship
Volunteering & Community Service
Video Game Design & Esports
Social Skills & Team Building Activities
Other
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Registration Fee & Monthly Dues
Promo Code
*
prev
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( X )
Registration Fee
Select Total Number of Children Registering
$25.00
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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By signing below, I confirm that I have read, understood, and agree to the terms and conditions for my child’s participation in the Crescent Scouts program.
Submit
Submit
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