RCRP Mini Car Registration Form

RCRP Mini Car Registration Form
Which summer program site will your future leader be attending?
Which summer program site will your future leader be attending?
INDIVIDUAL REGISTRATION:
Participant Full Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Grade Level
Gender (choose one)
School Name
School District
T-Shirt size:
Any food allergies?
If yes, please explain:
Any medical conditions?
If yes, please explain:
Take medicine on a daily basis?
If yes, please explain:
Phone Number (if applicable)
Please enter a valid phone number.Format: (000) 000-0000.
Email (if applicable)
example@example.com
Which MCSD Summer Learning site will you attend?
PARENT/GUARDIAN INFORMATION:
Full Name

First NameLast Name
Relationship to Participant
Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Income Range of Participant Household
How many participants are you registering?
PHOTO WAIVER:
I, Signature grant and convey to Let’s Grow STEAMx all rights, title, and interest in any and all photographs, images, video, or audio recordings of my child(ren) or likeness made by Let’sGrowSTEAMx or its agents in connection with allowing my child to participate in Let’s Grow STEAMx activities.
Should be Empty: