Pre-medical Scrub Scouts Registration Form

Pre-medical Scrub Scouts Registration Form

The Scouts program will take place on Sunday, May 31st at 10:00 AM at the Francis D. Martini Memorial Shell Park and Moynihan Recreation Area. Please note this is an outdoor location, and attendance is contingent upon favorable weather conditions. The program duration is one hour, with pick-up promptly at 11:00 AM.
Child 1 Name

First NameLast Name
Child 1 Age
Child 2 Name

First NameLast Name
Child 2 Age
Child 3 Name

First NameLast Name
Child 3 Age
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Parent 2 Full Name

First NameLast Name
Parent 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent 2 Email Address
example@example.com
Important Addresses

Address Line 1

Address Line 2
CityState/ProvinceZip/Postal Code
Why are you interested in the Pre-medical Scrub Scouts program?
Health Issues
Does the child have any health issues?
Please describe any health issues, allergies, medications, or other special considerations.
Should be Empty:

Health Issues