SRCC Trail Life Sign-up

Dad's Name

First Name Last Name

Mom's Name

First Name Last Name

Email

example@example.com

Phone Number

Area Code Phone Number

Number of boys you would like to enroll in SRCC Trail Life

First Child's Name

First Name Last Name

Age (as of 10/31/19)

Second Child's Name

First Name Last Name

Age (as of 10/31/19)

Third Child's Name

First Name Last Name

Age (as of 10/31/19)

Fourth Child's Name

First Name Last Name

Age (as of 10/31/19)

Fifth Child's Name

First Name Last Name

Age (as of 10/31/19)

Each child will need to pay $40 to SRCC Trail Life troop to cover materials. This is in addition to the $26 each child will pay while registering on the Trail Life website later. Please choose below how you wish to pay for your child.

Payment Options

Cash/Check Credit Card on this form

SRCC Registration Payment

Registration Cost - SRCC Trail Life $ 40.00

Number of boys

Total $ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year