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 10/31/21)

Grade for 2021:

Second Child's Name

First Name Last Name

Age (as of 10/31/21)

Grade for 2021:

Third Child's Name

First Name Last Name

Age (as of 10/31/21)

Grade for 2021:

Fourth Child's Name

First Name Last Name

Age (as of 10/31/21)

Grade for 2021:

Fifth Child's Name

First Name Last Name

Age (as of 10/31/21)

Grade for 2021:

Each child will need to pay $40 to SRCC Trail Life troop to cover materials. This is in addition to the $29 each child will pay while registering on the Trail Life website later.

Payment Options

Cash/Check Credit Card on this form

PAYMENT INFORMATION

If your son(s) earned a gift certificate through the fundraiser last year that covers their enrollment fee, please choose the Gift Certificate option below and bring the gift certificate to the first meeting this fall.

If you have multiple sons in the program and only one earned a certificate please choose the option to pay the cost for the boys that did not get a certificate AND the Gift Certificate option for the boy that did.

SRCC Registration Payment

Registration Cost - SRCC Trail Life $ 40.00

Number of boys

Gift Certificate Free

Earned through the 2020 Flashlight Fundraiser

Number of boys who earned a certificate

Total $ 0.00

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