RC Kids Registration

Parent/Guardian 1

Name

Phone

This address will receive a confirmation email

Address

Parent/Guardian 2

Name

Phone

Address

Child Information

1st Child

Name

Grade

N/A K 1st 2nd 3rd

Gender

Please list any existing medical conditions, medication and/or special attention your child may require.

Allergies?

2nd Child

Name

Grade

Gender

Please list any existing medical conditions, medication and/or special attention your child may require.

Allergies?

3rd Child

Name

Grade

Gender

Please list any existing medical conditions, medication and/or special attention your child may require.

Allergies?

4th Child

Name

Grade

Gender

Please list any existing medical conditions, medication and/or special attention your child may require.

Allergies?

If you have additional children please fill out another form. Thank You!

Photo Release

I grant to Resurgence City, it's representatives and employees the right to take photographs of my child(ren) in connection with RC Kids. I authorize Resurgence City, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Resurgence City may use such photographs of my child(ren) with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

Agree Disagree

RC Kids Registration

Description

Please Fix the Following