Fields marked with an * are required

2017 Summer Programs Registration Form














Parent/Guardian 1:



















Parent/Guardian 2:



















Emergency Contact (Other than Parent/Guardian):

Contact 1






Contact 2






Contact 3






Authorized to Pick Up (other than parent/ Guardian):

Contact 1






Contact 2






Contact 3






Contact 4






NOT Authorized to Pick Up (Legal documentation must be provided if listing a parent. Documentation may be emailed to summerprograms@rbcs.org):

Contact 1






Contact 2






In the Event of a life threatening emergency, First Aid will automatically be provided until emergency services arrive.












Statement of cooperation









By typing my name below, I, the custodial parent/guardian, acknowledge and agree that my electronic signature is the equivalent of a manual/actual signature. I give Rocky Bayou Christian School authorization to seek emergency care and treatment, according to its best judgement, for the well-being of my above named child.





Cancellation and refund policy