RSK Registration Form

Name

First Name

Last Name

Gender

Cell #

(###)

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Age

Date of Birth

YYYY

Grade Next September

School

Street Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian name #1

Cell #

(###)

###

####

Work#

(###)

###

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Parent/Guardian Name #2

Cell #

(###)

###

####

Work#

(###)

###

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Emergency Contact

Relationship

Phone#

(###)

###

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Email 1

Email 2

Special request, food allergy, alerts or comments

IMPORTANT INFORMATION

The Cedarmore Corporation’s Ready Set kNOw – Making Right Decisions Program was designed to incorporate learning and discussion making beyond program hours. Our staff will only have time with your child for a brief three weeks where we will introduce them to ideas and concepts based on statistical and scientific data as well as provide them information that is both relative and instructional.

Parental consent

Parental consent to use child’s photograph by The Cedarmore Corporation is hereby given. The child and parent/guardian agree to abide by the rules and regulations set by for the safety and welfare of all concerned.

Parent/Guardian Full Name (Digital Signature)

Consent Date

YYYY

Ages: 9-17
Registration: On-going
Program dates: July 5 - July 16
Cost: $25.00
Phone: 516-378-3415
Location: Virtual programming via Zoom

About the Program:

We educate and empower youth on healthy decision-making as the foundation for successful living. Interactive instruction is inclusive of personal development, self-esteem, goal-setting and relationships.

Coronavirus Update

Please check out our Events page and follow our social media channels to learn about our exciting and cutting-edge programs designed to elevate, encourage and empower. Please review the resources from the Centers for Disease Control and Prevention for the latest information available to assist you and your family. We are constantly monitoring the recommended health & safety protocols and will make adjustments accordingly.