Ross Community Center: Mission Space!
March 25th- 28th
3PM-4:30PM
ages 9-12pm
Admission $10
Sign in to Google to save your progress. Learn more
Name (first & last) *
Gender
Clear selection
Birthday  *
MM
/
DD
/
YYYY
Age  *
Address
 *
School
 *
Allergies  *

Parent Signature  *
Parent Phone  *
Parent Email  *
Person to call in case of emergency, if unable to contact Parent/Guardian: (Name and Telephone Number)
 *
Relationship to Participant
 *
My Child has Permission to arrive/leave the Ross Center by:
 *
Required
Parent/Guardian Authorization
I hereby authorize my child to attend after school programs at the Ross Community Center:I also give permission to the Ross Community Center to videotape and take photographs of my child for the purpose of publication of events at the Center, in print, presentations, on their website and social media. I understand that no royalty, fee, or other compensation shall be payable to me by reason of use. I also release Ross Community Center staff and volunteers from liability.
Parent/Guardian Authorization *
Parent/Guardian Signature *
Date *
MM
/
DD
/
YYYY
 The following persons have my permission to pick my child up from the Ross Community Center:
Person No.1 (Name, Relationship to Child, Telephone Number)
Person No.2 (Name, Relationship to Child, Telephone Number)
Person No.3 (Name, Relationship to Child, Telephone Number)
Parent/Guardian Signature *
Date *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Ross Community Center. Report Abuse
Google Forms