You R You Check/Cash Registration Form

Parent Contact Information:

First Name:

Last Name:

Email:

Phone:

Relationship to Child:

Are you their Emergency Contact?

Do you want to add a second parent?

Yes

First Name:

Last Name:

Email:

Phone:

Relationship to Child:

Preferred Address:

Address

Apt, Suite or Bldg.

City/Town

State/Province

ZIP/Postal Code

Participant Information

First Name:

Last Name:

Gender:

Date of Birth:

Name of School, Fall 2024

Please list any known allergies

Please list any medications the participant is currently taking

Participant Waiver

R ead Through Waiver Here

Please click above to read through our participant waiver, once you've read through it please sign electronically below.

signature

Complete Registration

Scholarship and/or Payment Options

Full Scholarship

Partial Scholarship

Cash/Check

Other…

Please select a scholarship option, or if you are paying via cash/check make checks payable to United Way of Washington County-East and drop off or mail in payment to

United Way of Washington County-East
1825 Curve Crest Blvd.
Stillwater, MN 55082

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