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2. Please select:

   1. D.A.R.E.
   2. C.A.R.E.
4. Student Information:
7. First Name
8. Last Name
10. Date of Birth
    Date of Birth
11. Child's age as of June 2026
13. Grade 2025/2026 School Year:
15. Address
17. City
18. State
19. Zip Code
23. Parent Information:
25. Name
26. Email Address
28. Phone Number
32. Emergency Contact Information:
34. Name
36. Phone Number
38. Authorization:

    1. Yes

    I have read the information and wish for my child to participate in the Randolph County Sheriff's Office C.A.R.E. or D.A.R.E. Summer Program.

40. Signature:

    1. Accept

    By accepting above, I confirm that I have read, understood, and agree to the terms of this authorization.

42. You will be asked to sign in person on the first day of the class.

     

    Signature: ______________________________________________

    
    

    Date: _________________________________

     

Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field