S and F Athletes After School Program Application

Parent and Student Information

CURRENT GRADES

ELAR: *

Math: *

Social Studies: *

Science: *

Elective 1: *

Elective 2: *

Grade *

Age *

Gender *

Male
Female

Mentoring *

Mentoring

PHYSICAL ACTIVITIES (copy) *

How did you hear about us? *

Other:

What do you want your child to gain from this program? *

Youth's Name: *

First

Last

School: *

Parent/Guardian Name: *

First

Last

Contact Number: *

Email Address: *

Relationship to Youth: *

Mother
Father

Other:

Medical History

Does your son or daughter have any physical or health problems or limitations? *

Yes
No

If yes, please explain:

Does your son or daughter have any allergies to any foods or drinks? *

Yes
No

If yes, please list:

Does your son or daughter currently receive treatment for any behavior issues? *

Yes
No

If yes, please explain:

Parent

How can we help you? *

How would you like to be involved? *

What day(s) are you available (Please select all that apply)? *

What time(s) are you available? *

List of other adults that will be picking up your child other than yourself. Please list below first and last name, relationship and number *

Consent Form

Skill and Faith Athletes appreciates you and your child’s interest in participating in our after-school program. This application is intended as a means of informing and gaining the consent of the parent/guardian to allow their son or daughter to participate in S and F Athletes after-school mentoring programs. Much of the information you supply in this application packet will be used to help us understand your child better. Therefore, the S and F Athletes staff and mentors may at times need to access and share this information to help us better serve your child.

Please initial each of the following statements: *

I give my informed consent and permission for my child to participate in the S and F Athletes after-school programs and its related activities.
I agree to have my child follow all S and F Athletes after-school program guidelines and understand that any violation on my child’s part may result in suspension and/or termination of the program.
I hereby acknowledge that my child will be transported by S and F Athletes staff and/or representatives, if needed, while participating in any S and F Athletes after-school program, and that such transportation is voluntary and at his/her own risk.
I release the S and F Athletes of all liability of injury, death, or other damages to me, my child, family, estate, heirs, or assigns that may result from his/her participation in the program, including but not limited to transportation, and hold harmless any S and F Athletes mentors, staff, or other representatives, both collectively and individually of any injury, physical or emotional, other than where gross negligence has been determined.
I agree to allow S and F Athletes to use any photographic image of my child taken while participating in the S&F Athletes youth programs. These images may be used in promotions or other related marketing materials.
I authorize S and F Athletes staff only to obtain any needed information regarding my child from his/her school’s staff, including academic and behavioral records and conversations with teachers, counselors, and other administrative staff.
I agree to return all of the following items completed within 7 days after received. I understand a delay can result in your child’s participation in S and F Athletes after-school programs. Documents that need to be completed and returned are the After-school Program Application, Consent Form and Consequences for Misbehavior.

By checking this box, I attest to the truthfulness of all information listed in this application packet and agree to all the above terms and conditions.

S&F Athletes After School Program Application

Parent and Student Information

CURRENT GRADES

Medical History

Parent

Consent Form