S and F Athletes After School Program Application

(To Be Completed by the Parent/Guardian if under 18)

The information you provide is essential for securing government funding. We kindly request that you fill out the application honestly and accurately. Thank you for your cooperation.

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? Please select all that apply. *

Improved academic performance (ELR-english language and reading, Mathematics, Science, Social Studies)
Raise self-esteem and build confidence
Improved behavior
Improved Social skills
Improved in skill's development
School Attendance Increases

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

Any areas we can assist you with? Please select all that apply. *

If you check others. Please list here. *

How would you like to be involved? Please select all that apply. *

Volunteer as a mentor
Volunteer Administration help
Volunteer help with Fundraising
Volunteer help with events
Volunteer working AT&T event to help raise funds
Volunteer to help with Concession stand at Georgia Farrow Recreation Center

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

What time(s) are you available? *

What is your total household income? Please pick a category. *

Household income can include wages, salaries, self-employment earnings, Social Security benefits, pensions, retirement income, investment income, welfare payments, and more.

Is your current living situation considered a single-parent or a two-parent household? Please pick one. *

Single-parent
Two-Parent

How many people currently live in your household *

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

I Agree *

By checking this box, I confirm that all the information included in this application packet is accurate and truthful.

Printing your name serves as your signature *

First

Last

Consent Form

Skill and Faith Athletes values your and your child’s interest in participating in our after-school program. This application is designed to inform and obtain the consent of the parent or guardian to allow their child to be involved in the S and F Athletes after-school mentoring programs. The information you provide in this application will help us understand your child better. As such, S and F Athletes staff and mentors may need to access and, at times, share this information to enhance our ability to support 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 related activities.
I agree that my child will follow all guidelines set by the S and F Athletes after-school program and understand that any violations may lead to suspension or termination from the program.
I acknowledge that my child may be transported by S and F Athletes staff and/or representatives when participating in any after-school program activities, and that such transportation is voluntary and taken at my child's own risk.
I release S and F Athletes from all liability for any injury, death, or other damages that may occur to me, my child, my family, estate, heirs, or assigns as a result of participation in the program, including transportation. I hold harmless S and F Athletes mentors, staff, or representatives, both collectively and individually, for any injury, physical or emotional, except in cases of gross negligence.
I agree to allow S and F Athletes to use any photographic images of my child taken during participation in the S and F Athletes youth programs for promotional purposes or other related marketing materials.
I authorize S and F Athletes staff to obtain necessary information regarding my child from his/her school staff, including academic and behavioral records, as well as communications with teachers, counselors, and other administrative personnel.
I commit to returning all of the following items completed within 7 days of receipt. I understand that any delay may impact my child's participation in S and F Athletes after-school programs. The documents that need to be completed and returned are: • After-school Program Application • Consent Form • Consequences for Misbehavior

I Agree *

By checking this box, I affirm that all information provided in this application packet is truthful and that I agree to all the terms and conditions stated above.

Printing your name serves as your signature *

First

Last

Consequences for Misbehavior

The consequences for misbehavior outlined below aim to strike a balance between forgiveness and accountability. Our goal is for any youth who commits an offense to learn from the experience and return to their group with a clean slate. We encourage full participation in activities and will not hold past offenses against a youth, with the hope that negative behavior does not continue. All youth will be held accountable for their actions, but they will not be condemned.

Print youth your name *

First

Last

Consequences for Offenses *

1. 1st Offense: The youth will receive a verbal warning.
2. 2nd Offense: The youth will have a one-on-one discussion with a program leader regarding the offense, and parents will be informed via in-person meeting, email, or text.
3. 3rd Offense: The youth will be asked to leave the group, and parents will be notified through in-person meeting, email, or text. Additionally, both the parent and the mentee will be informed that the next offense will result in a 2-week suspension from the after-school program.
4. 4th Offense: The youth and their parents will be informed that the child will not be allowed to return to the after-school program for 4 weeks (depending on the severity of previous offenses). After the suspension period, a meeting will be held with the parent and mentee if the child is interested in rejoining the program.

Program leaders have the authority to assess the severity of misbehavior and may choose to skip or modify any of the consequences stated above.

Additional Notes

Youth who reach their 4th offense multiple times may lose their ability to participate in all S and F Athletes Youth after-school program activities and events until further notice.

Additional Notes

Youth with repeated 4th offenses may also be required to attend a meeting with the S and F Athletes Executive Director, group leader, and parent before being allowed back into the programs. A written request from the parent/guardian is necessary to withdraw their child from the S and F Athletes after-school program.

I Agree *

By checking this box. You acknowledge that you will follow the outlined consequences for misbehavior and understand that failure to adhere to them will result in the specified consequences.

Behavior Guideline *

I Agree *

By checking all boxes. You acknowledge and understand the outlined behavior guideline expectations .

Additionally, you will be asked to complete a survey at the end of the program.

Printing your name serves as your signature *

First

Last

S&F Athletes After School Program Application

(To Be Completed by the Parent/Guardian if under 18)

CURRENT GRADES

Medical History

Parent

Consent Form

Consequences for Misbehavior

Additional Notes

Additional Notes