Student Registration

Confirmation Email:

Student's Full Name:

Child's Birthdate:

Child's Gender:

Grade Child is Entering in the Fall

School:

Disabilities/Special Needs/Restrictions:

Allergies:

Does your child have permission to walk to and from The Hope Center Philly?

Yes

If "NO" please list who will has permission to pick up your child:

ADDRESS

Address Line 1

Address Line 2:

City:

State:

Zip Code:

PARENT/GUARDIAN NAME #1

First Name:

Last Name:

Cell Phone

Main Email:

Relationship to Student:

If 'Other', what is the relationship to student:

PARENT/GUARDIAN NAME #2

First Name:

Last Name:

Cell Phone:

Main Email:

Relationship to Student:

If 'Other', what is the relationship to student:

EMERGENCY CONTACT

First Name:

Last Name:

Relationship to Student:

Phone Number:

Opt-In

I understand that every effort will be made to contact my child’s parent or guardian. In the event that I cannot be reached, I hereby give permission for emergency treatment to be given to my child. I/We release, hold harmless, and indemnify The Hope Center Philly, its employees and volunteers from all claims for damages whatsoever, including costs and attorney fees. On behalf of the child and myself as well as all heirs, executors, administrators or assigns, I hereby fully release and discharge The Hope Center Philly, a nonprofit corporation, and its directors, officers agents, or their assigns from all rights, claims, and actions. On behalf of my child and myself, we acknowledge that there is some risk of loss, damage, or injury in any activity no matter how damage, loss, or injury occurs. On behalf of my child and myself, we recognize and specifically release The Hope Center Philly, its directors, officers, and agents, or their assigns from any activity off the premise of The Hope Center Philly. In consideration of the mutual promises references hereto, we hold harmless and indemnify The Hope Center Philly, its directors, officers, agents, volunteers, or their assigns from any claim for damages, loss, or injury including attorney fees. The terms of this agreement are acknowledged to be freely, voluntarily, and knowingly executed. I fully understand all of the rights being surrendered and have adequate opportunity to investigate the premises, the activities, the individuals involved, and consult with any advisors I desire before signing or entering into the agreement.

Parent/Guardian Full Name

PHOTO RELEASE

I hereby authorize the Bridge Academy and Community Center to use pictures, video or audio recordings of the child/children named in this registration form for the Bridge Academy brochures, flyers, website, and other advertising purposes.

Yes

STUDENT CELL PHONE POLICY

I hereby authorize The Hope Center Philly to use pictures, video or audio recordings of the child/children named in this registration form for The Hope Center Philly brochures, flyers, website, and other advertising purposes.

Yes

BEHAVIOR POLICY

I understand that fighting, bullying, use of profane language, stealing and behavior issues related to other students, volunteers or staff is not permitted. I understand that my child and all related adults or guardians are expected to act in accordance with this policy. I understand that if my child or individuals picking up or dropping off my child can not follow these guidelines, then this will result in removal from programs. I understand that I am responsible for reviewing The Hope Center Philly policy.

Yes

PERMISSION TO TRAVEL

Transportation: I give permission for my child to be transported in a motor vehicle driven by staff and volunteers of The Hope Center Philly sponsored events, and other partnering organizations, to The Hope Center Philly locations, specific pick-up locations and other special activities. I understand that my child is expected to follow all applicable laws regarding riding in a motor vehicle and is expected to follow the directions provided by the driver and/or other adult volunteers. I have read, understand, and discussed with my child that: (1) They will be traveling in a motor vehicle driven by an adult and they are to wear their safety-belt while traveling; (2) They are expected to respect each other, the vehicles they ride in, and the people they travel with during the trip; (3) Riding in a motor vehicle may result in personal injuries or death from wrecks, collisions or acts by riders, other drivers, or objects; and (4) They are to remain in their seats and not be disruptive to the driver of the vehicle.

Yes

APPROPRIATE ATTIRE POLICY

I understand that my student may participate in a variety of activities. I understand that my student should wear appropriate active shoes and clothing. Crop tops, clothes with inappropriate paraphernalia, short shorts or skirts, low cut tops, tight or revealing clothing are not allowed. One piece bathing suits/fully covering tankinis will be required as a swimmer- shirts may be worn to cover suits. I understand that is my child is wearing any of the above, they may be asked to change.

Yes

Full Name

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Student Registration

Student Registration

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SW Philadelphia, PA 19142

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