Evolve Project Sign Up Form

Students! We are excited that you are interested in signing up for one of our after school programs! Please fill out the form and make sure to select the program(s) you are interested in!

Please complete the form below. Required fields marked with an asterisk *

Student First Name*

Answer Required

Student Last Name*

Answer Required

Grade Level*

Answer Required

9th

10th

11th

12th

Student Email Address*

Answer Required

Gender*

Answer Required

Male

Female

Date of Birth*

Answer Required

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Cell Phone Number*

Number Required

Ethnicity*

Answer Required

Caucasian

African-American

Latino

Asian

Native Hawaiian or Pacific Islander

Native American

Two or More Races

MEDIA, EVALUATION AND REPORTING CONSENT: I give consent for my child to be photographed, videotaped, and audiotaped during RISE Academy program activities and to participate in evaluation/reporting activities undertaken as part of his/her participation in the program.*

Answer Required

Yes

I AUTHORIZE MY CHILD TO PARTICIPATE IN THE EVOLVE PROGRAM AT IHSCA. ME AND MY CHILD COMMIT TO ATTENDING THE PROGRAM REGULARLY, FOLLOW THE RULES AND TREAT ALL MATERIALS WITH CARE AND RESPECT. (please type your name below as your signature and confirmation of the above statement)*

Answer Required

Please fix the highlighted areas below before submitting.

Evolve Project Sign Up Form