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 for "Student First Name"

Student Last Name*

Answer required for "Student Last Name"

Grade Level*

Answer required for "Grade Level"

9th

10th

11th

12th

Student Email Address*

Answer required for "Student Email Address"

Gender*

Answer required for "Gender"

Male

Female

Date of Birth*

Answer required for "Date of Birth"

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Cell Phone Number*

Number Required

Ethnicity*

Answer required for "Ethnicity"

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 for "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."

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 for "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)"

Please fix the highlighted areas below before submitting.

Evolve Project Sign Up Form