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Before+After School Program Enrollment

Participant and Parent Information
First Name *
Last Name *
Country
Address Line 1
City
State/Province
Postal Code
Is the student eligible for free or reduced lunch?
No file selected
First Name *
Last Name *
Would you be willing to be a career day speaker at EYFO
First Name
Last Name
Would you be willing to be a career day speaker at EYFO

Emergency Contact information and Authorization Pick- up Information

Person/s to be contacted in the case of an emergency/authorized pick up other than parents or guardians.

EMERGENCY 1ST CONTACT
First Name *
Last Name *
EMERGENCY 2ND CONTACT
First Name
Last Name
EMERGENCY 3RD CONTACT
First Name
Last Name
I Receive Subsidy from the Following
Medical History and Authorization Information
Month
/
Day
/
Year
Month
/
Day
/
Year

I hereby authorize and consent to the administration of any and all medical dental and surgical examination or operations and treatment or all other related care, including emergency transportation.

I understand that Empowering Youth and Families, its volunteers or facilities and their officers, employees assume no financial obligator or liability in case of my child’s accident or illness. I assume full financial responsibility for emergency treatment for my child. EYFO carries no additional liability coverage for illness or accident for your child.

General Authorization and Information
My Child experiences the following
Learning Disability - Does your child have a current Individualized Education Learning Plan (IEP)?
Fieldtrips and Outings
My child has permission to participate to attend fieldtrips including but not limited to visits to the parks, beach shopping, movies, museums, water parks, neighborhood walks or other fieldtrips as scheduled by means or walking, bus, van or metro
Release of Publication
My child may be photographed for EYFOs publication
Release and Indemnity Agreement

The foregoing information is complete and true to the best of my knowledge. I also confirm the authorizations and consent detailed within this document. I understand that should my child act in a manner that is unsafe for him/her self he/she may be excluded from the program. I hereby release, discharge and covenant not to sue EYFO, its employees, volunteers, officers, agents and the facilities used for all liability to me or my child or my child’s personal representatives, assigned heirs and next of kin from any and all claims, demands, losses or damages on account of any injury or damage to property caused or arising from my child’s participation in the program.

Programs

Events

Fundraisers and events help us raise awareness and generate crucial resources to serve our community. Join us at our next event and see how you can get involved.
Find out more.

Empowering Youth and Families Outreach students in the College and Career Readiness Program on our annual college and experiential tour at Bowie State University in Maryland.

Programs

Our programs are designed to further our mission and provide much needed services for our constituents.
Take a look.

Empowering Youth and Families Outreach volunteers helping the students with their homework.

Volunteer

Improve your community by joining our cause. You'd be surprised at what a huge difference a little bit of your time can make.
Read more.