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Operation Amani Student Registration Form
This form is designed for parents or guardians to enroll students in either the Soliders of Hope Program offered by Operation Amani. Completion of this form is required for participation.
Student's Full Name
Student's Date of Birth
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Student's Age
Student's Gender
Clear selection
Student's School Name
Student's Grade Level
Parent/Guardian's Full Name
Relationship to Student
Parent/Guardian's Email Address
Parent/Guardian's Phone Number
Emergency Contact Name
Emergency Contact Phone Number
Which program(s) is the student interested in?
Primary Care Physician's Name
Primary Care Physician's Phone Number
Health Insurance Provider
Health Insurance Policy Number
Does the student have any allergies or medical conditions we should be aware of?
Clear selection
If yes, please describe the allergies or medical conditions:
Does the student currently take any medications?
Clear selection
If yes, please list the medications:
Parent/Guardian Consent: I, the undersigned, am the parent or legal guardian of the student listed above. I give my consent for my child to participate in the selected program(s) at Operation Amani. I understand that I am responsible for transportation to and from the program, and I will ensure my child adheres to the guidelines set forth by the program leaders. Additionally, I give permission for my child’s image to be used in photographs, videos, or promotional materials related to Operation Amani programs. I acknowledge that participation in the program(s) may involve physical activities and, while precautions will be taken, there are inherent risks.
Parent/Guardian Signature
Date of Consent
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Program Commitment: Please confirm your commitment to the following program expectations.
I acknowledge and agree
Attendance: The student must attend all scheduled sessions for the selected program(s) unless otherwise discussed in advance.
Behavior: The student agrees to follow the rules and guidelines of the program and maintain respectful behavior towards staff, peers, and the program.
Equipment and Attire: The student agrees to wear appropriate attire for the program (e.g., athletic wear for boxing or Media production attire).
Payment (if applicable): The parent/guardian agrees to any payment terms related to program fees (if applicable).
Will the student need transportation assistance?
Clear selection
If yes, please specify transportation preferences or needs:
Additional Information/Questions: Please provide any additional information that may assist us in preparing for your child's participation in the program(s):
Program Start Date
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