CY Spring 2025 Enrichment Registration Form

Spring Programming begins Monday, February 10th

Cultivating Youth's after-school program is geared towards 8-12 year olds. We operate after school Monday - Thursday from 3:30pm - 6:30pm. Students complete homework/studying with college students on-site (if needed), actively work with mentors, participate in physical fitness activities or athletic training and will receive a free meal daily. Although education is important in our program, students that need extensive academic assistance should not use our program as an alternative to getting specialized assistance.​

Our mentoring program is geared towards 13-18 year old youth. We require a check-in, at minimum, twice a week with mentors to provide updates on their improvement plans that are curated to their specific needs and or to participate in enrichment activities. 

*All students are required to participate a minimum of  2 days per week to remain active. 

Cost: Free

Who: Students age 8-18 years old

When: Monday - Thursday After-School 

Time: 

3:30 - 4:00pm: Arrival/Free time

4:00pm - 5:00pm: Homework

5:00pm - 6:00pm: Workout

6:00pm - 6:30pm: Dinner/Pickup

Apparel: Athletic apparel and tennis shoes required

Location: MT Athletic Academy - 3445 Toledano Street NOLA 70125

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Email *
We require all youth to attend twice weekly. Is your child available to attend at least two days/week between Monday - Thursday? We do not operate on Friday. *
We do ask that your child is dropped off and/or allow their bus to be routed to our location. We provide limited transportation. Does your child need transportation? If yes, beginning address to ending address.
Youth's Date of Birth *
Youth's Name *
Youth's Gender and Pronoun *
Youth's School *
Youth's Grade *
Youth's Home Address *
Youth's Shirt Size *
Youth's Weight *
Youth's Height *
What is the youth's religion?  *
What recreational activities are youth involved in?
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What are some of the youth's strengths?
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What are some of the youth's struggles?
Do you have any physical health concerns for the youth or would like to see improvement in this area? Explain.
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Do you have any behavioral health concerns for the youth or would like to see improvement in this area? Explain.
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Do you have any mental health concerns or would like to see improvement in this area? Explain.
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Do you have any medical concerns or areas of improvement for the youth? Explain.
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Are there are traumatic events that affect this youth that you'd like to disclose?
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Parent/Guardian Name *
Cell Phone *
Place of Work 
Work Phone
Parent/Guardian Name
Cell Phone
Place of Work
Work Phone
Emergency Contact *
Relationship *
Cell Phone *
Emergency Contact
Relationship
Telephone
Cell Phone

Policies & Procedures

Youth hereby agrees to abide by all posted safety guidelines and regulations while using facility and equipment.

Youth agree to dress and conduct themselves in a manner deemed appropriate for a fitness facility.

Youth are required to clean equipment after each use.                

Youth shall show respect to all staff, trainers and members.

3 late arrivals/pickups will cancel Youth’s participation in program

Youth shall not consume drugs, alcohol, or tobacco products on property.

Youth and family are required to respect everyone in the facility, any confrontations will result in dismissal of participation with the possibility of banning from property.

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Cultivating Youth does not discriminate on the basis of race, color, sex, handicap, religion or national origin. Cultivating Youth reserves the right at its sole discretion to refuse an application or dismiss a child from camp. No refund will be made of fees if the child has attended any portion of the camping period. I AGREE AND UNDERSTAND. (Initials Please) *
I give Cultivating Youth and Affiliates permission to photograph and/or videotape my youth for public relations and/or marketing purposes. Photos will remain archived at Cultivating Youth and Affiliates and can be used for promotional purposes without notification. I AGREE AND UNDERSTAND. (Initials Please)
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 I understand that the facility culture is to workout comfortably. Working out shirtless and shoeless may occur. I AGREE AND UNDERSTAND. (Initials Please)
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I give permission for Cultivating Youth and Affiliates to transport my youth off of property for the purpose of home transportation and/or medical care.  I AGREE AND UNDERSTAND. (Initials Please)

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I authorize management to act as the agent of the parents in any emergency situation or to administer basic first aid for the health and welfare of the youth involved. I am responsible for the expenses involved if the services of a physician or hospital are required. Please request a waiver for persons requesting exemption from medical treatment. I AGREE AND UNDERSTAND. (Initials Please)
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Hospital Preferred: *

By signing below I agree to adhere to all the policies & procedures set for by Cultivating Youth and Affiliates. (Type Parent/Guardian's Name as Signature)

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The medical background of each youth is required as part of the youth's registration process. We must be advised in writing of any condition that would limit the youth’s ability to participate in any program.

Youth's Pediatrician's Name

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Pediatrician's Phone Number

 *

Date of youth's last physical

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Please list any current problems/chronic conditions or past surgeries for youth:

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Required

If you have checked any of the above please explain: (N/A if it doesn't apply)

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List all current medications regardless of whether it needs to be taken while with Cultivating Youth and Affiliates or not. (N/A if there are no current medications)

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Allergies: (Please put N/A if your child does not have any allergy)

1. Food

2. Medication

3. Other

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Special food diet? *

Does your child require an Epi-pen?

If yes, please request a medical dispensing form. Return the form, current prescription and epi-pen in a zip-lock bag with your youth’s name on it on the first day of participating with Cultivating Youth and Affiliates.

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Specific Activities to be restricted for health reasons:

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By signing below I agree to accuracy and have disclosed all previous injuries and medical conditions: (Type Parent/Guardian's Name as Signature)

Release of Liability

I understand that exercise involves certain risks, including but not limited to, serious neck and spinal injuries resulting in complete or partial paralysis, heart attack, stroke or even death. Also, injuries could occur to bones, joints or muscles. Slips, falls, and unintended loss of balance could result in muscular, neurological, orthopedic or other bodily injury. I AGREE AND UNDERSTAND. (Initials Please)

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I understand that part of the risk involved in undertaking any activity or program is relative to my own state of fitness or health (physical, mental, or emotional) and to the awareness, care and skill which I conduct myself in that activity or program. I AGREE AND UNDERSTAND. (Initials Pleases)

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Knowing the material risks and appreciating, knowing and reasonably anticipating that other injuries are a possibility, I hereby expressly assume all of the delineated risks of injury, all other possible risk of injury, and even risk of possible death, which could occur by reason of my participation. I AGREE AND UNDERSTAND. (Initials Please)

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I do hereby waive, release and forever discharge Cultivating Youth and Affiliates from any and all responsibilities or liability for any present and future injuries or damages resulting or arising from participating in any activities including but not limited to exercise, personal training or use of the equipment including any injuries and damages caused by the negligent act or omission of any of those persons or entities mentioned above. I AGREE AND UNDERSTAND. (Initials Please)

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By signing below I agree to adhere to all terms of the Release of Liability set by Cultivating Youth and Affiliates. Type Parent/Guardian's Name as Signature
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A copy of your responses will be emailed to the address you provided.
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