JADA GEMS Application

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JADA GEMS (Guiding and Empowering Minds for Success)
At JADA GEMS, we encourage youth to take ownership of their actions, choices, and commitments as they grow into greater independence.

Students will gain career readiness skills and lifestyle guidance in areas such as:

1. Work Etiquette

2. Lifestyle Review

3. Career Exploration

4. Introduction to Resume Building

5. The Mind & Nutrition....and more!

Parent/Guardian Acknowledgment
By completing this form, I understand and agree that:

My child will be provided with a meal during each session and will remain under the care of JADA House International for the full duration of each session.
Students may be photographed or recorded for program marketing purposes.
JADA GEMS sessions will be held at JADA House International (4944 Second Avenue).
Bus tickets may be provided, but families are responsible for ensuring students have a safe transportation plan to return home after each session.

Student Name *

Student Grade *

Student Cell Phone

Parent/Guardian Name *

Parent/Guardian Cell Phone *

Parent/Guardian Email *

Date of Form Filled *

YYYY

Emergency Contact Name *

Emergency Contact Phone Number *

In the event that your child experiences minor health issues such as headaches, cuts, or other minor injuries while participating in our program, do you authorize our site staff to administer simple solutions or first aid as deemed necessary. *

Yes, I authorize the site staff to administer solutions to minor health concerns for my child during their time in the program.

No, I prefer to be contacted before any action is taken regarding minor health concerns for my child.

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