WYLA After School Application
The Westside Youth Leadership Academy After School Program is currently accepting applications for students in grades Kindergarten - 5th grade.

                                                           PROGRAM DETAILS

Location: Westside Missionary Baptist Church | 4001 Hughes Avenue, Chattanooga, TN 37410

Start Date: Monday, September 11, 2023

Program Days: Monday - Thursday

Program Time: 3p-6p

Focus School: Calvin Donaldson Elementary

Transportation Provided: Yes (Pickup from school and drop off at home after the program)

Snacks Provided: Yes
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Email *
Is your child returning from last year? *
Name of Parent or Guardian *
Are you the parent or legal guardian? *
Relationship to Child(ren) *
Child(ren) name(s), Date of Birth, School and Grade, Allergies/Medication *
Address *
City *
State *
Zip *
Contact Number 1 *
Contact Number 2 *
Emergency contact name, phone number, relationship *
Please read the below release information.             

Transportation Release Form:                                                I grant permission for my child to be transported by The Net Resource Foundation , Westside Missionary Baptist Church during the  After School Program.            

Permission to treat:                                                                  I hereby permit group leaders, volunteers, staff  members, and the like  to call 911 and/or to contact a medical facility or physician to provide proper treatment to my child and that I will be responsible for all expenses arising in association with such treatment. 

Indemnity and Waiver of Claim:                                             I hereby acknowledge that as a condition of my child participating in this program, I agree to indemnify and hold harmless The Net Resource Foundation, Westside Missionary Baptist Church, its employees and volunteers from any liability, lawsuit, cost, expense or claim of any type whatsoever (including legal fees) for any harm, injury or death arising out of the above mentioned programs.                                                 

Permission to use photo:                                                         I release all rights to use of video and/or photography that  maybe included in The Net Resource Foundation, Westside Missionary Baptist Church its representatives and/or its’ employees. I also give permission to use, display, distribute, publish, and copy either digitally or by means of print whether by Internet, CD, magazine, brochure, newspaper, TV, or other types of media without restrictions. I also understand that my name may or may not be used with the video and/or photography taken of me or the video and/or photography in which I may be included.  I also release the videographer/photographer and any agents associated with the videographer/photographer of any claims, demands, lawsuits, that may arise in connection with the video and/or photography taken.
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