Sankofa Summer Program: Summer Camp/Afterschool Program 2018-2019
Online Registration
Email address *
Participants name *
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Birthdate *
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Home Address *
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City, State and Zip code *
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Email Address *
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Home Phone number and or Cell Phone (Please label number) *
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Student Cell *
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Summer Program *
Grade/Classification(Just Completed) *
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Allergies and Medical Info *
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Parent/Guardian's Name and Phone Number *
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Emergency Contact Name and Phone Number: *
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The following people have permission to pick up my child from the program events( Please Provide Name, Relationship to Student and their Phone Number): *
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By agreeing with the terms and my electronic signature in the spaces below, I herby verify that the above information is accurate. My electronic signature grants permission for my child to participate in the Sankofa Cultural Arts Center, field trips and activities therein. In giving my permission to participate, I understand that he/she will take part in scheduled practices, performances, meetings, workshops, cultural, educational and recreational programs. I agree to provide transportation for my child to all scheduled activities. I also agree to facilitate and support my child's timely attendance and participation and I agree not to hold the Inner City Cultural League or the Sankofa Cultural Arts Center Programs and its members responsible and/or liable for any injuries or illnesses that my child may sustain while in attendance at the sessions of the program. I also agree not to hold the above-named organizations, or its members or appointees individually, liable for the loss or destruction of my child's property. *
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Electronic Signature Below *
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