Good Journey Development Foundation's 2017 Summer Leadership Academy (SLA) application
Please complete and submit the 2017 SLA application for youth ages 9 to 16 by April 25, 2017.

Contact Dionne at 314-229-9079 or Dionne.ferguson@goodjourney.org and check out our website at www.goodjourney.org for more information.

The Summer Leadership Academy is funded through donations from caring people like you and sponsored by Good Journey Development Foundation with assistance from Sudan Illustrators, F.I.R.E., City of St. Louis Public Safety Department, and Missouri Department of Health and Senior Services.

Email address
Good Journey's Eight Weeks of Summer Leadership Academy at F.I.R.E., June 13 - August 4, will explore a different part of the world each week and feature guest basket making artists from South Carolina and South Africa sharing their art and culture!
Colombia, South Africa, Ethiopia, Senegal, Egypt, Haiti, Jamaica & more to EXPLORE!
Good Journey Development Foundation, through its Summer Leadership Academy, has planned a program of cultural, social and educational learning experiences in collaboration with other organizations, including Sudan Illustrators, Inc. and Firefighters Institute for Racial Equality (F.I.R.E.) and community leaders. Through the program, your child(ren) will be matched with Summer Academy leaders, mentors, educators, artists and volunteers who will meet and work with them. Activities will, customarily, be held at the F.I.R.E. location at 1020 N. Taylor, St. Louis, MO 63113. We want your consent, as set out below, to involve your child as a part of the Summer Leadership Academy’s program and activities. By filling out and submitting this Parental Consent Form to Good Journey you, the legal parent/guardian give your consent for your child(ren) to participate in the Good Journey Summer Leadership Academy activity.
PLEASE TYPE IN YOUR NAME BELOW AS THE LEGAL PARENT/GUARDIAN PROVIDING CONSENT AS SET OUT ABOVE AND BELOW TO INVOLVE YOUR CHILD(REN) AS A PART OF THE SUMMER LEADERSHIP ACADEMY'S PROGRAM AND ACTIVITIES:
Your answer
CUSTOMARY MEETING LOCATION:
Firefighters Institute for Racial Equality (F.I.R.E.) at 1020 N. Taylor Avenue, St. Louis, MO 63113
BEGINNING AND ENDING DATES:
SLA will begin on Tuesday, June 13, 2017 and end on Friday, August 4, 2017 (Note: no program activities on July 4th)
DAYS AND TIME:
Mondays through Fridays, 9:00am to 2:30pm daily
LOCATION OF ACTIVITIES:
F.I.R.E., Beckett Park, Neighborhoods (Lewis Place, Vandeventer, Fountain Park for Community Treasure Hunt), Turner Park, YMCA (swimming fieldtrip), Progressive Emporium & Education Center and other fieldtrip locations to be announced with details provided to parents/guardians and youth
PLANS FOR MEALS:
Breakfast, lunch and afternoon snack provided by Good Journey
TRANSPORTATION:
Daily transportation provided or approved by parents or guardians; Fieldtrip transportation provided by Good Journey Development Foundation and its affiliated staff and organizations
PLEASE COMPLETE THE FOLLOWING INFORMATION REQUESTED BELOW:
Child's full name:
Your answer
Child's age:
2nd Child's full name:
Your answer
2nd Child's age:
3rd Child's full name:
Your answer
3rd Child's age:
4th Child's full name:
Your answer
4th Child's age:
Parent/Guardian address - include zip code:
Your answer
Parent/Guardian home number:
Your answer
Parent/Guardian cell number:
Your answer
Parent/Guardian work number:
Your answer
Parent/Guardian email address:
Your answer
2nd Parent/Guardian name:
Your answer
2nd Parent/Guardian address - include zip code:
Your answer
2nd Parent/Guardian home number:
Your answer
2nd Parent/Guardian cell number:
Your answer
2nd Parent/Guardian work number:
Your answer
2nd Parent/Guardian email address:
Your answer
1. I understand that I am responsible for my child(ren)'s travel to and from the program location, unless the program is transporting my child(ren) in connection with fieldtrips, or a specific arrangement has been communicated by me to the SLA Director.
2. My child(ren) has my permission to be transported in the manner described above.
3. I understand that my child(ren) will be under supervision by personnel working under the auspices of Good Journey Development Foundation and I agree to instruct my child(ren) to obey all rules, regulations and instructions given by staff, volunteers and/or mentors authorized by Good Journey. I further agree that no authorized personnel shall be held liable for any harm incurred by my child(ren) as a result of my child(ren)'s deliberate, disobedience of rules, regulations or instructions.
4. The authorized personnel, volunteers and mentors under the auspices of Good Journey will supervise your child(ren), and neither they, nor Good Journey, nor any collaborating organization shall be liable, absent gross negligence on their part.
YOUR SIGNATURE AND DATE (TYPE NAME AND THE DATE) BELOW INDICATES THAT YOU HAVE READ AND AGREED TO THE AFORESAID AND THAT WE HAVE YOUR PERMISSION FOR YOUR CHILD(REN) TO PARTICIPATE IN THE ACTIVITIES AND TO HAVE TRANSPORTATION PROVIDED AS REQUIRED BY ACTIVITIES (Type name & date to sign below):
Your answer
GOOD JOURNEY'S SUMMER LEADERSHIP ACADEMY FEE
Good Journey receives donations and grant funds to provide the Summer Leadership Academy, however, it is not enough to cover the expenses to provide meals and the quality summer experience our young participants deserve. Below, find the fee requested from families to ensure we are offering our young people the best 8 week Summer Leadership Academy experience possible.
SUMMER LEADERSHIP ACADEMY FEE:
$200 TOTAL PER CHILD FOR THE SUMMER.
$25 NONREFUNDABLE DEPOSIT REQUIRED PER CHILD TO RESERVE YOUR CHILD(REN)'S SPACE.
USE GOOD JOURNEY'S PAYPAL LINK TO RESERVE YOUR CHILD'S SPACE WITH A $25 NONREFUNDABLE DEPOSIT.
GOOD JOURNEY'S PAYPAL LINK: PAYPAL.ME/GOODJOURNEY
Number of Children participating in Summer Leadership Academy
Good Journey is a community oriented organization, and desires participation from families of all income levels. Please contact us about scholarship and bartering opportunities for your family. We do not want anyone to miss out on participating in Summer Leadership Academy because of income. Scholarships will be provided based on family need. Choose one of the following 3 options based on your desire to assist with a successful Summer Leadership Academy and family situation:
Please type your name and the date to acknowledge the above payment option chosen (type name & date to sign below):
Your answer
MEDIA RELEASE: I consent to have my child(ren) to be interviewed, photographed, videotaped by authorized parties or designees of Good Journey Development Foundation. I also consent to have my child(ren) participate in activities of Good Journey, under the auspices of Good Journey Development Foundation and to have any of the photographs (digital/paper), slides, computer images, videos, slide shows, and/or audio-television interviews used for public relations, news articles, advertising, research and or inclusion on Good Journey affiliated social medial and official websites. As parents/guardians, I waive all rights I may have to any claims for payments or royalties in connection with any of the publicity. I also waive all rights to inspect or approve any phot, video, film, interview as it relates to Good Journey Development Foundation when and if my child is a participant. I further consent to have all negatives and positives, whether prints, video film or sound recordings released to Good Journey Development Foundation, Inc. and recognize that all said materials are the property of Good Journey Development Foundation.
I declare that I am legally eighteen (18) years or older and legally competent to execute the above media release. I consent to abide by these terms and I have voluntarily signed this document. I consent to hold harmless and release and forever discharge Good Journey Development Foundation from any claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf of my estate. I hereby certify that by signing this document, I do herby give my consent without reservation to the Media Release for my child(ren) to be included in media and publicity efforts of Good Journey Development Foundation. My signature (TYPED NAME AND DATE BELOW) on this Media Release authorizes my willing consent hereby:
Your answer
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