Good Journey Development Foundation's 2021 Summer Leadership Academy (SLA) application
Complete and submit the 2021 SLA application for youth ages 9 to 16 by May 14, 2021.

Contact Dionne at 314-229-9079 or Dionne.ferguson@goodjourney.org OR Carol at 314-718-3791 or Carol.robinson@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.
Email *
Good Journey's seven weeks of Summer Leadership Academy, June 14 - July 30, will explore art, gardening, social justice, STEAM, finance, Kiswahili, Black history, community service, international games and more!
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 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. 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 2021 activities.
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 GOOD JOURNEY DEVELOPMENT FOUNDATION'S SUMMER LEADERSHIP ACADEMY'S PROGRAM AND ACTIVITIES: *
CUSTOMARY MEETING LOCATION:
Multiple locations in St. Louis City, including Good Journey Youth Community Garden
BEGINNING AND ENDING DATES:
SLA will begin on Monday, June 14, 2021 and end on Friday, July 30, 2021
DAYS AND TIME:
Mondays through Fridays, 9:00am to 2:30pm daily
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: *
Child's age: *
2nd Child's full name:
2nd Child's age:
Clear selection
3rd Child's full name:
3rd Child's age:
Clear selection
4th Child's full name:
4th Child's age:
Clear selection
Parent/Guardian address - include zip code: *
Parent/Guardian home number: *
Parent/Guardian cell number: *
Parent/Guardian work number:
Parent/Guardian email address:
2nd Parent/Guardian name:
2nd Parent/Guardian address - include zip code:
2nd Parent/Guardian home number:
2nd Parent/Guardian cell number:
2nd Parent/Guardian work number:
2nd Parent/Guardian email address:
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.
5. Parents/Guardians will adhere to the COVID-19 procedures required by Good Journey to keep all participants, staff and volunteers safe.
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): *
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:
$225 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 or CASH APP TO RESERVE YOUR CHILD'S SPACE WITH A $25 NONREFUNDABLE DEPOSIT.
GOOD JOURNEY'S PAYPAL LINK: paypal.me/goodjourney
GOOD JOURNEY'S CASH APP: $GoodJourneySTL
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): *
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. (Type NO below if you do not agree to the media release) *
A copy of your responses will be emailed to the address you provided.
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