SANKOFA PROGRAM REGISTRATION FORM 

Thank you for your interest in the Sankofa School Program! Please complete this registration form no later than Saturday October 3rd.

Please note:

  • A separate registration form must be completed for each child you are enrolling.
  • Sankofa School will begin on Saturday, October 10th and will meet on the following date:
  • October 10th and 17th, November 7th and 21st, December 5th and December 19th
  • Classes are held from 9:00 a.m. to 12:00 p.m.
  • Students may be dropped off no earlier than 30 minutes before class begins (8:30 a.m.).
  • Please ensure your child is picked up no later than 12:15 p.m.

We look forward to a wonderful semester of learning, culture, and community with your family!

Email *
Student's Name *
Gender *
Student Date of Birth *
Street Address, City, State, Zip Code   *
Current Grade Level *
T-Shirt Size  *
Does your child have any Allergies?  *
Does your child have any physical limitations?  *
Are there any other medical or behavioral concerns we should know about? *
If you answered "Yes" to any of the questions above, please explain. Include any medications (such as inhalers, insulin, etc.) or medical devices (hearing aids, crutches, etc.) and when they are required. *
Parent/Guardian Name  *
Relationship to Student *
Parent/Guardian Phone Number *
Parent/Guardian Email Address *
Emergency Contact Name (please list 2)  *
Emergency Contacts Relationship to Student *
Emergency Contact phone number ( list for Contact A and Contact B)  *
Emergency Contact email address ( list for Contact A and Contact B)  *
AGAPE CONNECTION INCORPORATED IMPORTANT INFORMATION:
Waiver of All Claims and Assumptions of Risk Agape Connection Inc. is completely responsible for the selection and screening of staff and program activities. Agape Connection is committed to conducting all of its programs, activities, and field trips in a safe manner. Because Agape Connection Inc. holds the safety and security of all participants in high regard, all staff members insist that students follow all safety and security rules. Even so, students and parents/guardians must be aware that there is an inherent risk of injury when choosing to participate in recreational and social activities. As the parent/guardian you are solely responsible for determining if your minor child is physically, emotionally, psychologically, and intellectually fit to participate in the Agape Connection Inc.’s Sankofa Program. Also, students may be photographed or videotaped in connection with the Agape Connection Inc., Sankofa Program, and all claims and rights to such photos or video recordings are released by signing below. Agape Connection Inc. may use these recordings and photos for any purposes that they deem appropriate. I understand that by registering my child to participate in the Agape Connection Inc. Sankofa Program, I am expressly assuming the risk and the legal liability that arises or may arise out of such participation. I also understand that I am waiving and releasing all claims for injuries, damages, or losses, which my child might sustain as a result of participating in any and all activities connected with and associated with said programs/activities. I recognize and acknowledge that there are certain risks of physical injury to participants in these programs/activities, and I voluntarily agree to assume the full risk of any and all injuries, damages, and losses regardless of severity, that my minor child may sustain as a result of said participation except in cases of gross negligence or intentional misconduct. I further agree to waive and relinquish all claims that I, my successors, assigns, or my minor child may have (or which may accrue to me, my successors,
assigns, or my minor child), as a result of participation in these programs/activities against Agape Connection Inc. its affiliated or partnering entities, board of directors, volunteers, employees, and associated entities. I do hereby fully release and forever discharge Agape Connection Inc., from any and all claims for injuries, damages, or loss that my minor child may have or which may accrue arising out of connection with or in any way associated with these programs/activities, except in cases of gross negligence or intentional misconduct. All students will be dismissed when the program ends for the day. By signing below, I assume responsibility for my minor child’s transportation, safety and security. By signing ( choosing Agree ) below, I am registering my child for the Agape Connection Inc. Sankofa Program. I understand that it’s a cultural, educational, and social program, that it is my discretion to enroll my child in this program and I have read the terms and conditions above regarding my minor child’s participation in the Sankofa Program. I also understand that my child will be expected to conform to the Agape Connection Inc./Sankofa Program code of conduct i.e. no bullying, no foul or disrespectful language, no weapons, no alcohol, no drugs, etc., and if s/he does not, I will be immediately notified, and my child may be removed from the Sankofa Program.
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