After School Registration Form

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Welcome to the M.A.C.C. Foundation's Empower Your Change: Financial Literacy After-School Program! This form will help us register your child and better prepare to serve them. Please fill out each section thoroughly. Once submitted, you'll receive a confirmation email. For questions, contact us at hello@makingachildchangefdn.org.

Email *

Record my email address with my response

STUDENT INFORMATION

Full Name (First, Middle, Last): *

Preferred Name/Nickname: *

Date of Birth: *

YYYY

Grade Level: *

9th grade

10th grade

11th grade

12th grade

Middle School

School Name: *

Student Email Address: *

Student Phone Number: *

PARENT/GUARDIAN INFORMATION

Parent/Guardian Full Name: *

Relationship to Participant:

Phone Number: *

Email Address: *

Home Address (Street, City, Zip) *

Preferred Method of Contact:

Phone

Text Message

Emergency Contact Information (other than parent/guardian)

Emergency Contact Name: *

Relationship to Student: *

Phone Number: *

Health & Transportation:

Does your child have any allergies or medical conditions we should be aware of?

Does your child require any accommodations or support services?

Will your child need transportation assistance (if available)?

Yes

Student Interest Questions:

What do you hope to learn from this program?

Have you ever taken a class on money, finances, or budgeting before?

Yes

What career or business goals do you have for the future?

Permissions & Agreements

I understand this is an educational after-school program focused on financial literacy and personal development.

I understand.

Required

I agree to ensure my child attends regularly and follows program rules.

I agree.

Required

I give permission for my child to be photographed or recorded for promotional purposes.

OPT-IN (YES!)

OPT-OUT (NO.)

Required

I acknowledge this is a free program, but donations are encouraged to help continue our youth programs.

I understand.

Required

Digital Signature

Parent/Guardian Name (Typed Signature):

Date:

Send me a copy of my responses.

Submit

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