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Youth Enrollment

Youth EnrollmentCharis2023-08-15T17:48:59+00:00

Please fill out the form below and we will be in contact within 48-hours.

Parents and Guardians: Please note that this is a non-judgement program. We all have a past and we do not cast judgement on parents or guardians for the trauma children carry. We all carry trauma that has manifested itself in many ways and we’re just doing the best we can with what we were given as children…It’s our hopes that we can help this generation finally heal the way we wished we could’ve. We are not here to condem, only to offer support. We see you, we love you, no judgement.

First and Last name *

School Name and Grade

E-mail *

Address

Emergency Contact Information (If Different from Parent/Guardian Info Above)

Medical Release Information: Name of Health Care Provider & Contact Information

I understand that Humanity Hale or any of it’s affiliates will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian

Please share any past or current traumas or issues your child may be experiencing, (this will help us better serve them. Please remember, this is a non-judgement zone, we do not condemn parents or guardians for this information, we all have trauma and anything you share with us is only used to help, never hurt you or the child.)

Please list all approved adults, who are permitted to pick up your child:

Gender Identification *

Age

Birthday

Parent/Guardian Name

Parent/Guardian Contact Phone Number

Parent/Guardian Email Address

Emergency Contact Phone Number

Is your youth presently being treated for an injury, sickness, or taking any form of medication for any reason? *

yes

If Yes, Please explain:

Is your child allergic to any type of food or medication?

yes

If Yes, Please explain:

The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment. I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill.

How did you hear about Happy Hearts, Healing Arts 12-Week Youth Program?

Website

Word of mouth

School

Flyer

Newspaper

other

Release *

Humanity Hale and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. Students’ photos and quotes may be used for publicity purposes. In case of an emergency, and if a family member cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician). I understand, acknowledge and agree that Humanity Hale, will provide for reasonable supervision of students within its care and control. The supervision will be consistent with the ages of the students. However, the Humanity Hale Board is not an insurer of the safety of the students nor can it supervise all movements of all students at all times. In addition, there are certain risks inherent in travel and at the destination. I further understand that an employee or volunteer has no personal liability unless he or she has acted recklessly, wantonly, or intentionally to injure my child.

Terms of Agreement Photo Release

I hereby give my permission for my child to be photographed during the workshop sessions. I understand the photos will be used to keep a journal of activities to share during power point presentation and/or reports to our donors and for promotional purposes including flyers, brochures, newspaper and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not I do not expect compensation and that all photos are the property of the Humanity Hale. *

Transportation Release

I hereby give permission for the transportation of my child for official Youth Sessions activities by modes of transportation agreed to by the Humanity Hale organizers

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ABOUT
YOUTH ENROLLMENT
GET INVOLVED
- VOLUNTEER
- SPONSORS
DONATE

Youth Enrollment

FOLLOW US On Instagram

@humanityhale

be a hero

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