Student Enrollment Form

Student Enrollment Form: 2023-2024 Program Year

Please Select for the 2023-2024 School Year

Program Location(Required)

Bethune Elementary - College Park, GA (Fulton County Schools)

Heritage Elementary - College Park, GA (Fulton County Schools)

Heritage Academy - Hapeville, GA (Atlanta Public Schools)

William M. Boyd Elementary - Atlanta, GA (Atlanta Public Schools)

Harbison West Elementary School - Columbia, SC (Lexington-Richland 5 School District)

CrossRoads Intermediate School - Columbia, SC (Lexington-Richland 5 School District)

St. Matthews K8 Elementary - St. Matthews, SC (Calhoun County Public Schools)

St. Stephen Elementary - St. Stephen, SC (Berkeley County School District)

Arthur W. Christopher Community Center - Charleston, SC (Charleston County School District)

What elementary school does your child attend?(Required)

Please spell out the school's name.

Grade(Required)

Teacher's Name(Required)

Student Information

Student's Name(Required)

First Middle Last

Student's Date of Birth(Required)

Student's Race(Required)

Black or African American

White or Caucasian

Asian or Pacific Islander

Native American or Alaska Native

Biracial

Multiracial

A race not listed here

Student's Ethnicity(Required)

Hispanic or Latino

Non-Hispanic or Latino

Primary Language Spoken at Home(Required)

English

Spanish

Other

Student's Gender(Required)

Female

Male

Other

Prefer not to disclose

Home Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Parent/Guardian Contact Information

Parent/Guardian Name(Required)

First Last

Parent/Guardian Cell Phone(Required)

Parent/Guardian Home Phone

Parent/Guardian Email(Required)

Parent/Guardian Name

First Last

Parent/Guardian Cell Phone

Parent/Guardian Home Phone

Parent/Guardian Email

We would love your help!

Would you be interested in receiving more information about volunteering at WINGS?

Yes

Not at this time

Other Important Information

Will your child ride the CCSD school bus to the Center's nearest stop (Line & Flood St)?(Required)

A WINGS Leader will meet all students who are dropped of at the Line St & Flood St stop, next to Charleston Development Academy, and walk with them to the Center. PLEASE NOTE: Pick-up after WINGS is required. The bus will NOT be running after WINGS.

Yes

Not sure yet

Authorized Pick-Up People & Relationship to Child(Required)

Please list people who you authorize to pick up your child from WINGS and list what their relationship is to you/child/family.

How Will Your Student(s) Get Home After WINGS?(Required)

Pick-up

Walk

How Will Your Student(s) Get Home After WINGS?(Required)

Pick-up

Bus

How Will Your Student(s) Get Home After WINGS?(Required)

Pick-up

Which Bus Stop Will You be Picking Up Your Child/Children?

Select your stop from the drop-down menu below.

Which Bus Stop Will You be Picking Up Your Child/Children?

Select your stop from the drop-down menu below.

Which Bus Stop Will You be Picking Up Your Child/Children?

Select your stop from the drop-down menu below.

Phone Number(Required)

Emergency Contact(Required)

First Last

Emergency Contact Phone(Required)

Emergency Contact Relationship to Student(Required)

Student's Known Allergies and/or Medications

Consent & Waivers

As the Adult signing below: (1) I am giving up substantial actual or potential rights in order to allow the child to participate in WINGS; (2) I have signed this Agreement without any inducement or assurance of any nature, and with full appreciation of the risks inherent in WINGS; (3) I have fully read the Agreement in its entirety, have paid particular attention to the bolded language, and have no question regarding the scope or intent of this Agreement; (4) I, as a parent or legal guardian, have the right and authority to enter into this Agreement, and to bind myself, the child, and any other family member, personal representative, trustee, or guardian to the terms of this Agreement; (5) I have explained this Agreement to the child, who understands his/her obligations.

Consent(Required)

I Agree to the Wings for Kids Program Participation Waiver for Lexington-Richland 5 School District

In consideration for the Child’s ability to participate in the Wings for Kids After School Program (“WINGS”) operating in School District Five of Lexington & Richland Counties (“District”), for the 2023-24 school year, the Parent or Legal Guardian (“Adult”) signing this Agreement agrees as follows:

1. It is a privilege, not a right, to participate in WINGS. The privilege may be revoked at any time, for any reason, that does not violate Federal, State or District laws, policies or procedures.

2. WINGS is a free after school program and there is no cost to parents/families including in-kind or monetary donations. WINGS is not a licensed child care provider, and therefore is exempt from any local, state, or federal child care licensing regulations.

3. WINGS provides an engaging, safe space after school, and supports the social and emotional well-being of children.

4. Designated program times of WINGS shall be communicated with parents/families. WINGS is only responsible for the child during the designated program times. Upon dismissal from the program, whether by car, bus, or walking, I release WINGS from any responsibility and/or liability that may result once the child is no longer present in WINGS during designated program times.

5. I have been given ample opportunity to ask questions about the environment in which the child will be and the activities in which the child will participate during attendance in the program. The Adult understands the nature of the program, activities, and lessons at WINGS, including the inherent or potential risks of after school programming, such as: bodily contact during athletics or playground time and use of tools and materials in arts class. By this Agreement, the child and Adult are deemed to fully assume all such risks and understand and agree to the fullest extent allowed by law they are waiving and releasing any potential future claim (including reasonable attorneys’ fees) they might otherwise have been able to assert against WINGS, the District, the School, the County Board of Education, or any Board Member, employee, agent, volunteer of WINGS, the District, the School “(“Released Parties”) by or on behalf of the child or any parent, administrator, executor, trustee, guardian, or family member.

6. WINGS provides field trips throughout the year. I give permission for the child to attend such field trips or excursions. I understand WINGS shall provide notice when children are going on these trips and I must provide 48 hours advance notice if my child is not allowed to attend a specific trip. This Agreement may be photocopied as field trip permission. I grant permission for the child to be transported to and from WINGS and to and from field trips or other excursions by car, bus, or walking, whether directly by WINGS or contracted service with another company/organization (i.e. Samson Trailways). The Adult completely releases and forever discharges WINGS, the District, the County Board of Education, and WINGS, School, and District board members, employees, affiliates, agents, volunteers, from all potential claims, demands, injuries, and damages of any nature whatsoever, including medical expenses, court costs, legal expenses, and attorney’s fees, which the Adult or child has, and are related in any way to transportation services.

7. The child is in sufficiently good health and physical condition to participate in WINGS, and voluntarily chooses to participate in WINGS.

8. Any pre-existing health or medical condition shall be provided to WINGS by a licensed medical practitioner with a statement that the child has been physically examined and is deemed to be in sufficiently good health and fitness so that the child may fully participate in WINGS. Documentation must be provided prior to participation in WINGS.

9. Emergency medical information regarding the child is on file with WINGS. The Adult agrees to provide updated medical information during the course of the child’s participation in WINGS. If an injury or medical emergency occurs during WINGS, WINGS employees, volunteers, agents have my express permission to administer or to authorize the administration of urgent or emergency care, including the transportation of the child to an urgent care or emergency care provider. In such circumstances, notice to me and/or the Emergency Contact of the injury or medical emergency may be delayed. Therefore, any urgent or emergency medical care provider has my express authority to conduct diagnostic or anesthetic procedures, and/or to provide medical care or treatment (including surgery), as they may deem reasonable or necessary under all existing circumstances. I also consent to WINGS, the District, and/or school to release any and all information for the purposes of such medical care and/or for insurance purposes. All costs and expenses associated with such care are solely my responsibility.

10. The child shall comply with the instruction and directions of WINGS staff, volunteers, agents, and instructors. During the child’s participation in WINGS, including any academic and/or other activities, the child shall comply with all applicable District, school, and WINGS Codes of Conduct. The child shall generally conduct himself/herself at all times in keeping with the highest moral and ethical standards so as to reflect positively on himself/herself, WINGS, the District, and School. Failure to meet these obligations may, in the discretion of WINGS, result in immediate removal from WINGS. Should the violation of these obligations also result in bodily injury or property damage during WINGS, the Adult will (a) pay to restore or replace any property damaged as a result of the child’s violation, (b) pay any damages caused to bodily injury to an individual, and (c) defend, protect, and hold WINGS harmless from such property damage or bodily injury claims.

11. The Adult understands WINGS does not condone, authorize, or engage in any type of corporal punishment.

12. Employees, agents, or volunteers of WINGS, members of the press or media, or other persons who may attend or participate in WINGS activities, may photograph, videotape, or take statements from the child. Such photographs, videotapes, recordings, or written statements may be published or reproduced in a manner showing the child’s name, face, likeness, voice, thoughts, beliefs, or appearance to third parties, including, without limitation, webcasts, television, motion pictures, films, newspapers, yearbooks, and magazines. Such published or reproduced items, whether or not for a profit, may be used for security, training, advertising, news, publicity, promotional, informational, or any other lawful purpose. I hereby authorize and consent to any such publications or reproductions, without compensation, and without reservation or limitation. If I do not consent to any such publications or reproductions I will notify WINGS in writing.

13. I authorize and approve the District and/or school to release the following data to WINGS for the purposes of grant reporting, research and evaluation purposes, and/or monitoring child achievement: (a) Demographic data (including but not limited to, race/ethnicity, grade level, school name); (b) Limited English Proficiency (LEP) status; (c) Exceptional Children (EC) and/or Gifted (AIG) status; (d) course grades; (e) standardized test score, levels, proficiency occurring throughout the year; (f) attendance data; (g) behavior data (including suspensions); (h) promotion/retention; (i) student identification number. I also authorize and agree to the release of identifiable child data from the two previous school years to WINGS.

14. WINGS engages in research and evaluation and may ask participants to complete surveys to help WINGS evaluate its program. All collected data will be confidential. Participation is not mandatory. I acknowledge that I understand this information about program evaluation and agree to allow the child to participate in such research. If I prefer the child not participate, I will notify WINGS in writing.

15. This Agreement shall be governed by the laws of the State of South Carolina. This Agreement is to be broadly construed to enforce the purposes and agreements set forth above, and shall not be construed against the Released Parties solely on the basis that this Agreement was drafted by WINGS. If any part of this Agreement is deemed invalid or ineffective, all other provisions shall remain in force. No oral modification of this Agreement, or alleged change or modification of its terms by subsequent conduct or oral statements, is allowed. This Agreement contains the sole and exclusive understanding of the parties, with no other representation relied upon by the Adult or child in determining whether to execute this Agreement or in agreeing to participate in WINGS.

As the Adult signing below: (1) I am giving up substantial actual or potential rights in order to allow the child to participate in WINGS; (2) I have signed this Agreement without any inducement or assurance of any nature, and with full appreciation of the risks inherent in WINGS; (3) I have fully read the Agreement in its entirety, have paid particular attention to the bolded language, and have no question regarding the scope or intent of this Agreement; (4) I, as a parent or legal guardian, have the right and authority to enter into this Agreement, and to bind myself, the child, and any other family member, personal representative, trustee, or guardian to the terms of this Agreement; (5) I have explained this Agreement to the child, who understands his/her obligations.

Date(Required)

Consent & Waiver

As the Adult signing below: (1) I am giving up substantial actual or potential rights in order to allow the child to participate in WINGS; (2) I have signed this Agreement without any inducement or assurance of any nature, and with full appreciation of the risks inherent in WINGS; (3) I have fully read the Agreement in its entirety, have paid particular attention to the language, and have no question regarding the scope or intent of this Agreement; (4) I, as a parent or legal guardian, have the right and authority to enter into this Agreement, and to bind myself, the child, and any other family member, personal representative, trustee, or guardian to the terms of this Agreement; (5) I have explained this Agreement to the child, who understands his/her obligations.

Consent(Required)

I Agree to the Wings for Kids Program Participation Waiver for Calhoun County School District

In consideration for the Child’s ability to participate in the Wings for Kids After School Program (“WINGS”) operating in Calhoun County School District (“District”), for the 2023-24 school year, the Parent or Legal Guardian (“Adult”) signing this Agreement agrees as follows:

1. It is a privilege, not a right, to participate in WINGS. The privilege may be revoked at any time, for any reason, that does not violate Federal, State or District laws, policies or procedures.

2. WINGS is a free after school program and there is no cost to parents/families including in-kind or monetary donations. WINGS is not a licensed child care provider, and therefore is exempt from any local, state, or federal child care licensing regulations.

3. WINGS provides an engaging, safe space after school, and supports the social and emotional well-being of children.

4. Designated program times of WINGS shall be communicated with parents/families. WINGS is only responsible for the child during the designated program times. Upon dismissal from the program, whether by car, bus, or walking, I release WINGS from any responsibility and/or liability that may result once the child is no longer present in WINGS during designated program times.

5. I have been given ample opportunity to ask questions about the environment in which the child will be and the activities in which the child will participate during attendance in the program. The Adult understands the nature of the program, activities, and lessons at WINGS, including the inherent or potential risks of after school programming, such as: bodily contact during athletics or playground time and use of tools and materials in arts class. By this Agreement, the child and Adult are deemed to fully assume all such risks and understand and agree to the fullest extent allowed by law they are waiving and releasing any potential future claim (including reasonable attorneys’ fees) they might otherwise have been able to assert against WINGS, the District, the School, the County Board of Education, or any Board Member, employee, agent, volunteer of WINGS, the District, the School “(“Released Parties”) by or on behalf of the child or any parent, administrator, executor, trustee, guardian, or family member.

6. WINGS provides field trips throughout the year. I give permission for the child to attend such field trips or excursions. I understand WINGS shall provide notice when children are going on these trips and I must provide 48 hours advance notice if my child is not allowed to attend a specific trip. This Agreement may be photocopied as field trip permission. I grant permission for the child to be transported to and from WINGS and to and from field trips or other excursions by car, bus, or walking, whether directly by WINGS or contracted service with another company/organization (i.e. Samson Trailways). The Adult completely releases and forever discharges WINGS, the District, the County Board of Education, and WINGS, School, and District board members, employees, affiliates, agents, volunteers, from all potential claims, demands, injuries, and damages of any nature whatsoever, including medical expenses, court costs, legal expenses, and attorney’s fees, which the Adult or child has, and are related in any way to transportation services.

7. The child is in sufficiently good health and physical condition to participate in WINGS, and voluntarily chooses to participate in WINGS.

8. Any pre-existing health or medical condition shall be provided to WINGS by a licensed medical practitioner with a statement that the child has been physically examined and is deemed to be in sufficiently good health and fitness so that the child may fully participate in WINGS. Documentation must be provided prior to participation in WINGS.

9. Emergency medical information regarding the child is on file with WINGS. The Adult agrees to provide updated medical information during the course of the child’s participation in WINGS. If an injury or medical emergency occurs during WINGS, WINGS employees, volunteers, agents have my express permission to administer or to authorize the administration of urgent or emergency care, including the transportation of the child to an urgent care or emergency care provider. In such circumstances, notice to me and/or the Emergency Contact of the injury or medical emergency may be delayed. Therefore, any urgent or emergency medical care provider has my express authority to conduct diagnostic or anesthetic procedures, and/or to provide medical care or treatment (including surgery), as they may deem reasonable or necessary under all existing circumstances. I also consent to WINGS, the District, and/or school to release any and all information for the purposes of such medical care and/or for insurance purposes. All costs and expenses associated with such care are solely my responsibility.

10. The child shall comply with the instruction and directions of WINGS staff, volunteers, agents, and instructors. During the child’s participation in WINGS, including any academic and/or other activities, the child shall comply with all applicable District, school, and WINGS Codes of Conduct. The child shall generally conduct himself/herself at all times in keeping with the highest moral and ethical standards so as to reflect positively on himself/herself, WINGS, the District, and School. Failure to meet these obligations may, in the discretion of WINGS, result in immediate removal from WINGS. Should the violation of these obligations also result in bodily injury or property damage during WINGS, the Adult will (a) pay to restore or replace any property damaged as a result of the child’s violation, (b) pay any damages caused to bodily injury to an individual, and (c) defend, protect, and hold WINGS harmless from such property damage or bodily injury claims.

11. The Adult understands WINGS does not condone, authorize, or engage in any type of corporal punishment.

12. Employees, agents, or volunteers of WINGS, members of the press or media, or other persons who may attend or participate in WINGS activities, may photograph, videotape, or take statements from the child. Such photographs, videotapes, recordings, or written statements may be published or reproduced in a manner showing the child’s name, face, likeness, voice, thoughts, beliefs, or appearance to third parties, including, without limitation, webcasts, television, motion pictures, films, newspapers, yearbooks, and magazines. Such published or reproduced items, whether or not for a profit, may be used for security, training, advertising, news, publicity, promotional, informational, or any other lawful purpose. I hereby authorize and consent to any such publications or reproductions, without compensation, and without reservation or limitation. If I do not consent to any such publications or reproductions I will notify WINGS in writing.

13. I authorize and approve the District and/or school to release the following data to WINGS for the purposes of grant reporting, research and evaluation purposes, and/or monitoring child achievement: (a) Demographic data (including but not limited to, race/ethnicity, grade level, school name); (b) Limited English Proficiency (LEP) status; (c) Exceptional Children (EC) and/or Gifted (AIG) status; (d) course grades; (e) standardized test score, levels, proficiency occurring throughout the year; (f) attendance data; (g) behavior data (including suspensions); (h) promotion/retention; (i) student identification. I also authorize and agree to the release of identifiable child data from the two previous school years to WINGS.

14. WINGS engages in research and evaluation and may ask participants to complete surveys to help WINGS evaluate its program. All collected data will be confidential. Participation is not mandatory. I acknowledge that I understand this information about program evaluation and agree to allow the child to participate in such research. I acknowledge that I understand and agree to allow WINGS to share the child's data (as outlined in #13) to third parties, specifically and only for, education and research purposes (including South Carolina Afterschool Alliance and researchers such as Public Profit). If I prefer the child not participate, I will notify WINGS in writing.

15. This Agreement shall be governed by the laws of the State of South Carolina. This Agreement is to be broadly construed to enforce the purposes and agreements set forth above, and shall not be construed against the Released Parties solely on the basis that this Agreement was drafted by WINGS. If any part of this Agreement is deemed invalid or ineffective, all other provisions shall remain in force. No oral modification of this Agreement, or alleged change or modification of its terms by subsequent conduct or oral statements, is allowed. This Agreement contains the sole and exclusive understanding of the parties, with no other representation relied upon by the Adult or child in determining whether to execute this Agreement or in agreeing to participate in WINGS.

As the Adult signing below: (1) I am giving up substantial actual or potential rights in order to allow the child to participate in WINGS; (2) I have signed this Agreement without any inducement or assurance of any nature, and with full appreciation of the risks inherent in WINGS; (3) I have fully read the Agreement in its entirety, have paid particular attention to the bolded language, and have no question regarding the scope or intent of this Agreement; (4) I, as a parent or legal guardian, have the right and authority to enter into this Agreement, and to bind myself, the child, and any other family member, personal representative, trustee, or guardian to the terms of this Agreement; (5) I have explained this Agreement to the child, who understands his/her obligations.

Date(Required)

Consent & Waivers

As the Adult checking the consent box below: (1) I am giving up substantial actual or potential rights in order to allow the child to participate in WINGS; (2) I have signed this Agreement without any inducement or assurance of any nature, and with full appreciation of the risks inherent in WINGS; (3) I have fully read the Agreement in its entirety, have paid particular attention to the language, and have no question regarding the scope or intent of this Agreement; (4) I, as a parent or legal guardian, have the right and authority to enter into this Agreement, and to bind myself, the child, and any other family member, personal representative, trustee, or guardian to the terms of this Agreement; (5) I have explained this Agreement to the child, who understands his/her obligations.

Consent(Required)

I Agree to the Wings for Kids Program Participation Waiver for Fulton County Schools

In consideration for the Child’s ability to participate in the Wings for Kids After School Program (“WINGS”) operating in Fulton County School District (“District”), for the 2023-24 school year, the Parent or Legal Guardian (“Adult”) signing this Agreement agrees as follows:

1. It is a privilege, not a right, to participate in WINGS. The privilege may be revoked at any time, for any reason, that does not violate Federal, State or District laws, policies or procedures.

2. WINGS is a free after school program and there is no cost to parents/families including in-kind or monetary donations. WINGS is not a licensed child care provider, and therefore is exempt from any local, state, or federal child care licensing regulations.

3. WINGS provides an engaging, safe space after school, and supports the social and emotional well-being of children.

4. Designated program times of WINGS shall be communicated with parents/families. WINGS is only responsible for the child during the designated program times. Upon dismissal from the program, whether by car, bus, or walking, I release WINGS from any responsibility and/or liability that may result once the child is no longer present in WINGS during designated program times.

5. I have been given ample opportunity to ask questions about the environment in which the child will be and the activities in which the child will participate during attendance in the program. The Adult understands the nature of the program, activities, and lessons at WINGS, including the inherent or potential risks of after school programming, such as: bodily contact during athletics or playground time and use of tools and materials in arts class. By this Agreement, the child and Adult are deemed to fully assume all such risks and understand and agree to the fullest extent allowed by law they are waiving and releasing any potential future claim (including reasonable attorneys’ fees) they might otherwise have been able to assert against WINGS, the District, the School, the County Board of Education, or any Board Member, employee, agent, volunteer of WINGS, the District, the School “(“Released Parties”) by or on behalf of the child or any parent, administrator, executor, trustee, guardian, or family member.

6. WINGS provides field trips throughout the year. I give permission for the child to attend such field trips or excursions. I understand WINGS shall provide notice when children are going on these trips and I must provide 48 hours advance notice if my child is not allowed to attend a specific trip. This Agreement may be photocopied as field trip permission. I grant permission for the child to be transported to and from WINGS and to and from field trips or other excursions by car, bus, or walking, whether directly by WINGS or contracted service with another company/organization (i.e. Samson Trailways). The Adult completely releases and forever discharges WINGS, the District, the County Board of Education, and WINGS, School, and District board members, employees, affiliates, agents, volunteers, from all potential claims, demands, injuries, and damages of any nature whatsoever, including medical expenses, court costs, legal expenses, and attorney’s fees, which the Adult or child has, and are related in any way to transportation services.

7. The child is in sufficiently good health and physical condition to participate in WINGS, and voluntarily chooses to participate in WINGS.

8. Any pre-existing health or medical condition shall be provided to WINGS by a licensed medical practitioner with a statement that the child has been physically examined and is deemed to be in sufficiently good health and fitness so that the child may fully participate in WINGS. Documentation must be provided prior to participation in WINGS.

9. Emergency medical information regarding the child is on file with WINGS. The Adult agrees to provide updated medical information during the course of the child’s participation in WINGS. If an injury or medical emergency occurs during WINGS, WINGS employees, volunteers, agents have my express permission to administer or to authorize the administration of urgent or emergency care, including the transportation of the child to an urgent care or emergency care provider. In such circumstances, notice to me and/or the Emergency Contact of the injury or medical emergency may be delayed. Therefore, any urgent or emergency medical care provider has my express authority to conduct diagnostic or anesthetic procedures, and/or to provide medical care or treatment (including surgery), as they may deem reasonable or necessary under all existing circumstances. I also consent to WINGS, the District, and/or school to release any and all information for the purposes of such medical care and/or for insurance purposes. All costs and expenses associated with such care are solely my responsibility.

10. The child shall comply with the instruction and directions of WINGS staff, volunteers, agents, and instructors. During the child’s participation in WINGS, including any academic and/or other activities, the child shall comply with all applicable District, school, and WINGS Codes of Conduct. The child shall generally conduct himself/herself at all times in keeping with the highest moral and ethical standards so as to reflect positively on himself/herself, WINGS, the District, and School. Failure to meet these obligations may, in the discretion of WINGS, result in immediate removal from WINGS. Should the violation of these obligations also result in bodily injury or property damage during WINGS, the Adult will (a) pay to restore or replace any property damaged as a result of the child’s violation, (b) pay any damages caused to bodily injury to an individual, and (c) defend, protect, and hold WINGS harmless from such property damage or bodily injury claims.

11. The Adult understands WINGS does not condone, authorize, or engage in any type of corporal punishment.

12. Employees, agents, or volunteers of WINGS, members of the press or media, or other persons who may attend or participate in WINGS activities, may photograph, videotape, or take statements from the child. Such photographs, videotapes, recordings, or written statements may be published or reproduced in a manner showing the child’s name, face, likeness, voice, thoughts, beliefs, or appearance to third parties, including, without limitation, webcasts, television, motion pictures, films, newspapers, yearbooks, and magazines. Such published or reproduced items, whether or not for a profit, may be used for security, training, advertising, news, publicity, promotional, informational, or any other lawful purpose. I hereby authorize and consent to any such publications or reproductions, without compensation, and without reservation or limitation. If I do not consent to any such publications or reproductions I will notify WINGS in writing.

13. I authorize and approve the District and/or school to release the following data to WINGS for the purposes of grant reporting, research and evaluation purposes, and/or monitoring child achievement: (a) Demographic data (including but not limited to, race/ethnicity, grade level, school name); (b) Limited English Proficiency (LEP) status; (c) Exceptional Children (EC) and/or Gifted (AIG) status; (d) course grades; (e) standardized test score, levels, proficiency occurring throughout the year; (f) attendance data; (g) behavior data (including suspensions); (h) promotion/retention; (i) student identification number. I also authorize and agree to the release of identifiable child data from the two previous school years to WINGS.

14. WINGS engages in research and evaluation and may ask participants to complete surveys to help WINGS evaluate its program. All collected data will be confidential. Participation is not mandatory. I acknowledge that I understand this information about program evaluation and agree to allow the child to participate in such research. If I prefer the child not participate, I will notify WINGS in writing.

15. This Agreement shall be governed by the laws of the State of Georgia. This Agreement is to be broadly construed to enforce the purposes and agreements set forth above, and shall not be construed against the Released Parties solely on the basis that this Agreement was drafted by WINGS. If any part of this Agreement is deemed invalid or ineffective, all other provisions shall remain in force. No oral modification of this Agreement, or alleged change or modification of its terms by subsequent conduct or oral statements, is allowed. This Agreement contains the sole and exclusive understanding of the parties, with no other representation relied upon by the Adult or child in determining whether to execute this Agreement or in agreeing to participate in WINGS.

Date(Required)

Notice of Exemption

Date

Consent & Waiver

Consent(Required)

I Agree to the Wings for Kids Program Participation Waiver for Berkeley County School District

In consideration for the Child’s ability to participate in the Wings for Kids After School Program (“WINGS”) operating in Berkeley County School District (“District”), for the 2023-24 school year, the Parent or Legal Guardian (“Adult”) signing this Agreement agrees as follows:

1. It is a privilege, not a right, to participate in WINGS. The privilege may be revoked at any time, for any reason, that does not violate Federal, State or District laws, policies or procedures.

2. WINGS is a free after school program and there is no cost to parents/families including in-kind or monetary donations. WINGS is not a licensed child care provider, and therefore is exempt from any local, state, or federal child care licensing regulations.

3. WINGS provides an engaging, safe space after school, and supports the social and emotional well-being of children.

4. Designated program times of WINGS shall be communicated with parents/families. WINGS is only responsible for the child during the designated program times. Upon dismissal from the program, whether by car, bus, or walking, I release WINGS from any responsibility and/or liability that may result once the child is no longer present in WINGS during designated program times.

5. I have been given ample opportunity to ask questions about the environment in which the child will be and the activities in which the child will participate during attendance in the program. The Adult understands the nature of the program, activities, and lessons at WINGS, including the inherent or potential risks of after school programming, such as: bodily contact during athletics or playground time and use of tools and materials in arts class. By this Agreement, the child and Adult are deemed to fully assume all such risks and understand and agree to the fullest extent allowed by law they are waiving and releasing any potential future claim (including reasonable attorneys’ fees) they might otherwise have been able to assert against WINGS, the District, the School, the County Board of Education, or any Board Member, employee, agent, volunteer of WINGS, the District, the School “(“Released Parties”) by or on behalf of the child or any parent, administrator, executor, trustee, guardian, or family member.

6. WINGS provides field trips throughout the year. I give permission for the child to attend such field trips or excursions. I understand WINGS shall provide notice when children are going on these trips and I must provide 48 hours advance notice if my child is not allowed to attend a specific trip. This Agreement may be photocopied as field trip permission. I grant permission for the child to be transported to and from WINGS and to and from field trips or other excursions by car, bus, or walking, whether directly by WINGS or contracted service with another company/organization (i.e. Samson Trailways). The Adult completely releases and forever discharges WINGS, the District, the County Board of Education, and WINGS, School, and District board members, employees, affiliates, agents, volunteers, from all potential claims, demands, injuries, and damages of any nature whatsoever, including medical expenses, court costs, legal expenses, and attorney’s fees, which the Adult or child has, and are related in any way to transportation services.

7. The child is in sufficiently good health and physical condition to participate in WINGS, and voluntarily chooses to participate in WINGS.

8. Any pre-existing health or medical condition shall be provided to WINGS by a licensed medical practitioner with a statement that the child has been physically examined and is deemed to be in sufficiently good health and fitness so that the child may fully participate in WINGS. Documentation must be provided prior to participation in WINGS.

9. Emergency medical information regarding the child is on file with WINGS. The Adult agrees to provide updated medical information during the course of the child’s participation in WINGS. If an injury or medical emergency occurs during WINGS, WINGS employees, volunteers, agents have my express permission to administer or to authorize the administration of urgent or emergency care, including the transportation of the child to an urgent care or emergency care provider. In such circumstances, notice to me and/or the Emergency Contact of the injury or medical emergency may be delayed. Therefore, any urgent or emergency medical care provider has my express authority to conduct diagnostic or anesthetic procedures, and/or to provide medical care or treatment (including surgery), as they may deem reasonable or necessary under all existing circumstances. I also consent to WINGS, the District, and/or school to release any and all information for the purposes of such medical care and/or for insurance purposes. All costs and expenses associated with such care are solely my responsibility.

10. The child shall comply with the instruction and directions of WINGS staff, volunteers, agents, and instructors. During the child’s participation in WINGS, including any academic and/or other activities, the child shall comply with all applicable District, school, and WINGS Codes of Conduct. The child shall generally conduct himself/herself at all times in keeping with the highest moral and ethical standards so as to reflect positively on himself/herself, WINGS, the District, and School. Failure to meet these obligations may, in the discretion of WINGS, result in immediate removal from WINGS. Should the violation of these obligations also result in bodily injury or property damage during WINGS, the Adult will (a) pay to restore or replace any property damaged as a result of the child’s violation, (b) pay any damages caused to bodily injury to an individual, and (c) defend, protect, and hold WINGS harmless from such property damage or bodily injury claims.

11. The Adult understands WINGS does not condone, authorize, or engage in any type of corporal punishment.

12. Employees, agents, or volunteers of WINGS, members of the press or media, or other persons who may attend or participate in WINGS activities, may photograph, videotape, or take statements from the child. Such photographs, videotapes, recordings, or written statements may be published or reproduced in a manner showing the child’s name, face, likeness, voice, thoughts, beliefs, or appearance to third parties, including, without limitation, webcasts, television, motion pictures, films, newspapers, yearbooks, and magazines. Such published or reproduced items, whether or not for a profit, may be used for security, training, advertising, news, publicity, promotional, informational, or any other lawful purpose. I hereby authorize and consent to any such publications or reproductions, without compensation, and without reservation or limitation. If I do not consent to any such publications or reproductions I will notify WINGS in writing.

13. I authorize and approve the District and/or school to release the following data to WINGS for the purposes of grant reporting, research and evaluation purposes, and/or monitoring child achievement: (a) Demographic data (including but not limited to, race/ethnicity, grade level, school name); (b) Limited English Proficiency (LEP) status; (c) Exceptional Children (EC) and/or Gifted (AIG) status; (d) course grades; (e) standardized test score, levels, proficiency occurring throughout the year; (f) attendance data; (g) behavior data (including suspensions); (h) promotion/retention; (i) student identification number. I also authorize and agree to the release of identifiable child data from the two previous school years to WINGS.

14. WINGS engages in research and evaluation and may ask participants to complete surveys to help WINGS evaluate its program. All collected data will be confidential. Participation is not mandatory. I acknowledge that I understand this information about program evaluation and agree to allow the child to participate in such research. I acknowledge that I understand and agree to allow WINGS to share the child's data (as outlined in #13) to third parties, specifically and only for, education and research purposes (including South Carolina Afterschool Alliance and researchers such as Public Profit). If I prefer the child not participate, I will notify WINGS in writing.

15. This Agreement shall be governed by the laws of the State of South Carolina. This Agreement is to be broadly construed to enforce the purposes and agreements set forth above, and shall not be construed against the Released Parties solely on the basis that this Agreement was drafted by WINGS. If any part of this Agreement is deemed invalid or ineffective, all other provisions shall remain in force. No oral modification of this Agreement, or alleged change or modification of its terms by subsequent conduct or oral statements, is allowed. This Agreement contains the sole and exclusive understanding of the parties, with no other representation relied upon by the Adult or child in determining whether to execute this Agreement or in agreeing to participate in WINGS.

As the Adult signing below: (1) I am giving up substantial actual or potential rights in order to allow the child to participate in WINGS; (2) I have signed this Agreement without any inducement or assurance of any nature, and with full appreciation of the risks inherent in WINGS; (3) I have fully read the Agreement in its entirety, have paid particular attention to the bolded language, and have no question regarding the scope or intent of this Agreement; (4) I, as a parent or legal guardian, have the right and authority to enter into this Agreement, and to bind myself, the child, and any other family member, personal representative, trustee, or guardian to the terms of this Agreement; (5) I have explained this Agreement to the child, who understands his/her obligations.

Date(Required)

Consent & Waiver

Consent(Required)

I Agree to the Wings for Kids Program Participation Waiver for Charleston County School District

In consideration for the Child’s ability to participate in the Wings for Kids After School Program (“WINGS”) operating in Charleston County School District (“District”), for the 2023-24 school year, the Parent or Legal Guardian (“Adult”) signing this Agreement agrees as follows:

1. It is a privilege, not a right, to participate in WINGS. The privilege may be revoked at any time, for any reason, that does not violate Federal, State or District laws, policies or procedures.

2. WINGS is a free after school program and there is no cost to parents/families including in-kind or monetary donations. WINGS is not a licensed child care provider, and therefore is exempt from any local, state, or federal child care licensing regulations.

3. WINGS provides an engaging, safe space after school, and supports the social and emotional well-being of children.

4. Designated program times of WINGS shall be communicated with parents/families. WINGS is only responsible for the child during the designated program times. Upon dismissal from the program, whether by car, bus, or walking, I release WINGS from any responsibility and/or liability that may result once the child is no longer present in WINGS during designated program times.

5. I have been given ample opportunity to ask questions about the environment in which the child will be and the activities in which the child will participate during attendance in the program. The Adult understands the nature of the program, activities, and lessons at WINGS, including the inherent or potential risks of after school programming, such as bodily contact during athletics or playground time and use of tools and materials in arts class. By this Agreement, the child and Adult are deemed to fully assume all such risks and understand and agree to the fullest extent allowed by law they are waiving and releasing any potential future claim (including reasonable attorneys’ fees) they might otherwise have been able to assert against WINGS, the District, the School, the County Board of Education, or any Board Member, employee, agent, volunteer of WINGS, the District, the School “(“Released Parties”) by or on behalf of the child or any parent, administrator, executor, trustee, guardian, or family member.

6. WINGS provides field trips throughout the year. I give permission for the child to attend such field trips or excursions. I understand WINGS shall provide notice when children are going on these trips and I must provide 48 hours advance notice if my child is not allowed to attend a specific trip. This Agreement may be photocopied as field trip permission. I grant permission for the child to be transported to and from WINGS and to and from field trips or other excursions by car, bus, or walking, whether directly by WINGS or contracted service with another company/organization (i.e. Samson Trailways). The Adult completely releases and forever discharges WINGS, the District, the County Board of Education, and WINGS, School, and District board members, employees, affiliates, agents, volunteers, from all potential claims, demands, injuries, and damages of any nature whatsoever, including medical expenses, court costs, legal expenses, and attorney’s fees, which the Adult or child has, and are related in any way to transportation services.

7. The child is in sufficiently good health and physical condition to participate in WINGS, and voluntarily chooses to participate in WINGS.

8. Any pre-existing health or medical condition shall be provided to WINGS by a licensed medical practitioner with a statement that the child has been physically examined and is deemed to be in sufficiently good health and fitness so that the child may fully participate in WINGS. Documentation must be provided prior to participation in WINGS.

9. Emergency medical information regarding the child is on file with WINGS. The Adult agrees to provide updated medical information during the course of the child’s participation in WINGS. If an injury or medical emergency occurs during WINGS, WINGS employees, volunteers, agents have my express permission to administer or to authorize the administration of urgent or emergency care, including the transportation of the child to an urgent care or emergency care provider. In such circumstances, notice to me and/or the Emergency Contact of the injury or medical emergency may be delayed. Therefore, any urgent or emergency medical care provider has my express authority to conduct diagnostic or anesthetic procedures, and/or to provide medical care or treatment (including surgery), as they may deem reasonable or necessary under all existing circumstances. I also consent to WINGS, the District, and/or school to release any and all information for the purposes of such medical care and/or for insurance purposes. All costs and expenses associated with such care are solely my responsibility.

10. The child shall comply with the instruction and directions of WINGS staff, volunteers, agents, and instructors. During the child’s participation in WINGS, including any academic and/or other activities, the child shall comply with all applicable District, school, and WINGS Codes of Conduct. The child shall generally conduct himself/herself at all times in keeping with the highest moral and ethical standards so as to reflect positively on himself/herself, WINGS, the District, and School. Failure to meet these obligations may, in the discretion of WINGS, result in immediate removal from WINGS. Should the violation of these obligations also result in bodily injury or property damage during WINGS, the Adult will (a) pay to restore or replace any property damaged as a result of the child’s violation, (b) pay any damages caused to bodily injury to an individual, and (c) defend, protect, and hold WINGS harmless from such property damage or bodily injury claims.

11. The Adult understands WINGS does not condone, authorize, or engage in any type of corporal punishment.

12. Employees, agents, or volunteers of WINGS, members of the press or media, or other persons who may attend or participate in WINGS activities, may photograph, videotape, or take statements from the child. Such photographs, videotapes, recordings, or written statements may be published or reproduced in a manner showing the child’s name, face, likeness, voice, thoughts, beliefs, or appearance to third parties, including, without limitation, webcasts, television, motion pictures, films, newspapers, yearbooks, and magazines. Such published or reproduced items, whether or not for a profit, may be used for security, training, advertising, news, publicity, promotional, informational, or any other lawful purpose. I hereby authorize and consent to any such publications or reproductions, without compensation, and without reservation or limitation.

13. I authorize and approve the District and/or school to release the following data to WINGS for the purposes of grant reporting, research and evaluation purposes, and/or monitoring child achievement: (a) Demographic data (including but not limited to, race/ethnicity, grade level, school name); (b) Limited English Proficiency (LEP) status; (c) Exceptional Children (EC) and/or Gifted (AIG) status; (d) course grades; (e) standardized test score, levels, proficiency occurring throughout the year; (f) attendance data; (g) behavior data (including suspensions); (h) promotion/retention. I also authorize and agree to the release of identifiable child data from the two previous school years to WINGS.

14. WINGS engages in research and evaluation and may ask participants to complete surveys to help WINGS evaluate its program. All collected data will be confidential. Participation is not mandatory. I acknowledge that I understand this information about program evaluation and agree to allow the child to participate in such research. If I prefer the child not participate, I will notify WINGS.

15. This Agreement shall be governed by the laws of the State of South Carolina. This Agreement is to be broadly construed to enforce the purposes and agreements set forth above, and shall not be construed against the Released Parties solely on the basis that this Agreement was drafted by WINGS. If any part of this Agreement is deemed invalid or ineffective, all other provisions shall remain in force. No oral modification of this Agreement, or alleged change or modification of its terms by subsequent conduct or oral statements, is allowed. This Agreement contains the sole and exclusive understanding of the parties, with no other representation relied upon by the Adult or child in determining whether to execute this Agreement or in agreeing to participate in WINGS.

Date(Required)

Consent & Waiver

As the Adult consenting below: (1) I am giving up substantial actual or potential rights in order to allow the child to participate in WINGS; (2) I have signed this Agreement without any inducement or assurance of any nature, and with full appreciation of the risks inherent in WINGS; (3) I have fully read the Agreement in its entirety, have paid particular attention to the bolded language, and have no question regarding the scope or intent of this Agreement; (4) I, as a parent or legal guardian, have the right and authority to enter into this Agreement, and to bind myself, the child, and any other family member, personal representative, trustee, or guardian to the terms of this Agreement; (5) I have explained this Agreement to the child, who understands his/her obligations.

Consent(Required)

I Agree to the Wings for Kids Program Participation Waiver for Atlanta Public Schools

In consideration for the Child’s ability to participate in the Wings for Kids After School Program (“WINGS”) operating in Atlanta Public Schools District (“District”), for the 2023-24 school year, the Parent or Legal Guardian (“Adult”) signing this Agreement agrees as follows:

1. It is a privilege, not a right, to participate in WINGS. The privilege may be revoked at any time, for any reason, that does not violate Federal, State or District laws, policies or procedures.

2. WINGS is a free after school program and there is no cost to parents/families including in-kind or monetary donations. WINGS is not a licensed child care provider, and therefore is exempt from any local, state, or federal child care licensing regulations.

3. WINGS provides an engaging, safe space after school, and supports the social and emotional well-being of children.

4. Designated program times of WINGS shall be communicated with parents/families. WINGS is only responsible for the child during the designated program times. Upon dismissal from the program, whether by car, bus, or walking, I release WINGS from any responsibility and/or liability that may result once the child is no longer present in WINGS during designated program times.

5. I have been given ample opportunity to ask questions about the environment in which the child will be and the activities in which the child will participate during attendance in the program. The Adult understands the nature of the program, activities, and lessons at WINGS, including the inherent or potential risks of after school programming, such as: bodily contact during athletics or playground time and use of tools and materials in arts class. By this Agreement, the child and Adult are deemed to fully assume all such risks and understand and agree to the fullest extent allowed by law they are waiving and releasing any potential future claim (including reasonable attorneys’ fees) they might otherwise have been able to assert against WINGS, the District, the School, the Atlanta Board of Education, or any Board Member, employee, agent, volunteer of WINGS, the District, the School “(“Released Parties”) by or on behalf of the child or any parent, administrator, executor, trustee, guardian, or family member.

6. WINGS provides field trips throughout the year. I give permission for the child to attend such field trips or excursions. I understand WINGS shall provide notice when children are going on these trips and I must provide 48 hours advance notice if my child is not allowed to attend a specific trip. This Agreement may be photocopied as field trip permission. I grant permission for the child to be transported to and from WINGS and to and from field trips or other excursions by car, bus, or walking, whether directly by WINGS or contracted service with another company/organization (i.e. Samson Trailways). The Adult completely releases and forever discharges WINGS, the District, the Atlanta Board of Education, and WINGS, School, and District board members, employees, affiliates, agents, volunteers, from all potential claims, demands, injuries, and damages of any nature whatsoever, including medical expenses, court costs, legal expenses, and attorney’s fees, which the Adult or child has, and which are related in any way to transportation services.

7. The child is in sufficiently good health and physical condition to participate in WINGS, and voluntarily chooses to participate in WINGS.

8. Any pre-existing health or medical condition shall be provided to WINGS by a licensed medical practitioner with a statement that the child has been physically examined and is deemed to be in sufficiently good health and fitness so that the child may fully participate in WINGS. Documentation must be provided prior to participation in WINGS.

9. Emergency medical information regarding the child is on file with WINGS. The Adult agrees to provide updated medical information during the course of the child’s participation in WINGS. If an injury or medical emergency occurs during WINGS, WINGS employees, volunteers, agents have my express permission to administer or to authorize the administration of urgent or emergency care, including the transportation of the child to an urgent care or emergency care provider. In such circumstances, notice to me and/or the Emergency Contact of the injury or medical emergency may be delayed. Therefore, any urgent or emergency medical care provider has my express authority to conduct diagnostic or anesthetic procedures, and/or to provide medical care or treatment (including surgery), as they may deem reasonable or necessary under all existing circumstances. I also consent to WINGS, the District, and/or school to release any and all information for the purposes of such medical care and/or for insurance purposes. All costs and expenses associated with such care are solely my responsibility.

10. The child shall comply with the instruction and directions of WINGS staff, volunteers, agents, and instructors. During the child’s participation in WINGS, including any academic and/or other activities, the child shall comply with all applicable District, school, and WINGS Codes of Conduct. The child shall generally conduct himself/herself at all times in keeping with the highest moral and ethical standards so as to reflect positively on himself/herself, WINGS, the District, and School. Failure to meet these obligations may, in the discretion of WINGS, result in immediate removal from WINGS. Should the violation of these obligations also result in bodily injury or property damage during WINGS, the Adult will (a) pay to restore or replace any property damaged as a result of the child’s violation, (b) pay any damages caused to bodily injury to an individual, and (c) defend, protect, and hold WINGS harmless from such property damage or bodily injury claims.

11. The Adult understands WINGS does not condone, authorize, or engage in any type of corporal punishment.

12. Employees, agents, or volunteers of WINGS, members of the press or media, or other persons who may attend or participate in WINGS activities, may photograph, videotape, or take statements from the child. Such photographs, videotapes, recordings, or written statements may be published or reproduced in a manner showing the child’s name, face, likeness, voice, thoughts, beliefs, or appearance to third parties, including, without limitation, webcasts, television, motion pictures, films, newspapers, yearbooks, and magazines. Such published or reproduced items, whether or not for a profit, may be used for security, training, advertising, news, publicity, promotional, informational, or any other lawful purpose. I hereby authorize and consent to any such publications or reproductions, without compensation, and without reservation or limitation. If I do not consent to any such publications or reproductions I will notify WINGS in writing.

13. I authorize and approve the District and/or school to release the following data to WINGS for the purposes of grant reporting, research and evaluation purposes, and/or monitoring child achievement: (a) Demographic data (including but not limited to, race/ethnicity, grade level, school name); (b) Limited English Proficiency (LEP) status; (c) Exceptional Children (EC) and/or Gifted (AIG) status; (d) course grades; (e) standardized test score, levels, proficiency occurring throughout the year; (f) attendance data; (g) behavior data (including suspensions); (h) promotion/retention; (i) student identification number. I also authorize and agree to the release of identifiable child data from the two previous school years to WINGS.

14. WINGS engages in research and evaluation and may ask participants to complete surveys to help WINGS evaluate its program. All collected data will be confidential. Participation is not
mandatory. I acknowledge that I understand this information about program evaluation and agree to allow the child to participate in such research. If I prefer the child not participate, I will notify WINGS in writing.

15. This Agreement shall be governed by the laws of the State of Georgia. This Agreement is to be broadly construed to enforce the purposes and agreements set forth above, and shall not be construed against the Released Parties solely on the basis that this Agreement was drafted by WINGS. If any part of this Agreement is deemed invalid or ineffective, all other provisions shall remain in force. No oral modification of this Agreement, or alleged change or modification of its terms by subsequent conduct or oral statements, is allowed. This Agreement contains the sole and exclusive understanding of the parties, with no other representation relied upon by the Adult or child in determining whether to execute this Agreement or in agreeing to participate in WINGS.

Date(Required)

21st Century Community Learning Center & WINGS

Date

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