ABC After School Enrichment Program


ENROLLMENT/REGISTRATION INFORMATION 2021
Entrance to program is based upon availability so space (All applicants will be notified)


Kids Hope Alliance will not assume the responsibility of issuing medications to any child/youth. If it is deemed that we are incapable of providing routine, necessary care due to mental or physical incapacity program participation may be denied.
Person to be contacted in case of illness, accident, emergency and authorized to remove the child from the facility in the absence of a parent/guardian. If a child’s biological parent is not allowed to pick a child up, please provide the necessary documentation, i.e. notarized statement or judgment.

Person(s) authorized to pick-up child:



The following person(s) listed are authorized to pick up my child(ren)




General Release of Liability:

In consideration of being allowed to participate in any related events and activities the undersigned agrees to the following:

I acknowledge and fully understand that each participant will be engaging in activities that may involve risk or serious injury; including permanent disability and severe social and economic losses, which might result not only from their actions, inactions or negligence, but the action, inaction or negligence of others, the rules of play or the condition of the premises or of any equipment used. Further, that there may be risks not known to us or not reasonably foreseeable at this time. To the best of my knowledge, my daughter/son is physically fit to engage in the activity in question. I understand that Abyssinia Missionary Baptist Church (ABC After-School Enrichment Program) and their volunteers and agents will exercise reasonable care while my daughter/son is in their custody and care engaging in activities through the Abyssinia Missionary Baptist Church (ABC After-School Enrichment Program) After-School Program.


I agree that Abyssinia Missionary Baptist Church (ABC After-School Enrichment Program) will be held harmless from any and all liability, which may arise while exercising their duty of care, relating to my daughter/son for personal injury or illness that may be suffered or any loss of property that may occur to my daughter/son while participating in the Abyssinia Missionary Baptist Church (ABC After-School Enrichment Program) After-School Program.


Authorization for Emergency Care:

In case of accident or serious illness, and the program site is unable to reach me, I hereby authorize Abyssinia Missionary Baptist Church (ABC After-School Enrichment Program) to contact the physician indicated on the application and to follow his/her instructions: If it is impossible to contact this physician, Abyssinia Missionary Baptist Church (ABC After-School Enrichment Program) may make whatever arrangements necessary to provide care and treatment for my child.
In case of accident/serious illness where the immediate treatment of my child is not necessary, but he/she is unable to remain in the program, I will be contacted or transportation arrangements will be made for my child. If the program is unable to reach me, I authorize Abyssinia Missionary Baptist Church (ABC After-School Enrichment Program) to contact one of the persons indicated on the enrollment form and ask them to pick up and transport my child home.


Photo/Media Release:

I acknowledge and understand that publicity activities such as interviews, photos, and videotaping may occur. I consent and permit my child, as a participant in the Abyssinia Missionary Baptist Church (ABC After-School Enrichment Program) After-School Program and events, to be photographed, videotaped, and/or interviewed for publicity activities.


Abyssinia ABC After-School Enrichment Program Authorization:

I give Abyssinia Missionary Baptist Church (ABC After School Enrichment Program) staff the authorization to review my child’s school records. (Application is not considered complete unless signed below to indicate agreement with all of the above).


Application is not considered complete unless signed below to indicate agreement with all of the above