Barnabas Club Application 2016-17x

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Application

We are EXCITED to receive your family's application for participation in CIA activities! Please note; filling out an application does not enroll you child(ren) into Barnabas Club. Once your application has been received, reviewed, and an opening is identified, for your child(ren), you will be notified. Transportation is available, in limited capacity, to Golden Isles Elementary, Altama Elementary, C.B. Greer Elementary and Needwood Middle Schools. For additional questions, please email us admin@ciasportsclub.org or contact Matt at 912-332-8000.

* Indicates required field

Guardian's Name: *

First

Last

Guardian's Email: *

Cell Phone: *

Alt. Phone: *

Barnabas Club is a free after-school program bringing children from all race, social and economic backgrounds together to encourage the importance of making good choices and demonstrating what is achievable through teamwork...

There is no financial charge for the Barnabas Club, however participants are required to participate in fundraising activities, volunteer hours and snacks.

Afternoon activities consist of a healthy snack, 30 minutes supervised free time, 45 minutes huddle/devotion and character development, 45 minutes homework and 45 minutes of physical activity.

Children are taught through biblical stories that:
Poor Choices = Bad Consequences
Good Choices = Good Consequences

1st Student's Name: *

First

Last

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Gender: *

Male Female

Grade: *

1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade

School: *

Altama Elementary (WAITING LIST) C.B. Greer Elementary Golden Isles Elementary Needwood Middle School Drop Off

2nd Student's Name: *

First

Last

Gender: *

Male Female

Grade: *

1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Greade

School: *

Altama Elementary (WAITING LIST) C.B. Greer Elementary Golden Isles Elementary Needwood Middle School Drop Off

3rd Student's Name: *

First

Last

Gender: *

Male Female

Grade: *

1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade

School: *

Altama Elementary (WAITING LIST) C.B. Greer Elementary Golden Isles Elementary Needwood Middle School Drop Off

4th Student's Name: *

First

Last

Gender: *

Male Female

Grade: *

1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade

School: *

Altama Elementary (WAITING LIST) C.B. Greer Elementary Golden Isles Elementary Needwood Middle School Drop Off

5th Student's Name: *

First

Last

Gender: *

Male Female

Grade: *

1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade

School: *

Altama Elementary (WAITING LIST) C.B. Greer Elementary Golden Isles Elementary Needwood Middle School Drop Off

Snack Agreement *

I agree to provide a designated snack, enough for 30 children, one day a month (per participating child in my household) and contributing designated items to the CIA pantry once a semester.

Transportation *

This is to certify that I give C.I.A. Sports Club permission to transport my child to and from school and field trips. C.I.A. is authorized to receive my child.

School Visitation *

I hereby give consent to C.I.A. staff to eat lunch and visit with my child(ren) in class.

Report Card and Progress Reports *

I hereby give consent to C.I.A. Sports Club to view and copy my child(ren)'s report card and progress reports and to interact with teachers/staff verbally and electronically concerning my child's progress and behavior. These reports will help my child's progress and help the staff at the club better serve my child. Please forward all available academic (including testing information), medical and discipline records that you may have for my child(ren).

Pictures/Videos *

Throughout the year, there are occasions when CIA Sports Club will take pictures/videos of your child(ren) participating in activities. We may use, duplicate, broadcast, distribute, and display these pictures/videos in CIA publications, local newspapers, advertising or on websites maintained for CIA. Thank you in advance for your permission, support and understanding.

Barnabas Club Registration *

I HAVE READ AND FULLY UNDERSTAND THIS FORM. I, as parent or Guardian, hereby give my consent for my child(ren) to participate in activities and in consideration of CIA Sports Club allowing my child(ren) to participate in any related activities, and for other good and valuable consideration, I hereby covenant and agree not to sue CIA Sports Club, or any staff, member, or coach thereof, and hereby release and forever discharge CIA Sports Club, or any staff, member, or coach thereof from any and all claims, demands, rights and causes of action of whatsoever kind of nature for any damages including bodily or personal injury sustained by my child and arising from his or her participation in such activity, sponsored by CIA Sports Club, including transportation in such activity. I authorize any staff, member or coach of CIA Sports Club associated with the program to obtain, through a physician of its own choice, any emergency medical care that may seem to them to be necessary for my child(ren). I agree to pay all associated cost.

Your application has been received. Thank you!

Submit

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