SCCORE SUMMER 2025 Youth Program Application

SCCORE will take place @ HURON PLACE Port Huron, MI 48060.

Start Date and End Date: Tues. July 1st, 2025 (First Full Day) through Friday, August 14th, 2025.

Locations: Huron Place, Nern, Port Huron, MI 48060.

Name of Child

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

T-Shirt Size

Note: (If your child/ren have t-shirts from past program that fit please have them wear it on the first day or if your child/ren need a shirt please provide their size).

Small

Medium

Large

X-Large

My child has permission (if applicable) to be photographed/video for program promotion, via website, newspaper, and/or other social media formats.

I AGREE:

My child has my permission to attend the SCCORE SUMMER 2025 Program

I understand that for each activity in which transportation is provided by SSBP I have/will be notified of the type, place, and purpose of trip and thereby give permission for my child to travel with them to field trips, lunch sites, and approved activities.

I have provided a list of all my child(ren)(s) medication, allergens, emergency care contact, and desired place to have my child seen in case of an emergency.

I have received a copy of process of correction and guidance that will be provided by our staff in relationship to helping your child, if they need assistance, in reestablishing socially appropriate behavior, and assistance to help him/her continue to be allowed to participate in the program if any discipline is needed throughout their participation in the program. Are there any helpful methods that you would like to share that you find work best with your child/ren.

DISCLAIMERS

I, also, agree to indemnify and hold harmless the sponsoring institute S.C.C.O.R.E, PHASDA, PHHD, and/or any other collaborators and/or sponsors from liability arising from any accident or injury occurring during this program and any trips agreed upon for the summer. This specifically includes injury arising from negligence on the part of those mentioned above. This contract is recognized among this organization, student and parents. This does not include gross negligence on the part of those mentioned above. Port Huron Schools does not sponsor this event/activity and the district assumes no responsibility for it. In consideration for the privilege to distribute these material, the Port Huron Area School District shall be held harmless from any cause of action filed in any court or administrative tribunal arising out of the distribution of these materials, including all cost, attorney’s fees and judgments or awards.

Parent Name

First Name

Last Name

Date

YYYY

SCCORE SUMMER, 2025 Bridge Program Parent Consent Sheet

I Give my child (ren) permission to participate in the following and provide all emergency information needed to prevent and assist my child in the case of an emergency.

Please read the follow and initial that you have been provided with an understanding of program areas and sign off information.

To continue promotion of our youth, and/or community-based programs, throughout the program we will periodically take pictures, videos, etc. to use only for the purpose of establishing a picture history and to help promote program to continue to provide a means to highlight the program, and to assist in obtain ongoing and future funding for the SCCORE Spring and positive community- based programs and services.

I AGREE:

PARTNER WITH US