SCCORE IMPACT Program | SCCORE Equity

S.C.C.O.R.E. St.Clair County Organizing Regional Equity
IMPACT Program

Registration: Now through Friday, January 10, 2025. Register online or onsite @ St. John United Church of Christ 710 Pine St Port Huron, MI 48060. Start Date and End Date: Tues. January 3rd, 2025 (staff/volunteers), January 7th, 2024 (First Full Day) through Friday, February 28th, 2025.

Locations: @ St. Johns United Church of Christ 710 Pine St Port Huron, MI 48060.

Start Date and End Date: Tues. January 6th, 2025 (First Full Day) through Friday, February 28th, 2025.

Parent / Guardian First & LastName

Parent / Guardian Address and Phone:

Email:

Number of Children

Child(ren's) Full Name(s), Age(s), and any Allergies

Child/Children Shirt Sizes (Enter the number of each size needed)

My child has permission (if applicable) to be photographed/video for program promotion, via website, newspaper, and/or other social media formats. My child has my permission to attend the SCCORE Winter/Spring 2025 Program. Answer Yes or No

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. Answer Yes or No.

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.

Please read the following Disclaimer

Parent Signature

Date

SCCORE IMPACT & WRITE-2-READ PROGRAMS 2025 Bridge Program Parent Consent Sheet

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

I agree to the terms & conditions

Thanks for submitting!

S.C.C.O.R.E. St.Clair County Organizing Regional Equity IMPACT Program

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S.C.C.O.R.E. St.Clair County Organizing Regional Equity
IMPACT Program