SCCORE IMPACT Program | SCCORE Equity

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

Registration: Now through Tuesday, July 3rd, 2023. SCCORE will take place @ St. Johns United Church of Christ 710 Pine St Port Huron, MI 48060. Start Date and End Date: Tues. July 11th, 2023 (First Full Day) through Friday, August 18th, 2023.

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

Start Date and End Date: Tues. July 11th, 2023 (First Full Day) through Friday, August 18th, 2023.

First Name

Last Name

Number of Children

Child(ren's) Name(s) and Age(s)

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 2023 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 PROGRAM 2023 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.

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