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    Good Shepherd UMC
    After School Program 2019

    Registration Form
    **If the online registration system is not working with your device, please contact the church office at 410-243-1129 so we can help you.**

    Please consider a financial donation to help offset the costs of the program. Thank you. 

    The cost of using online giving for credit cards is 2.9% + $0.30/transaction. The cost of using online giving for ACH (bank account) is 1% + $0.30/transaction. You will be given the opportunity to cover the fees in addition to your donation, and will be given an emailed receipt for tax purposes.

    Participant's Information

    ***Please Note: All children entering grades 1-8 who live or go to school near Good Shepherd UMC are welcome to attend the After School Program. Walking pick-up is provided from Hampden Elementary/Middle School as a courtesy. Other students must provide their own transportation to the program. If they arrive to the Church before the larger group (approximately 3pm), we are not responsible for their actions or safety. Please ensure your child has proper supervision. 

    Parent/Guardian Information

    Health Information (Will be stored confidentially)

     If you check the "no insurance" option, we will call you to discuss emergency procedures.

    Photo/Media Release

    I hereby give permission Good Shepherd UMC, to photograph and/or videotape the student for educational or promotional purposes.
    By selecting the button below, and typing my name and date, I understand that this serves as my electronic signature, with the same authority and use as my actual signature. 

    Signatures

    By electronically signing below, I attest that the information contained on this form is accurate to the best of my knowledge and ability. I understand that this is an application and registration form, but that registration is NOT complete until  ALL waivers are signed in hard copy (including Permission to Treat, Permission to Transport, Waivers of Liability, and Student Code of Conduct). 
    I also understand that while the following does not represent an exhaustive list, a student may be immediately dismissed from the program for the following reasons:
    -Leaving the site or established boundaries;
    -Bringing a weapon (defined as any object designed, used for, or capable of inflicting bodily harm or physical damage); alcohol; drugs; or any illegal substance to the program; a firearm; explosives; or anything else deemed inappropriate by the staff or volunteers;
    -Inappropriate interaction (physical or verbal) from the participant and/or their parent(s)/guardian(s) with staff, volunteers, or any other program participant's (parent(s), guardian(s), and/or students); and
    -Striking or hitting an employee, volunteer, or participants.

    If the program fills to capacity, I understand that I will be notified as soon as possible so that I can make other arrangements for my student. 

    I also agree to update the staff with any changes to the information I've provided in a timely manner. 

    Additionally, I understand that this is a free program, provided as a ministry outreach of Good Shepherd United Methodist Church. We will be asking families to contribute to the program with snacks, supplies, or a donation to help purchase these items so that we can keep this program sustainable and available for the foreseeable future. 
    If you have questions, concerns, or need more information, please contact Pastor Randy Keith at goodshepherd.youthprograms@gmail.com or 410-243-1129.