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Name and Phone Number of Two Emergency Contacts
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Person Responsible for Pickup (Name and Relationship)
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I/We the parents of the above named child (ren) hereby give my/our approval to his/her participation in any and all of the activities of Future Ties, NFP after school program. I/We assume all risks and hazards incidental to the conduct of the activities. I/We hereby waive all claims against the organizers, sponsors, directors or any of the supervisors in case of injury to my child (ren). I hereby authorize Future Ties, NFP to transport my child on Future Ties, NFP Van/ buses to and from school and program activities where applicable. I hereby authorize my child to participate in field trips and activities that occur outside of Future Ties, NFP. I give permission for my child’s photo and artwork to be used in all forms of Future Ties, NFP publicity, brochures and web site.
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Medical History
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Please indicate any physical or medical concerns that Future Ties staff needs to be aware of, including allergies, medications, surgeries, or serious injuries.
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Join us for Juneteenth!
June 17, 2025
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