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Turning hope into action through structured support programs.
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Contact US
Donation Needed (Materials)
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Contact US
Student Information
After School Drop Off Authorization
Field Trip Release
Student Information
Student Name:
DOB
Please Select
Male
Female
Parent Guardian Contact:
Primary Contact
Name of Parent
Relationship
Telephone #
Secondary Contact
Name of Parent
Relationship
Telephone #
Medical Information
Allergies:
Insects:
Use of Epi Pen
Yes
No
Other Allergies:
Asthma
Yes
No
Inhaler
Yes
No
Uses it independently ?
Yes
No
Other Health Issues:
I give my child permission to walk home from Kidz with Hope Youth Organization Incorporated’s activities.
I give permission for Kidz with Hope Youth Organization Inc., to see my child’s report card in an effort to encourage him/her for their academic achievement.
Photograph/Video Release
I authorize Kidz with Hope Youth Organization Incorporated, or its designee, to edit, modify, copy, and use any photographs or videos of my child for promotional purposes.
I authorize the lawful use of photographs or videos of my child in media including, but not limited to, websites, magazines, journals, books, articles, and social media.
I agree that, once lawfully used, photographs or videos of my child will become the sole property of Kidz with Hope Youth Organization Incorporated, and I will have no ownership rights to them.
Signature
Date
Send
After School Drop Off Authorization
Student
DOB:
Address:
Telephone:
I authorize my child to be dropped off at the following location:
Kidz with Hope Youth Organization, Inc After School Program
716 Gilbert Street, Durham, NC
Please drop my child there on the following school days: (please check)
Tuesday
Wednesday
Thursday
This will begin on the following date:
Signature
Parent/Guardian Telephone:
Send
Field Trip Release
I give approval for my child
To participate in the field trip sponsored by Kidz with Hope Youth Organization Incorporated.
Field Trip Location:
Date of Trip:
Leave Time
Estimated Return:
I understand that my child will be supervised with appropriate safety measures. In an emergency, I authorize Kidz with Hope Youth Organization, Incorporated, to take my child to the nearest emergency room or hospital and allow hospital staff to provide any treatment a physician considers necessary for my child’s well-being.
Please check one of the following:
I will pick up my child when my child returns.
I will give my child permission to walk home when the trip ends.
Parent Signature
Date
Parent Telephone Number:
Best way of communicating: (check appropriate)
Text
Call
Send
Get Involved
If you are interested in enrolling your child, please complete the following documents
Student Information
After School Drop Off Authorization
Field Trip Release
Student Name:
DOB
Please Select
Male
Female
Parent Guardian Contact:
Primary Contact
Name of Parent
Relationship
Telephone #
Secondary Contact
Name of Parent
Relationship
Telephone #
Medical Information
Allergies:
Insects:
Use of Epi Pen
Yes
No
Other Allergies:
Asthma
Yes
No
Inhaler
Yes
No
Uses it independently ?
Yes
No
Other Health Issues:
I give my child permission to walk home from Kidz with Hope Youth Organization Incorporated’s activities.
I give permission for Kidz with Hope Youth Organization Inc., to see my child’s report card in an effort to encourage him/her for their academic achievement.
Photograph/Video Release
I authorize Kidz with Hope Youth Organization Incorporated, or its designee, to edit, modify, copy, and use any photographs or videos of my child for promotional purposes.
I authorize the lawful use of photographs or videos of my child in media including, but not limited to, websites, magazines, journals, books, articles, and social media.
I agree that, once lawfully used, photographs or videos of my child will become the sole property of Kidz with Hope Youth Organization Incorporated, and I will have no ownership rights to them.
Signature
Date
Send
Student
DOB:
Address:
Telephone:
I authorize my child to be dropped off at the following location:
Kidz with Hope Youth Organization, Inc After School Program
716 Gilbert Street, Durham, NC
Please drop my child there on the following school days: (please check)
Tuesday
Wednesday
Thursday
This will begin on the following date:
Signature
Parent/Guardian Telephone:
Send
I give approval for my child
To participate in the field trip sponsored by Kidz with Hope Youth Organization Incorporated.
Field Trip Location:
Date of Trip:
Leave Time
Estimated Return:
I understand that my child will be supervised with appropriate safety measures. In an emergency, I authorize Kidz with Hope Youth Organization, Incorporated, to take my child to the nearest emergency room or hospital and allow hospital staff to provide any treatment a physician considers necessary for my child’s well-being.
Please check one of the following:
I will pick up my child when my child returns.
I will give my child permission to walk home when the trip ends.
Parent Signature
Date
Parent Telephone Number:
Best way of communicating: (check appropriate)
Text
Call
Send
1. Student Information
Student Name:
DOB
Please Select
Male
Female
Parent Guardian Contact:
Primary Contact
Name of Parent
Relationship
Telephone #
Secondary Contact
Name of Parent
Relationship
Telephone #
Medical Information
Allergies:
Insects:
Use of Epi Pen
Yes
No
Other Allergies:
Asthma
Yes
No
Inhaler
Yes
No
Uses it independently ?
Yes
No
Other Health Issues:
I give my child permission to walk home from Kidz with Hope Youth Organization Incorporated’s activities.
I give permission for Kidz with Hope Youth Organization Inc., to see my child’s report card in an effort to encourage him/her for their academic achievement.
Photograph/Video Release
I authorize Kidz with Hope Youth Organization Incorporated, or its designee, to edit, modify, copy, and use any photographs or videos of my child for promotional purposes.
I authorize the lawful use of photographs or videos of my child in media including, but not limited to, websites, magazines, journals, books, articles, and social media.
I agree that, once lawfully used, photographs or videos of my child will become the sole property of Kidz with Hope Youth Organization Incorporated, and I will have no ownership rights to them.
Signature
Date
Send
2. After School Drop Off Authorization
Student
DOB:
Address:
Telephone:
I authorize my child to be dropped off at the following location:
Kidz with Hope Youth Organization, Inc After School Program
716 Gilbert Street, Durham, NC
Please drop my child there on the following school days: (please check)
Tuesday
Wednesday
Thursday
This will begin on the following date:
Signature
Parent/Guardian Telephone:
Send
3. Field Trip Release
I give approval for my child
To participate in the field trip sponsored by Kidz with Hope Youth Organization Incorporated.
Field Trip Location:
Date of Trip:
Leave Time
Estimated Return:
I understand that my child will be supervised with appropriate safety measures. In an emergency, I authorize Kidz with Hope Youth Organization, Incorporated, to take my child to the nearest emergency room or hospital and allow hospital staff to provide any treatment a physician considers necessary for my child’s well-being.
Please check one of the following:
I will pick up my child when my child returns.
I will give my child permission to walk home when the trip ends.
Parent Signature
Date
Parent Telephone Number:
Best way of communicating: (check appropriate)
Text
Call
Send
