Endeavor Center
For Youth and Community Development
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2019 Registration

Free Summer Program

8:30 am - 12:15 pm on Monday - Friday from June 22 - August 2, 2019

Regardless if they are only coming to eat or staying the entire morning, all participants must be registered. Complete this form once for each child (ages 18 and under).

THE SUMMER PROGRAM IS 100% FREE BUT DONATIONS ARE APPRECIATED.

Child's Name *
Child's Name
Birthdate *
Birthdate
Address *
Address
Phone *
Phone
Mother's Name
Mother's Name
Phone
Phone
Father's Name
Father's Name
Phone
Phone
Please Select All Weeks Your Child Will Be Participating *
EMERGENCY CONTACT (other than parent/guardian) *
EMERGENCY CONTACT (other than parent/guardian)
Phone *
Phone
By typing your name in this box, you are agreeing to the following statement: I do hereby fully and freely consent to the use of participant’s photography for promotional purposes on both printed material, websites, and social media. I do hereby release and hold harmless the Endeavor Center from any liability out of said participation, advertisement, and/or promotion.