HUB Kids 4 - 8 Registration Form

Please do not hesitate to call, text, or email if you have any questions. Call or text 419-731-3249 or email hubkids@wyandotconnections.org or info@wyandotconnections.org.

Please complete a form for each child you are registering.

Child Name

First NameLast Name

Child's Nickname

Date of Birth

Date

Child's Gender

Which school does your child attend?

Child's Grade

Child's T-Shirt Size

Do you have children that will be attending both sites (HUB Kids 1 - 3 at John Stewart and HUB Kids 4 - 8 at The HUB)?

Child's Phone (optional)

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Legal Guardian Name

First NameLast Name

Relationship to Child

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Prefer?

Email

example@example.com

Emergency Contact Name (different person than above)

First NameLast Name

Relationship to Child

Emergency Contact Phone

Please enter a valid phone number.Format: (000) 000-0000.

Who is NOT permitted to pick up your child from The HUB? Please list name and any details we need to be made aware of.

Medical Conditions, Allergies, Dietary Restrictions, Disabilities, or Other Information we should know.

Sign-in and Sign-out

Your child will be required to sign in when entering HUB Kids and sign out when leaving. (Children attending HUB Kids K - 3 at Union will need to be signed out by an adult or older sibling in Union School.) Once your child leaves HUB Kids he/she will not be able to return that same day. Wyandot Community Connections/The HUB is not responsible if your child leaves the facility before the time agreed upon between you and your child. If there is an issue we will help in any way we can.

Illness

Please do not send your child to HUB Kids if he/she is ill. If your child does not attend school due to illness they may not come to HUB Kids. They are welcome back when symptom free for 24 hours. If your child becomes ill while attending HUB Kids you will receive a call to pick up your child.

I (parent/legal guardian) reviewed the Parent/Youth Handbook (download the handbook at wyandotconnections.org) with my child (named above). By signing below, we (parent and child) understand and agree to abide by the rules and regulations of The HUB/Wyandot Community Connections (“WCC”).

I (parent/legal guardian) give permission and consent to Wyandot Community Connections/The HUB/HUB Kids and third parties collaborating with The HUB/HUB Kids/WCC to make, reproduce, edit, broadcast, or rebroadcast any photo, video, soundtrack recording of my child (named above) while participating in The HUB/HUB Kids/WCC activities and/or programs, and including any written or spoken narrative account of experiences at The HUB/Union School for publication, display, or exhibition in promotions, advertising, and legitimate business uses by and for The HUB/HUB Kids/WCC. I further understand there will be no compensation to, and/or claim, by me or my child for such items.

I (parent/legal guardian) agree and affirm as follows: in consideration for my child, as named here, participating in The HUB/HUB Kids/WCC programs and activities, I agree to assume the risk of such activities and further hold harmless The HUB/HUB Kids/WCC, employees, and volunteers from any and all claims, suits, losses, or related causes of action for damages, including but not limited to, such claims that may result from m/our injury or death, accidental or otherwise, during or arising in any way from my/our The HUB/HUB Kids/WCC involvement. I further represent and affirm that I have the legal capacity to bind any minor and or the heirs and or estate of same for whom this consent is given.

In the event that I cannot be reached in an emergency, I hereby give permission to medical personnel to order x-rays, routine tests, and treatment for my child if he or she becomes ill. I hereby give permission to the physician to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child as named here. I hereby give permission for my child to participate in screenings and testings, which may identify additional services which may benefit my child. I further agree to be financially responsible for all such medical services.

I hereby give permission to The HUB/HUB Kids/Wyandot Community Connections and area community schools to exchange information regarding the minor child listed on this application. The purpose of the exchange is to help both organizations better prepare the student to be successful in life.

I acknowledge that The HUB/HUB Kids/Wyandot Community Connections is a faith-based organization, founded on the teachings of Jesus. Our After School program is open to all eligible youth, regardless of religious affiliation or belief.

The information I have provided is current and correct to the best of my knowledge. I will let WCC know of any change in the information I have provided.

Child Signature

Parent/Legal Guardian Signature