Freedom School Registration Form

Manasota ASALH Freedom School is excited to announce that our Fall-Spring enrollment for K-12 students is now open! Embark on a FREE dynamic educational journey with us as we explore the rich heritage, contributions, and culture of African Americans and the broader African Diaspora. Our Saturday classes at Girls Inc., 201 S. Tuttle Ave, Sarasota, FL 34237, are designed to provide an in-depth and truthful education in Black History, tailored for young learners. Classes begin October 18, and we offer rolling enrollment to accommodate your family's schedule.

PROGRAM DATES:

October 18

October 25

November 1

November 8

November 15

December 6

December 9* (Tuesday - Community Kwanzaa Celebration)

January 24

January 31

February 7

February 14

February 21

February 28 (Black History Month Celebration)

WHERE : Girls Inc., 201 S. Tuttle Ave, Sarasota, FL 34237.

WHO: Kindergarten through 12th grade students

** REGISTRATION IS OPEN YEAR ROUND. However, we encourage families to commit to consecutive Saturdays to take advantage of attendance incentives like gift cards and special field trip opportunities!

We look forward to welcoming your family to our Freedom School community, where together we will deepen our understanding of Black History through comprehensive and interactive learning experiences.

Please select the session or sessions you are registering for:*

Fall-Spring

How many children will you be registering?*

Please provide ALL children's names and information below*

Child 2 information

Child 3 Information

Parent’s name and contact information*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Area CodePhone Number

Emergency Contact Name *

First NameLast Name

Emergency Contact Phone Number *

Area CodePhone Number

Drop off and pick up (check as many as apply)*

I will drop off and pick up my child from the programMy child will be coming to the program on their own.I give my permission for someone else to pick up and/or drop off my child/children on my behalf. (Please provide their name in space provided below.)

I give this person permission to pick up and or drop off my child on my behalf:*

First NameLast Name

Phone Number of Authorized Pick-Up/Drop-Off Person*

Area CodePhone Number

Manasota ASALH Freedom School Consent and Waiver Form

Medical Care/Treatment Authorization
As the parent or legal guardian of the child(ren) listed in this form, I hereby authorize medical treatment and/or hospital admission in the event of an accident or emergency. I consent to the attending physician providing necessary care consistent with the circumstances and their medical judgment. Furthermore, I authorize Manasota ASALH Freedom School staff to initiate and approve basic, non-emergency medical care at a local physician's office, urgent care center, or hospital.

Family Doctor’s Name *

First NameLast Name

Family Doctor’s Phone*

Area CodePhone Number

Insurance Phone Number:

Policyholder Name:

First NameLast Name

Insurance Company

Policy Number:

POSITIVE BEHAVIOR REINFORCEMENT: To maintain the open learning environment of Manasota ASALH Freedom School, I understand and agree that standards of behavior for all students will be enforced during all activities. I authorize the staff to contact me, another legal guardian, or the emergency contact if my child becomes ill or needs to be relocated from class during program participation.*

Parent/Guardian Initials Here

Adult Sessions Participation: Do you plan to attend any of the Adult Sessions offered concurrently with the youth classes during the Fall-Spring Freedom School sessions?

YESNO

MANASOTA ASALH FREEDOM SCHOOL PHOTO RELEASE FORM*

YES, I DO grant permission to Manasota ASALH Inc. and Manasota ASALH Freedom School to use photographs and/or video of my child/children taken at Freedom School programs, classes, and events in publications, news releases, online, and in other communications related to the mission of the Freedom School.NO, I DO NOT grant permission to Manasota ASALH Inc. and Manasota ASALH Freedom School to use photographs and/or video of my child/children taken at Freedom School programs, classes, and events in publications, news releases, online, and in other communications related to the mission of the Freedom School.

Release, Waiver, and Indemnification Agreement

As the parent or legal guardian of the child(ren) listed in this form, I assume all liabilities and risks associated with their participation in the specified event or activity, including transportation to and from the activity. I acknowledge that this activity may involve physical contact or other risks, including the potential for accidents during transportation.

I confirm that my child(ren) is/are in good health and has/have no medical conditions that would prevent safe participation. If there are any limitations, I have informed the program staff in writing in advance. I waive, release, and agree to indemnify and hold harmless Manasota ASALH, the Manasota ASALH Freedom School, its governing board, employees, and agents from any claims or liabilities arising from my child(ren)’s participation in the activity, including injuries or losses caused by negligence.

This agreement acknowledges that Manasota ASALH and the Manasota ASALH Freedom School will not be responsible for any costs related to injury or transportation during the activity. I voluntarily assume all risks of injury, liability, or loss associated with my child(ren)’s participation.

By initialing below, I confirm that I have carefully read and understood this document. I freely waive certain legal rights for myself and my child(ren).

Important Note: You are encouraged to consult with an attorney if you have any questions about the legal implications of this document before initialing.*

Parent/Guardian Initials Here

Permission to Teach (please sign): I give permission for my child/children to participate in and receive instruction at the Manasota ASALH Freedom School at Girls Inc. and agree to all of the above*

You can use your finger to sign.

After you register, you’ll be receiving additional details about the program.