Pathways Registration

Registrations are open for the Pathways "Bridge" program, meeting the 1st and 3rd weeks of each month from April-August at our 3 campuses from 5:45pm-9:00pm:

1st/3rd Mondays @ Marietta Campus
1st/3rd Tuesdays @ Austell Campus
1st/3rd Thursdays @ Atlanta Campuses

Please complete the form below to register for Bridges, and a member of our team will reach out with details!

The Pathways to Success Program is a yearlong curriculum-based youth leadership program where trained facilitators cover topics such as character education, integrity and self-control, emotional and mental health, discovering assets, strengths assessment, and job readiness training. Students also receive public speaking training, qualifying them for certification through Toastmasters International.

The goal is to provide each youth with assets, tools, and opportunities needed to change their trajectory.

Within the program, students also participate in enriching "Life Trips" including community service projects, visits to workplaces and colleges, and making connections with potential employers. Upon completion of the first 10-week Program, each student is matched with a Mentor to help them connect to resources, collaborate to set goals, continue accountability and celebrate every win.

Pathways "Bridge" Programs are also offered from April-August to provide continued opportunities for students to grow in between the Spring and Fall 10-week semester programs.

Registration fee for the Pathways to Success Program is $75 per student per calendar year. This fee includes the student's involvement in our programming opportunities for one year. The student will receive a scholarship for the rest of the program cost thanks to generous grants, donors, and sponsors. This fee is non-refundable, and is due upon the first week of the 10-week program. Payment details will be sent upon completion of this registration.

Should this fee be prohibitive in any way for the student to join the program, please complete this form to discuss options.

__________________________________________________________

"Caminos hacia el éxito” es un programa de liderazgo juvenil que guiará a los estudiantes a través de un probado plan de estudios, cubriendo la educación del carácter, valoración de los puntos fuertes del estudiante y formación de preparación para el trabajo. Los estudiantes del programa reciben formación para hablar en público y oportunidades de practicar y mejorar su manera de presentarse, lo cual les permite sacar el título de Toastmasters International.

La cuota de inscripción del programa “Caminos hacia el éxito” es $75 por estudiante. La cuota cubrirá la participación del estudiante en todos nuestros programas durante un año. El estudiante recibirá una beca para el resto del costo, gracias a la generosidad de varios patrocinadores, donantes y subsidios. La cuota es no reembolsable y se tiene que pagar para la primera semana del programa de diez semanas. Al completar este formulario de inscripción, Ud. recibirá por correo más detalles sobre el pago de esta cuota.

Si la cuota es algo que previene que su hijo(a) participe en el programa, por favor no dude en ponerse en contacto con la directora del programa, la Sra. Janet Porter, para hablar más sobre otras opciones.

Please select your language to continue / Por favor seleccione su idioma:*

EnglishEspañol

Parent/Guardian Name:*

Email*

example@example.com

Student/Minor Name:*

Parent/Guardian's Mobile Phone Number:*

Please enter a valid phone number.

I consent to receive periodic text messages from a 3rd party texting service at the above mobile number containing important updates and information from Four Corners Group about events, programming, opportunities, and more. If at any time I wish to unsubscribe, I can notify Four Corners Group.*

I agreeI do not agree

Parent/Guardian's Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian presence and involvement in home:*

Check ALL issues/concerns for youth:*

Alcohol/SmokingDrug Use (prescription/illegal)High Risk BehaviorAlternative SchoolYouth Detention Center/ RYDCCourt InvolvedMental/Behavioral Challenges (Please describe below - ADHD, Autism Spectrum, Anxiety, etc)Other (Please describe below)

If "Other" please describe:

Briefly describe your current family and living situation.*

Student's current school:*

Student's current grade level (select below):

Student's birthday:*

MonthDayYear

Student's Gender:*

Student's phone number (if applicable):

Please enter a valid phone number.

Please list any hobbies, sports or positive activities the youth is active or interested in.*

Which campus does your student plan to attend?*

Marietta Campus: Walton Ridenour "Commons" Building, 1425 Ridenour Blvd, Kennesaw, GAAustell Campus: 6130 Hotel St, Austell, GAAtlanta Campus @ City of Refuge City School Atlanta Center : 748 Gary Rd NW, Atlanta, GA

How were you referred to or hear about Pathways to Success?*

Are you a part of a Walton Community?*

YesNo

If Yes, which community?

Walton RidenourWalton VillageWalton ReserveOther

As a parent or guardian, I understand that activities sponsored by Four Corners Group (FCG) are not in any way affiliated with Cobb County School System, Communities in Schools, City of Refuge, Atlanta Public Schools, MUST Ministries, Passion For Life, Open Door Talk, Storehouse Ministries, Safe House or any of the community partners FCG services. I hereby give my full consent and approval for the above mentioned youth registrant to participate in all Four Corners Group “Pathways” activities, and be transported in commercial transportation designated by the members of the FCG/Pathways team to attend activities related to or sponsored by Four Corners Group. I hereby waive, release and hold harmless Four Corners Group, FCG Pathways team members, sponsors, representatives and affiliates for any injury or illness that may be suffered by my child in the normal course of participation in scheduled activities, whether the result of negligence or any other cause. In addition, I authorize transportation coordinators to act for me according to their best judgment in any emergency requiring medical attention. I understand that should an emergency arise, I and/or the person listed below will be contacted immediately.*

I give permission for my youth to be videotaped and/or photographed while participating in any FCG Pathways program with the intention of the videotape or photograph appearing in FCG Pathways promotional materials, advertisements, social media and/or newsletter. The videotape or photograph will be used for no other purpose than those stated above. I also agree to periodically provide insights to Four Corners Group about how my youth is doing through surveys, phone calls, etc.*

YesNo

Emergency Contact Name:*

Emergency Contact Phone Number:*

Please enter a valid phone number.

Additional comments and concerns that were not covered in the above questionnaire.*

Dirección de correo electrónico (email)/Su email*

Nombre del joven*

Nombre de los padres / tutor legal*

Número de teléfono de los padres / tutor legal*

Please enter a valid phone number.

Consiento en recibir mensajes de texto periódicos al número de arriba de un servicio de terceras partes en cuanto a novedades e información sobre los eventos, los programas y las oportunidades de la organización Four Corners Group. Si en algún momento deseo darme de baja, puedo notificarle a la organización Four Corners Group.*

Estoy de acuerdoNo estoy de acuerdo

Dirección*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Padres que están involucrados en la vida del joven:*

12Los dos están involucrados, pero viven en casas diferentesNiño en adopción temporal

Seleccione la conducta problemática: que está exhibiendo el/la estudiante:*

El/la estudiante está tomando alcohol o fumandoUso de drogas o de medicamento con recetaComportamiento de alto riesgoEl/la estudiante está inscrito en un colegio para adolescentes que requieren una atención diferenciadaEl/la estudiante está en un centro de detención juvenilEl/la estudiante ha tenido que ir ante un tribunal por su comportamiento

Por favor, explique brevemente su actual situación familiar.*

Escuela actual del estudiante*

Grado actual del estudiante (7th, 8th, etc*

Fecha de nacimiento del estudiante*

MonthDayYear

Número de teléfono del estudiante

Please enter a valid phone number.

Por favor, haga una lista de pasatiempos, deportes u otras actividades positivas que le interesan al joven.*

¿A qué centro piensa asistir su estudiante?*

Marietta Campus: Walton Ridenour "Commons" Building, 1425 Ridenour Blvd, Kennesaw, GAAustell Campus: Sweetwater Mission, 6130 Hotel St, Austell, GAAtlanta Campus: 748 Gary Rd NW, Atlanta, GA

¿Cómo te refirieron a esta programa?*

Como padre/tutor legal, entiendo que las actividades patrocinadas por la organización Four Corners Group (FCG) no son en absoluto afiliadas ni con el sistema escolar del condado de Cobb ni con las organizaciones Communities in Schools, MUST Ministries, Storehouse Ministries, Safe House ni ningún socio de la comunidad con lo cual trabaja en conjunto la organización FCG.Por medio del presente yo doy mi permiso completo y autorizo a mi hijo(a) a participar en todas las actividades del programa “Caminos hacia el éxito” de la organización Four Corners Group y a ser transportado a actividades relacionadas con o patrocinadas por FCG en vehículos comerciales indicados por los miembros de FCG. Por medio del presente, renuncio a toda la responsabilidad legal de la organización FCG, de sus miembros, de sus patrocinadores, de sus representantes y de sus afiliados de cualquier herida o enfermedad que sufra mi hijo(a) al participar en el curso normal de las actividades programadas, sean consecuencias de la negligencia o de cualquier otra causa. Además, si surge una emergencia en la cual se requiere atención médica inmediata, autorizo a los coordinadores de transporte a actuar de mi parte según su propio juicio. En este caso, entiendo que nos informarán enseguida a mí y a la persona enumerada a continuación.

Doy permiso para que mi hijo sea grabado en video y/o fotografiado mientras participa en cualquier programa de FCG Pathways con la intención de que la cinta de video o la fotografía aparezcan en materiales promocionales, anuncios, redes sociales y/o boletines informativos de FCG Pathways. La cinta de vídeo o la fotografía no se utilizarán para ningún otro fin que los indicados anteriormente.*

SíNo

Nombre de contacto de emergencia:*

Telefono de contacto de emergencia:*

Please enter a valid phone number.

Comentarios/preocupaciones adicionales que no se mencionan en el cuestionario de arriba:*

Registration fee for the Pathways to Success Program is $75 per student. This fee includes the student's involvement in our programming opportunities for one year. The student will receive a scholarship for the rest of the program cost thanks to generous grants, donors, and sponsors. This fee is non-refundable, and is due upon the first week of the 10-week program. If finances are a barrier, please still complete this registration and our team will follow up with you.

Payment options will be shared after registration is complete.

Thank you, and we look forward to working with you and your student(s)!

Pathways to Success Program - Registration

Parent/Guardian Registration Form.

Permission And Signature

Cuestionario de arriba (Español)

Registration Fee Information