JMCC - After School Attendee Registration Form

JMCC Spring 2025 After School Tutoring and classes.

a Program of ASA Now
We feel privileged to serve children in grades K-12th after school at Jacob's Mission Community Center. Our community center is located in East Mesa at 7830 E. University Drive, between Sossaman and the 202 Red Mountain Freeway. For the Spring Semester, we are offering after school Tutoring/Homework assistance. Besides tutoring, each child in attendance may choose to attend one (1) extra-curricular activity class, offered once a week. Please note that tutoring is 45 minutes long.

Tutoring and Extracurricular Activities start January 28th, 2025 and ends April 25th, 2025

No classes the week of March 10th, 2025

Note: Volunteers working with children and youth, are required to pass a background check and attend an orientation and trauma training prior to volunteering with your child.
Caregiver, Parent, or Guardian *

First NameLast Name
Email*
example@example.com
Primary Phone Number for Contact *

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload Caregiver, Parent or Guardian State-Issued Driver's License/ID Card:*

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Emergency Contact
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Emergency Contact Relation*
Ex: Spouse, Parent, Grandparent, etc.

Liability Release Form
Name of Guardian and/or "Minor's" Authorized Representative *

First NameLast Name
PARTICIPANT AGREEMENT, RELEASE, WAIVER, AND ASSUMPTION OF RISK - Click HERE to view waiver.
I have reviewed, understand, and agree to comply with the above terms*

I agree
ASSUMPTION OF RISK AND WAIVER OF LIABILITY RELATING TO CORONAVIRUS/COVID-19 - Click HERE to view waiver.
I have reviewed, understand, and agree to comply with the above terms*

I agree
GRANT OF RIGHT TO USE LIKENESS - Click HERE to view waiver.
I have reviewed, understand, and agree to comply with the above terms*

I agree
I acknowledge that I have read the above waiver and release, understand that I have given up substantial rights by signing it, and sign it voluntarily.*

I agree
Signature*

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Dated

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Date
I have read this entire Release Form and fully understand its contents. I am signing it voluntarily, without any duress or undue influence.*

I agree
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JMCC Spring 2025 After School Tutoring and classes.