The Allen Blash Foundation
A²E Initiative
ABF Academic & Athletic Excellence Initiative
The ABF Academic & Athletic Excellence Initiative (A²E Initiative) is a comprehensive year-round program designed to support the personal, academic, and athletic development of at-risk youth. This initiative provides structured mentoring, accountability, and skill-building opportunities, preparing students for success both in school and in life. If you have any questions or require assistance, feel free to contact us at 864-305-8601. We look forward to welcoming your child to the ABF A²E Initiative!
Parents Name
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First Name
Last Name
Contact Number
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E-mail
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example@example.com
Full Name of Child:
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First Name
Last Name
Relationship to Child
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Child's Date of Birth
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-
Month
-
Day
Year
Date
Gender
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Please Select
Male
Female
Grade Level
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(After Summer)
Student T-Shirt Size
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Please Select
Youth Small
Youth Med.
Youth Large
Youth XL
Adult Small
Adult Medium
Adult Large
What School will the student be attending Next School Year?
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Is the student eligible for free or reduced lunch at school?
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Please Select
Yes
No
Medical Information
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Any Allergies or Medical Conditions (please specify): If none write N/A
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
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First Name
Last Name
Relationship to Child
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Phone Number
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Please enter a valid phone number.
Consent and Release Form for A²E Program ParticipationBy signing below, I acknowledge that I am voluntarily enrolling myself/my child in the A²E program. I understand that this program is designed to provide academic support, mentorship, and extracurricular activities. I hereby consent to the following terms: Participation: I grant permission for myself/my child to participate in all A²E program activities, including, but not limited to, educational workshops, mentoring sessions, sports, and other recreational activities organized by the program. Medical Treatment: In the event of an emergency, I authorize the program staff to obtain medical treatment for myself/my child if I am unable to be reached. I understand that I will be responsible for any medical expenses incurred. Media Release: I consent to the use of photographs, video recordings, and audio recordings of myself/my child taken during program activities for promotional and educational purposes by A²E. I understand that these materials may be used in social media, newsletters, websites, and other promotional materials.Liability Waiver: I release A²E, its staff, volunteers, and affiliates from any liability for injuries, accidents, or any other incidents that may occur during participation in the program. I understand that every effort will be made to ensure a safe and positive experience for all participants. Data Collection: I understand that A²E may collect personal data, such as contact information and participation records, for program administration and reporting purposes. I consent to the collection and use of this information as outlined, with the understanding that it will be kept confidential and not shared with third parties without my permission. Behavioral Expectations: I acknowledge that myself/my child is expected to follow the rules and guidelines set forth by the A²E program to ensure a safe and productive environment. Failure to adhere to these expectations may result in dismissal from the program.
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Type Full Name:
Signature
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Submit
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