Next GIN Registration

NextGIN Registration Form
Member Information
First Name*
Last Name*
Middle Name*
Black/African AmericanWhiteLatino/HispanicOther
MaleFemale
Birth Date*

MonthDayYear
Address*
City*
State*
Zip*
School Attending & Grade Level *
Parent or Legal Guardian Information
Parent/Legal Guardian Name*
Relationship*
Cell Phone
Parent /Legal Guardian 2*
Relationship *
Cell Phone
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not avaliable)*
Phone Number
Relationship
Emergency Contact Name(if parent or guardian is not avaliable)*
Phone Number
Relationship
Income
Average Annual Income
Section 8PublicOther
Health Information
Any activity member should be restricted from?
Any physical, mental or other condition that would require special attention or medication?
List all medications, both prescribed and over the counter.
Doctors note will be needed if medication needs to be administered on site.
List any allergies (ex: bees,peanuts, dairy)
Any dietary needs that we should know about?
Transportation

Center to Home
Please provide the address for your teen to be dropped off
Photo Release

NextGIN and Taken By Vision has my full consent to use any publications including but not limited to photography and/or videography, statistics, and publicly to promote the organization through the likeliness or assumption of your child. I understand that the images or videos may be printed in brochures, on our website, social media, magazines, etc.. I also understand that both companies hold the right to pictures and videos and cannot be altered unless permission is given. I hereby waive my right to any royalty or any other compensation with regard to the usage of the photos referred to in this form.
YesNo
Elective Sign Up
Bible StudyCheer/DanceTheaterPower Play/BasketballSTEM
As the parent of my teen, I agree:

- to support my child on their endeavors of being a part of an elective.

- to motivate them

- tp exhibit responsible, respectful and thoughtful behavior to all members and other parents

-to read all program emails and respond, when necessary, in a timely manner

-to pay associated elective fees and understand that some electives may require additional supplies or uniforms not included in the fee

-to ensure that my teen maintains their GPA to participate in any elective

- to pick up my teen on time dependent upon dimissal time of elective
Signature*
Activity Waiver
I hereby agree and declare that I am the legal parent guardian of the above-named child and hereby consent to the child's participation in the activities that are described to me in registration process. I understand that activities of the kind described may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities.

If the above-named child requires any emergency medical treatment or procedures during the activities, I hereby consent to activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).

I, the parent/guardian, hereby agree and declare that I have carefully read and understand the scope of the after school and elective activities and I consent to the participation of the above-named child to these activities.

Any type of injury that may occur to the child without the fault of the Next GIN management and activity supervisors, the camp management directors cannot be held responsible for any harm that may occur to the child without the fault of the camp management and activity supervisors.
Signature
Payment Information
$100 Registration Fee (Due at time of registration)

General Weekly: $40

Elective Weekly: $20

Transportation Weekly: $20

Fall Elective Enrollment Fee: $100

All Fees can be sent via Cashapp $nextgintriad (our logo seen at the top of this form will be the logo on Cashapp)

Other Forms of payment include, check, money order or Zelle. Checks and Money Orders should be made out to Next GIN.
Payment Agreement
I would like to pay according to my selected payment option. I understand and agree failure to pay all charges by the agreed payment due date may leave my account subject to a hold and may result in a loss of privileges, being that my child will not be able to do the following:

-Attend field trips despite payment of field trip fee

-Be dropped off to attend afterschool

-Recieve mentoring services at anytime

-Participate in electives, despite payment of elective fee

I also understand and agree that any payment made to Next GIN will be credited first to any delinquent charges accrued and then applied to remaining balance.

Late Fees:

-$10 additional if the payment is recieved the following Monday after fees are due and $2 per day there after

Late Pick Up Fee will be as followed:

-$25 after 10 minutes of closing and $1 per minute if time exceeds 10 minutes

-Each family will recieve a 15 minute grace period per semester
Signature
Should be Empty:

NextGIN Registration Form

Member Information

Parent or Legal Guardian Information

Emergency Contact Info

Income

Health Information

Transportation

Photo Release

Elective Sign Up

Activity Waiver

Payment Information

Payment Agreement