After School Program Enrollment Form

🌟 Inspiring Minds After-School Program
A transformative experience powered by The Allen Blash Foundation

We’re excited to announce the return of Inspiring Minds to Spartanburg Preparatory School (SPA) this year! The program will start Mon. Sep. 8th.

Inspiring Minds is an after-school program designed to uplift, empower, and inspire students to become the best version of themselves—academically, emotionally, and socially. Through mentorship, academic support, life skills development, and creative enrichment, SPA students in this program will receive the tools and guidance needed to thrive inside and outside the classroom.

Whether your child needs help with homework, wants to build confidence, or is looking to discover their purpose and passions, Inspiring Minds creates a safe, structured, and engaging environment where all students are seen, heard, and supported.

This application is your first step in joining a community of learners, leaders, and future world-changers at SPA.

👉 Please complete and submit one form per student being enrolled in the After-School Program.

Parent's Name*

First NameLast Name

Parent's Phone Number*

Area CodePhone Number

Parent's Email*

Student's Name*

First NameLast Name

Grade grade level (2025)*

Grade 6Grade 7Grade 8

Effective date for enrollment in After School Program*

Please indicate the month and day that this agreement is to take effect. For example, if you will be using the After School Program from the first day, enter 09-08-2025.

Will you have any challenges with consistent daily pickup from the program? Our program is designed as a progressive journey—each session builds upon the last. Because of this, we strongly encourage 100% participation and consistent attendance. Important lessons, experiences, and opportunities are introduced throughout the curriculum, and missing days may impact your child’s ability to fully benefit from the program and participate in graduation at the end.*

No, we CAN NOT commit to daily pickup and full participation.Yes, we will provide transportation support in order for them to participate consistently.

Indicate the day(s) that you anticipate utilizing the After School Program:*

MondayFriday

Please note any known allergies:

Please specify each person, including the name of parents, who has permission to pick up your child from the After School Program.

Authorized Person 1:*

First NameLast Name

Phone Number 1:*

Area CodePhone Number

Authorized Person 2:

First NameLast Name

Phone Number 2:

Area CodePhone Number

Authorized Person 3:

First NameLast Name

Phone Number 3:

Area CodePhone Number

Authorized Person 4:

First NameLast Name

Phone Number 4:

Area CodePhone Number

1. Participation:
I grant permission for myself/my child to participate in all Inspiring Minds program activities, including but not limited to educational workshops, tutoring sessions, mentoring meetings, enrichment games, recreational activities, field trips, and any other events organized by The Allen Blash Foundation through the Inspiring Minds Program.

2. Medical Treatment:
In the event of an emergency, I authorize the program staff and designated personnel to seek and obtain appropriate medical treatment for myself/my child if I cannot be reached. I understand that I will be financially responsible for any resulting medical expenses. Every effort will be made to contact me prior to treatment, if possible.

3. Media Release:
I consent to the use of photographs, video recordings, and audio recordings of myself/my child taken during program activities for promotional, marketing, educational, and reporting purposes by The Allen Blash Foundation. I understand these materials may appear in social media, newsletters, the ABF website, and other official print or digital platforms. No compensation will be provided for the use of these images or recordings.

4. Liability Waiver:
I release The Allen Blash Foundation, its staff, volunteers, board members, partners, and affiliates from any liability for injuries, accidents, loss, or other incidents that may occur during my/my child’s participation in the Inspiring Minds program. I understand that all reasonable precautions and safety measures will be taken by the program to ensure a safe and positive experience.

5. Data Collection and Privacy:
I understand that The Allen Blash Foundation may collect personal and program-related data, including but not limited to contact information, attendance, academic performance (e.g., report card data), and participation records. This information will be used for administrative purposes, continuous improvement, and reporting to partners and funders. I consent to the collection and secure storage of this information, with the understanding that it will remain confidential and not be shared with third parties without consent.

6. Behavioral Expectations
I acknowledge that myself/my child is expected to follow the rules, behavioral guidelines, and safety protocols established by the Inspiring Minds program. This includes showing respect for peers, staff, and the environment. Failure to comply with these expectations may result in disciplinary action, including potential dismissal from the program.

7. Contact & Communication
I agree to maintain updated contact information and communicate with staff regarding my/my child’s attendance, availability, or concerns. I also agree to review and respond to program updates as needed.

8. Student Pick-Up Authorization
I understand that only the individuals I have listed on the official pick-up authorization form will be permitted to pick up my child from the Inspiring Minds program. I agree to update the program staff immediately in writing if there are any changes to this list. I acknowledge that program staff will not release my child to anyone not listed, and I accept responsibility for ensuring authorized pick-up arrangements are in place each day.

I have read and understand the Statement of Fees and Statement of Policy contained here.*

Agree

Signature