25/26 CREATIVE GENIUS® Free AfterSchool Program Registration

CREATIVE GENIUS® Registration Form

AfterSchool Arts Education & Technology program formerly known as "Squad Goals." Classes begin 01/12/2026
Date

MonthDayYear
Date
Youth 12 years old before May 31, 2026 OR in the 6th Grade?
This is calculated & for admin purposes.
Youth's Legal Name

First NameLast Name
Nickname
Birthdate

MonthDayYear
Date
Current Age
Ages 12-18 (unless turning 12 before May 31st, 2026)
Gender (at Birth)
Race/Ethnicity
Last 4 of SSN
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How will the youth attend Creative Genius?
Outbound Location
School Name
Current Grade Level
Current Grade Level
Student ID (Numbers Only. Do not include the 'S'. Enter 9999999 if homeschooled)
Parent/Guardian Name
Parent/Guardian E-mail
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How did you hear about this program?
#Creative Genius® Formerly Squad Goals
This program is available every day Monday through Friday. Participants must commit to a minimum of two (2) days a week, but can select as many as five (5).

Class sizes are limited and attendance is important.
Primary Discipline/Area of Interest
Secondary Discipline/Area of Interest
I am interested in attending the following days (Must pick at least 2):
List medications the youth is prescribed including dosage and frequency. (Type 'NA' if question does not apply.)
Youth's dietary restrictions. (Type 'NA' if question does not apply.)
List any allergies the youth may have. (Type 'NA' if question does not apply.)
Does the youth have a history of running away?
How does the youth get along with peers? Are there any social concerns?
Does your child have a history of any mental health needs?
Please provide details.
Consent & Release of Liability Waiver

I am signing this Parental Consent Form and Release of Liability Waiver for the purpose of authorizing the above named student’s participation in the enrichment activities, and provision of meals by staff and volunteers associated with the above program. I acknowledge that this is a voluntary activity for which I freely give permission for my child’s participation.

I further give my consent for my child to be photographed or videotaped during the activities involved in this learning experience and grant permission to The Performance Academy to use said photos or videos for promotional and/or educational purposes. Said consent is given without any expectation of compensation or reward for any photos taken and/or used in educational and promotional literature.

By signing below, I attest to the truthfulness of all information listed on this application and agree to all the above terms and conditions.
Parent/Guardian's Legal Name

FirstLast
Your Relationship to Youth Applicant
Emergency Contact Name
This is the person who should be responsible for taking any incident reports regarding youth or to pick up youth if absolutely necessary.
Emergency Contact Number
Format: (000) 000-0000.
Do you wish to receive emails regarding programs, events, and offers from The Performance Academy?
The Performance Academy, Inc.

3674 Beach Blvd, Jacksonville, Florida. 32207
Should be Empty:

CREATIVE GENIUS® Registration Form

The Performance Academy, Inc.