AfterSchool Program 2025 Waiver and Release Form  Logo
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  • Participation Waiver And Release Form

    2025-2026 | UrbanPromise Los Angeles
  • AfterSchool Details

    AfterSchool programs run from 9/15/2025 to 5/15/2026. Monday - Thursday, from 2:30-5:30pm (we are closed every Friday). Tuesday hours are 1:30-5:30pm. Our address is 22103 Vanowen St, Canoga Park, CA 91303.
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  • 1. I give permission for my child to participate in the activities sponsored by UrbanPromise Los Angeles and its partners. I understand that information will be available in advance of UrbanPromise activities, and it is my responsibility to ensure my child and I communicate about all such activities. If my child attends an UrbanPromise activity, UrbanPromise has my permission to allow them to participate in that activity.

    2. I understand the risks involved in this program and that the staff will exercise all reasonable care for my child. I release UrbanPromise Los Angeles and UrbanPromise International, along with all cooperating organizations and their respective staff, employees, and representatives, from any and all claims that may arise from injuries that occur to my child.

    3. In the event of a medical emergency, I understand that an effort will be made to reach me. However, I do give permission for the UrbanPromise staff of this program to authorize emergency medical care for my child(ren).

    4. I will not hold UrbanPromise Los Angeles or other cooperating organizations, their staff, or representatives responsible for injuries that occur to my child(ren).

    5. I understand that part of the UrbanPromise program includes Christian education.

    6. I agree to support my child(ren) and the staff of this program by accepting and enforcing the discipline structure that is used. Disruptive behavior will be communicated to the parent/guardian, initially by verbal warning. This will be followed by a written warning and may result in temporary or permanent removal from the program by the Director.

    7. I give permission for photographs, video, and/or the name of my child(ren) to be used in UrbanPromise materials and on the UrbanPromise website.

    8. I give UrbanPromise Los Angeles permission to pick up my child from school on program days and provide transportation to its programs and other related activities. I understand that UrbanPromise is not responsible for my child(ren) until and unless they arrive at the program site.

    9. I authorize my child(ren)’s school to release my child(ren)’s grades and academic records to UrbanPromise staff.

    10. I acknowledge that I have been informed and understand that UrbanPromise Los Angeles is not a licensed childcare center with the State of California. I give my full consent and permission for my child(ren) to attend its programs.

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  • Please note: completing this form adds you to our waiting list. You will be notified by our site coordinator when a spot becomes available for your child.

     

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