After School Program Enrollment Form

Next Wave Mentoring Program Empowered by Xzone

Beginning January 2026
The Next Wave Mentoring Program at XZone exists to empower the next generation of young leaders by equipping middle and high school students with essential life skills, character development, and Christ-centered mentorship. The Next Wave After-School Mentoring Program creates a structured, Christ-centered environment where students engage in small-group mentoring, peer relationships, and hands-on activities that develop practical life skills, strong character, and spiritual growth. Through consistent guidance from trained mentors and a rotating track of real-world topics, students are equipped to make wise choices, lead with integrity, and grow into the leaders God created them to be.

Please complete and submit one form per student being enrolled in the Next Wave After School Mentoring Program.
Parent/Guardian Name*

First NameLast Name
Parent/GuardianPhone Number*

Area CodePhone Number
Parent/Guardian Email*
Student Name*

First NameLast Name
Student Birthday

MonthDayYear
Date
Grade in fall (2025-2026)*

Grade 6Grade 7Grade 8Grade 9Grade 10
Please note any known allergies: (Please include food, medication , environmental)
Do you have any physical/mental/emotional/medical conditions that would prevent you from participating in specific activities? (Please specify the condition and which activities.)
Please note any specific medications (EX. EpiPen)
Please specify each person, including the name of parents, who has permission to pick up your child from Next Wave After School Mentoring 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
Statement of Registration Fees

A one-time fee of $75.00, per student, to be paid once registration is complete. Payment link will be sent upon receipt of form.
Statement of Fees

The total cost of $1750.00 per semester, will be billed and payable through Shopify. This link will be sent once registration fee is paid. Registration for the program is for the entire semester or year and payments will reflect that registration choice.
Statement of Policy
- Program to begin January 2026
- Only persons authorized by the parent or guardian may pick up your child from the After School program. Please notify the Director in writing if anyone other than a parent/guardian will pick up your child.
- All students attending the Next Wave After School Mentoring Program are required to follow all program rules. Behavioral problems will result in parent notification and possible suspension from the program.
- Students with a fever or contagious illness may not participate in the program.
- This program is available for all students currently enrolled in a school, Home school program, grades 6th - 10th.
- Fall semester for the Next Wave Mentoring Program runs from August - December.
- Spring semester for the Next Wave Mentoring Program runs from January – May.
- A Registration Form is required for all students participating in this program.
- Contracts are for the entire semester and will be billed accordingly. Contracts are payable and billed through Shopify. Payment options are availible through Shopify.
- The program ends each day promptly at 5:30 p.m. After 5:30 p.m., a late charge will be assessed at the rate of $10.00 for each 10 minute interval or fraction thereof.
I have read and understand the Statement of Fees and Statement of Policy contained here.*

Agree
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Next Wave Mentoring Program Empowered by Xzone

Statement of Registration Fees

Statement of Fees

Statement of Policy