Linwood YMCA: Aspire 2025-2026 (Every Monday, Tuesday, and Thursday)
Welcome to the Aspire Afterschool Program! This form is to be completed only by a parent or legal guardian. Please provide accurate information about your child and review all consent and permission statements carefully. By completing this form, you are registering your child for the Aspire program at the Linwood YMCA and providing your acknowledgment and digital signature for program participation, emergency contacts, medical information, and release of liability. Once submitted, you will receive a confirmation email, and your child’s registration will be processed. Please ensure all required fields are completed before submitting.
Youth Information
Youth's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Middle School:
*
Youth Cell:
Please enter a valid phone number.
Format: (000) 000-0000.
Birthdate
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Other
Race/Ethnic Background (select all that apply)
*
Black/African American
White
Hispanic/Latino
American Indian/Alaskan Native/
Somali
African (non-somali)
Asian/Pacific Islander
Hmong
Other
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Continue
Continue
Parent/Guardian Information
Parent Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Email
*
example@example.com
Gender
*
Male
Female
Other
Non-Parent Emergency Contacts & Medical Information
Emergency Contact Name
*
First Name
Last Name
Relationship
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Is the participant taking any medications?
*
Yes
No
If yes, what kind and why?
Does the student have any of the following?
Special needs
Allergies
Dietary Restrictions
Other
If so, please explain:
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Permission For Youth And Release Of Claim For Damages
Please review the following statements and check each box to indicate your consent and acknowledgment:
*
I give permission for my child to attend Aspire. My child may be transported with a qualified YMCA staff which may include walking or traveling in a bus. I also understand that there will be at least one adult volunteer or YMCA staff with my student.
I understand that my child can be removed by YMCA staff and or volunteers for any reason. The removed students parents will be contacted and the student must be picked up within 30 mins of being removed.
I give permission to use photography and video of my child in YMCA promotional materials.
In consideration of my child/children’s participation in activities at the YMCA of Greater Kansas City (Linwood YMCA), I, the undersigned, agree to release, waive, and discharge the YMCA of Greater Kansas City, including its officers, employees, and members, from any and all liability.I understand and acknowledge that my child/children’s participation may involve inherent risks. I, on behalf of myself, my heirs, executors, and administrators, forever waive any and all claims for damages arising out of or in connection withType a question participation in, or transportation to and from, YMCA activities.
*
Date
*
-
Month
-
Day
Year
Date
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Submit
Submit
Should be Empty: