Commonwealth Connects Afterschool & Summer Program Enrollment (2025

Commonwealth Connects is where learning comes alive and confidence takes root. Our program blends meaningful educational enrichment with hands-on experiences that keep students curious, engaged, and excited to show up each day. From literacy and math support that strengthens academic foundations to creative enrichment that sparks imagination, every moment is designed with your child in mind. And yes, learning goes beyond the classroom. Our fun, carefully curated field trips expose students to new places, ideas, and possibilities, turning exploration into inspiration. At Commonwealth Connects, students are not just supervised, they are supported, challenged, and celebrated in a safe, joy-filled environment where growth and fun go hand in hand.

Afterschool & Summer Program Enrollment
This enrollment form is for our Afterschool and Summer Programs.
All programs are free and include academic enrichment, field trips, and family engagement opportunities.

Commonwealth of Faith - 27171 West Chicago Road, Redford, Mi 48239

Afterschool (3 hours) 3:45pm - 6:45 pm

Mt. Calvary Community Service - 4743 Iroquois, Detroit, Mi 48214 (3 hours afterschool) June 15th - August 6th

Coming Summer 2026

Commonwealth of Faith - 27171 West Chicago Road, Redford, Mi 48239 June 15th - August 6th
Mt. Calvary Community Service - 4743 Iroquois, Detroit, Mi 48214 June 15th - August 6th
Hopewell Church - 1831 Ewald Circle, Detroit Mi - July 13th - August 21st 2026
First Baptist Church SW - 7642 Gould St, Detroit Mi
ETS - 2930 Woodward Ave, Detroit, Mi
King of Kings MBC - 2579 Maxwell St, Detroit Mi
Kingdom Covenant Church - 17357 Klinger St, Detroit, Mi - June 15th - August 6th 2026 -
The Room Church - 18000 Glendale St, Roseville, Mi - June 15th - August 6th 2026
New Grace MBC - 25 Ford St, Highland Park, Mi - June 22nd - August 5th 3:00pm - 7:00pm

Which program are you enrolling your child in? Please note that only spring Break Camp is at Commonwealth of Faith (3/30 - 4/2)

Program Site Location:

School Name:

Student Name:

D.O.B.

Date

Gender:

Primary Phone

Please enter a valid phone number.Format: (000) 000-0000.

Total Family Size (Children + Adults)

(For dinner planning and field trip purposes)

Address:

Number & Street, Apartment Number

Street Address Line 2

CityState / Province

Postal / Zip Code

Student’s Primary Language:

Other:

T-Shirt Size:

T-shirt size

If Other, please specify T-shirt size

Student Grade:

Teacher’s Name:

Teacher’s Email:

example@example.com

Student Race/Ethnicity (Check all that apply):

Before School Program

Afterschool Program

Are siblings enrolled?

If so, at which school/program?

Names of Siblings:

Name:

Email:

example@example.com

Same Address as Child?

If no, please provide

Address:

Number & Street, Apartment Number

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:

CellFormat: (000) 000-0000.

Phone Number:

WorkFormat: (000) 000-0000.

Authorized to Pick-up?

Name:

Email:

example@example.com

Same Address as Child?

If no, please provide

Address:

Number & Street, Apartment Number

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:

CellFormat: (000) 000-0000.

Phone Number:

WorkFormat: (000) 000-0000.

Authorized to Pick-up?

INTERNAL USE ONLY:

Date of Admission:

Date

Date of Discharge:

Date

This before school, afterschool, and summer program is made possible by a grant awarded by MiLEAP under 32n OST Grants Program.

In the event of a medical emergency, what is the Hospital Preferred for Medical Treatment:

Medical Conditions/Allergies/Disabilities or Special Instructions (“check” conditions that apply or check “none”):

Food allergies?

Allergic to Bees?

Other:

If medication is to be distributed during the program, I understand that a medication authorization form must be on file with the program leadership initials (initials) and it is my responsibility to make sure the leadership has the authorized medication to be administered in a timely manner initials(initials).

Please describe any Special Instructions/Information that may be useful for staff to know:

Additional Contacts can be used for transporting of my student if I am not available initials (initials).

EMERGENCY CONTACT 1

Name:

Phone:

Please enter a valid phone number.Format: (000) 000-0000.

Add’l Phone:

Please enter a valid phone number.Format: (000) 000-0000.

Relationship to Student:

EMERGENCY CONTACT 2

Name:

Phone:

Please enter a valid phone number.Format: (000) 000-0000.

Add’l Phone:

Please enter a valid phone number.Format: (000) 000-0000.

Relationship to Student:

EMERGENCY CONTACT 3

Name:

Phone:

Please enter a valid phone number.Format: (000) 000-0000.

Add’l Phone:

Please enter a valid phone number.Format: (000) 000-0000.

Relationship to Student:

PLEASE READ THE STATEMENT BELOW AND CHECK THE BOX NEXT TO EACH STATEMENT

Rows	Yes	No
Emergency Medical Treatment: I give permission to the program staff (licensed by the State of Michigan) to secure emergency medical and/or surgical treatment for the above.
Family Handbook: I have received a copy of the Family Handbook. I agree to the program’s policies.
Playground Equipment Recognition. The program utilizes the playground equipment available at our sites. I understand the equipment students use may not comply with licensing standards.
Immunization Records. My Child’s immunization records are up-to-date. The immunization record or appropriate waiver is on file with the school. My child is in good health with activity restrictions noted.
Contact Information. I agree to contact the program leadership at my site if my contact information changes.
Field Trip. I hereby give my permission for my student to attend field trips. I understand that information will be provided prior to every field trip. I agree to accept all medical responsibility in case of emergency due to accident or illness.
Topical Application Waiver. I give permission to the program staff to provide my child with insect repellant, sunscreen, and Neosporin wound cleanser when appropriate. I understand that specific product information is available upon my request from the program leadership team.
Program Enrollment. I understand that enrollment in this program is voluntary. In order to assure that each student makes the desired progress for academic success, I understand regular attendance is expected.

By signing my student up, I authorize this program to collect and use data about my child for the purposes of program development, safety, and improving educational outcomes.

I understand that this data will be kept confidential, stored securely, and used by authorized personnel within the organization, and shared with Michigan Department of Lifelong Education, Advancement, and Potential (MiLEAP) 32n OST Grants Program and state evaluation partners.

Photo and Media Release Waiver

By enrolling my child in Commonwealth Connects, I grant permission for my child to be photographed, recorded, or filmed during program activities. I understand these images and recordings may be used by Commonwealth Connects for educational, promotional, and communication purposes, including but not limited to websites, social media, printed materials, and presentations. I acknowledge that no compensation will be provided for the use of these images and that all media will be used respectfully and in alignment with the mission and values of Commonwealth Connects.

I, the undersigned parent or legal guardian, acknowledge that my child is voluntarily participating in Commonwealth Connects, an Out of School Time program administered by Commonwealth of Faith Church. Program activities may include educational and enrichment programming, recreational activities, transportation, and off-site field trips.

I understand that participation involves inherent risks, including injury, illness, behavioral incidents, accidents, or loss of personal property, and I knowingly assume all such risks on behalf of my child.

To the fullest extent permitted by law, I release and waive any claims against Commonwealth of Faith Church, Commonwealth Connects, its officers, employees, volunteers, contractors, partner sites, and affiliated organizations arising from my child’s participation in the program, except in cases of gross negligence or willful misconduct.

I acknowledge that Commonwealth Connects maintains behavior and safety expectations. Failure to follow program rules or staff direction may result in disciplinary action, including suspension or dismissal, at the discretion of program leadership. I understand that dismissal may result in forfeiture of participation privileges and that alternative placement is not guaranteed.

By signing below

Signature of Parent/Guardian:

Date

Printed Name of Parent/Guardian:

This before school, afterschool, and summer program is made possible by a grant awarded by MiLEAP under 32n OST Grants Program.

Commonwealth Connects Program Enrollment 2026

Parent 1/Legal Guardian

Parent 2/Legal Guardian

Participant Agreement and Release