S.A.F.E. For The Summer Application (2026)

S.A.F.E. For The Summer Application
Parent/Guardian

#1
Name

First NameLast Name
Phone Number (Mobile)
Format: (000) 000-0000.
Email
Phone Number (Emergency)
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Add Parent/Guardian
Parent/Guardian

#2
Name

First NameLast Name
Phone Number (Mobile)
Format: (000) 000-0000.
Email
Phone Number (Emergency)
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Eligible to Pickup Child?
Child

#1
Name

First NameLast Name
Age
Gender
School
Grade
Upcoming School Year
Allergies
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Child

#2
Name

First NameLast Name
Age
Gender
School
Grade
Upcoming School Year
Allergies
Add Another Child
Child

#3
Name

First NameLast Name
Age
Gender
School
Grade
Upcoming School Year
Allergies
Agreements
I give my child(ren) permission to attend the S.A.F.E. for the Summer program at North Side Partnership Project 2610 Maple Ave, Pittsburgh, PA 15214.
Signature of Parent/Guardian #1
Date

MonthDayYear
Date
During the S.A.F.E. for the Summer Program, North Side Partnership Project (NPP) will take field trips, which require leaving the premises and transportation to some areas; by signing this potion of the application, you are giving you child(ren) permission to go on field trips to various locations in the city of Pittsburgh and surrounding areas.
Signature of Parent/Guardian #1
Date

MonthDayYear
Date
During the summer there will be pictures and videos taken of activities and children involved. By signing this portion of the application, you are giving North Side Partnership Project (NPP) permission to take photos and videos of your child(ren) related to the S.A.F.E. for the Summer Program, which may be placed on social media and NPP website.
Signature of Parent/Guardian #1
Date

MonthDayYear
Date
By signing this Waiver and Release of Liability, with full appreciation of the risk involved, on my own behalf and on behalf of my child(ren), I hereby voluntarily release and forever discharge Northside Partnership Project (NPP), its trustees, officers, employees, agents, insurers and contractors from any and all legal or financial responsibility for any personal injury, disability, illness, damage, medical expense or death, arising from or related to my child(ren)’s participation in S.A.F.E. for the Summer camp. I agree, for myself and my child(ren), not to make any type of legal or equitable claim on NPP, or any of its trustees, officers, employees, agents, insurers or contractors with respect to any injury I or my child(ren) may suffer, whether or not it arises through the negligence, omission, default or other action of anyone affiliated with NPP, including other campers. I further agree that if any such claim is made, I will indemnify and defend NPP with respect to any such claim, injury or damage.
Signature of Parent/Guardian #1
Date

MonthDayYear
Date
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S.A.F.E. For The Summer Application

Parent/Guardian

Parent/Guardian

Child

Child

Child

Agreements