After School Oasis — 2026-27 Registration

After School Oasis — 2026-27 Registration
One form per child. Please complete a separate registration for each child.

Questions: info@afterschooloasis.org
Student First & Last Name
Current Grade
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Food allergies/dietary restrictions
Medications needed during program (Important note: Oasis does not have access to medication stored in Our Lady of the Elms Clinic. Parents must provide separate medications to Oasis prior to start of program, including rescue inhalers.)
Learning differences or challenges you'd like us to be aware of
Is there anything else you would like us to know about your child?
Parent / Guardian Information
Parent 1 First & Last Name
Parent 1 Phone Number
Parent 1 Email Address
example@example.com
Parent 2 First & Last Name
Parent 2 Phone Number
Parent 2 Email Address
Is there a court order in place that prevents contact between a parent or other adult and my child? (If yes, please email a copy to info@afterschooloasis.org)
Authorized Pickup

Parents do not need to be listed. List all adults authorized to pick up your child; they will be asked to provide ID at pickup. To add people during the year, email info@afterschooloasis.org.
Person 1 Full Name
Person 1 Relation to Child
Person 1 Phone Number
Person 2 Full Name
Person 2 Relation to Child
Person 2 Phone Number
Person 3 Full Name
Person 3 Relation to Child
Person 3 Phone Number
Handbook Acknowledgment
Please read the After School Oasis 2026-27 Handbook at www.afterschooloasis.org before signing below
Parent/Guardian Signature — Handbook
Activity Participation Agreement
Sponsoring Organization: OASIS Outreach Opportunity Inc. · Location: 1375 W Exchange St., Akron, OH 44313 · Sponsor's Coordinator: James Wright · Description of Activities: Participation in After School Oasis · Dates and location: all activities at 1375 W Exchange St., Akron, OH 44313, for one year from the date signed.
Media Release: I understand that OASIS Outreach Opportunity, Inc., its employees, or volunteers may take photographs, videotape, or digital recordings of my child and use these in any and all media, now or hereafter known, exclusively for the purposes of OASIS Outreach Opportunity, Inc., and to exhibit this work in print and electronic form, publicly or privately.
Media Release Consent
I represent that I am at least 18 years of age and have read and understand the previous statement. I acknowledge that participation in the activities described above involves risk to the Participant and to Participant's parents or guardians, and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, injury, property damage and financial damage. In consideration for the opportunity to participate in the activities described above (the "Activities"), the parent or guardian acknowledges and accepts the risks of injury associated with participation in and transportation to and from the Activities. The parent or guardian accepts personal financial responsibility for any injury or other loss sustained during the activities or during transportation to and from the activities, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the "Activities Sponsor"). Further the parent or guardian releases and promises to indemnify, defend, and hold harmless the Activities Sponsor for any injury arising directly or indirectly out of the described Activities or transportation to and from the Activities, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise. If a dispute over this agreement or any claim or damages arises, the parent or guardian agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the parent or guardian and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.
Parent/Guardian Signature — Participation Agreement
Second Parent/Guardian Signature (optional)
Emergency Medical Authorization

This section meets the requirement of Ohio Revised Code Section 3313.712
Program: After School Oasis — Oasis Outreach Opportunity, Inc. Purpose: to enable parents and guardians to authorize emergency treatment for children who become ill or injured while under program authority, when parents or guardians cannot be reached.
Student's Home Address
Residential Parent/Guardian Name
Parent/Guardian Daytime Phone
Second Parent/Guardian Name
Second Parent/Guardian Daytime Phone
Other Guardian's Name
Other Guardian's Daytime Phone
Relative or Childcare Provider
Name
Relationship
Daytime Phone
Address
Emergency Contacts

These may be the same people as your Authorized Pickup list
Emergency Contact #1's name
Emergency Contact #1's phone
Emergency Contact #1's address
Emergency Contact #2's name
Emergency Contact #2's phone
Emergency Contact #2's address
Emergency Contact #3's name
Emergency Contact #3's phone
Emergency Contact #3's address
Emergency Medical Consent
Doctor
Doctor's Phone
Dentist
Dentist's Phone
Local Hospital
Emergency Room Phone
Facts concerning the child's medical history including allergies, medications being taken, and any physical impairments to which a physician should be alerted
In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for: (1) the administration of any treatment deemed necessary by the above-named doctor, or, in the event the designated preferred practitioner is not available, by another licensed physician or dentist; and (2) the transfer of the child to any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.
Parent/Guardian Signature — Part I (Grant Consent)
I do NOT give consent for emergency medical treatment. In the event of illness or injury requiring emergency treatment, I wish program authorities to take the following action:
Part II (Refuse Consent)
Our Lady of the Elms may share your family's household income level, expressed only as a percentage of the federal poverty line, with After School Oasis. This information is kept strictly confidential and is used only for program administration and funding purposes.
Program Partners
After School Oasis partners with Pathway Caring for Children, who lead small-group activities centered on social and emotional learning during the program. Pathway enrolls participating children separately; if you opt in, we will share your child's registration information with Pathway so they can prepare their enrollment paperwork for your signature — you will not need to re-enter this information.
Pathway Caring for Children Participation
Should be Empty:

After School Oasis — 2026-27 Registration

One form per child. Please complete a separate registration for each child.

Parent / Guardian Information

Authorized Pickup

Handbook Acknowledgment

Activity Participation Agreement

Emergency Medical Authorization

Relative or Childcare Provider

Emergency Contacts

Program Partners