Elevate Registration Form

East Toledo Family Center presents

Elevate Summer Program

Wednesdays from 2:30 PM to 4:00 PM

Youth ages 11-17 years olds

Development Leadership skills
Peer to peer interaction
Build character
Positive environment
Community involvement
Games, group activities, indoor and outdoor activities

If you want more information, contact Holly Keenen our Youth Recreation Director at hollyk@etfc.org or call 419-691-1429 ext. 217.

Name of Student

First NameLast Name

Name of Parent

First NameLast Name

Student's Date of Birth

Date

What grade will your student in 2026/2027 school year?

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent email

example@example.com

Parents'/Guardians' Phone Number

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

Student interest, talents or hobbies?

Tell us more about your student, anything unique/special we need to know about your student?

Does your student have any allergies?

If yes to allergies, please list below:

List any allergies that your student has

Any medical conditions? If yes, please list below

Shirt Size:

(Adult sizes only)

How did you hear about us?

Please let us know how you found out about us, helps us promote our programs better.

Student/Parent Participation Agreement:

I fully understand that the East Toledo Family Center is being represented by me (the student) during all hours of program and volunteer opportunties. I acknowledge to show respect to my peers, leaders, and all members of the community during the time spent at ETFC, as well as during volunteering hours off the premises, and participating in outings with agencies associated with ETFC. I will choose to resolve conflicts peacefully, behave respectfully without arguing and cooperate when leaders give direction or make a request. I understand I will be able to voice my concerns at an appropriate time. I am responsible for myself and my belongings, and I agree to uphold myself honorably as expected out of those participating in the Elevate Youth Enrichment Program.

Student Signature:

Parent Signature:

PHOTO RELEASE: East Toledo Family Center has a Facebook account where photos and videos from Youth Recreation programs and events are periodically published, we need the parents permission to post photos or vidoes of the participants in our group to post/share on our social media accounts and on all marketing materials. Please select yes, if you consent. If you do not consent, please select no.

Photo Release consent:

Participation Waiver:

I fully understand that the East Toledo Family Center, the City of Toledo, or any other agencies affiliated with ETFC in producing the recreational activities are not responsible for any and/or all injuries that might occur during the class or travel to or from the said program, and I do hereby release the East Toledo Family Center, its officers, agents, employees and all agencies affiliated with the recreational activities, either directly or indirectly, from the responsibility of injuries that may occur as the result of participation in the program.

Please sign below if you agree to the waiver:

Signature

Student Information