Additional Info:

YOUTH AFTER SCHOOL AND SUMMER K-8TH GRADE REGISTRATION

To register, please take the time to fill out the information below.

YOUTH INFORMATION
PRIMARY CAREGIVER INFORMATION
Primary Care Giver Relationship (check):
Education:
Marital Status:
Employment Status
Secondary Caregiver (In case of emergency)
Secondary Care Giver Relationship (check):

PERMISSION TO PARTICIPATE IN Summer and After-School

The Thea Bowman Center provides summer and after school program for children K to 8th grade. Families/children must have access to a computer and Internet/Wi-Fi capability to participate in online. All families/children must participate in a mandatory orientation session for online with TBC center staff. By signing this form I (we) agree to the orientation session and will provide timely feedback information when requested. I give my child or children permission to participate in the online program. I understand the terms of participation.

Do you Understand?
I give permission for my child to participate in the Thea Bowman Center’s supervised After-School and Summer Program. Tutoring, Music, Kung- Fung, Field Trips, Black History and other learning activities .
PICTURES/STORIES: I will share pictures and stories of the program experience. I give TBC permission to use pictures and stories to promote TBC programs: brochures, web page, fund raising events, social media/Facebook.

I understand that youth (online and in person) program is presented, monitored and supervised by
trained Thea Bowman staff. Parents are expected to monitor and supervise the online activities of their
children. Children may participate in online and in person field trips and learning events of which
parents will know in advance. Please call 216 491 0699 or Sylvia Little-Harris
sylvia.littleharris@theabowmancenter.org

Thea Bowman Center

©2019 Thea Bowman Center | Thea Bowman Center is a 501 (c)(3). GED® is a registered trademark of the American Council on Education (ACE) and administered exclusively by GED® Testing Service LLC under license. For more information, visit: www.gedtestingservice.com.

Address:

11901 Oakfield Ave

(On the corner of E. 120th and Union)
Cleveland, OH 44105

T: 216-491-0699

F: 216-491-1678

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