Attic After School Parent/Guardian Consent

The Attic is a Christian non-profit after school program that seeks to help students 7-12th grade to write a better story.

This from must be filled out by a parent or guardian of the student(s) who will be attending the Attic After School.

IMPORTANT NOTE: Begin by adding the primary parent or guardian's information in the boxes at the beginning of this form. Your child's information will be added separately under the "add child" button beneath the Household Members section.

Questions? Text Jordan at 616-901-8531

Your name *

Email address *

Birthdate *

Address *

Phone number *

Household members

Click "add adult" to add contact info for other adults living in your household.
Click "add child" for each teen from your household that will be attending the Attic.

Check this box if your family or your teen would be interested in a ride to church on Sundays.

The Attic After School provides shuttle van rides to Wyoming Harbor Church for their Sunday 10:30am service for any people who may have trouble with transportation to Church.
Van shuttle pick up occurs between 9:30-10:15am.
Wyoming Harbor Church is located on the same property as the Attic After School.
2141 Porter Street, Wyoming, MI 49519.

Check this box if any adults from your household would be interested in helping volunteer for the Attic After School?

What areas are you hoping to see growth in your teenage child?

Does your student have any abilities, talents, or interests?

Parent/Guardian Acknowledgements (please read carefully) *

By checking the box above you above, you agree to the following terms of you child/children's attendance at the Attic After School:
In the event of sickness or medical emergency where I am not present and cannot be reached, I request that my child/children receive any medical attention or treatment deemed necessary by the staff and/or ministry leadership of Attic After School. Therefore, I give permission to any hospital, doctor, and/or health care provider to treat, transport/admit my child/children. I grant permission for the release of medical records in the case of accident during the activity. I understand that I am responsible for all expenses and charges for the treatment and care of my child/children if need be. The above-named child/children on this form has my permission to travel in an Attic After School or a privately-owned vehicle. I give permission for pictures and video of my child to be used on the Attic After School website and other in-house publicity. I understand that if my child/children have to be dismissed from the Attic After School for behavioral issues, that it is their responsibility to find a ride home (we will contact and explain the situation you should this happen).

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