HOPE[x] Scholar Registration 25-26

The HOPE[x] is a mentorship program for middle and high school boys. After doing homework and mentor time our scholars will learn valuable life skills and basic tech skills including coding and programming which will also give them the base knowledge and exposure to be successful in a tech workforce.

Our services are Mondays 5-7pm

The HOPE Program at Downtown Community Church located at 231 E Palmer Ave.
Visit our website dcchope.com for more information

Your name *

Email address *

Phone number *

Address *

SCHOLAR INFORMATION

ONE FORM PER CHILD. IF YOU HAVE MORE CHILDREN YOU WOULD LIKE TO ENROLL, PLEASE SUBMIT A NEW FORM.

Child Full Name *

Child Date of Birth *

School *

What grade is your son in? *

Medical Notes/Medical History

Does your child have any visible or invisible disabilities we should be aware of?

Is there any additional/background information you would like for us to know about your child?

EMERGENCY CONTACT

If we cannot reach you, please provide the contact information of someone who we can call with regards to your child.

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Address

Program Involvement Questions

Has your child been our program before?

Either our school year programming or summer camp

Yes

TRANSPORTATION *

We can only pick up children that live in a 2 mile radius of the church due to our limited capacity and availability. If you have the means and ability to provide transportation for your son, we ask that you do so as it would help our program overall.

*HOPE staff will not drop a child off at any house that is not on their paperwork without prior communication from the parent.

I need Downtown Community Church to provide transportation for my child* and I live in the 2 mile radius

I can and will provide transportation for my child

PLEASE READ THE FOLLOWING POLICIES

SCHOLAR EXPECTATIONS

This is what we expect of your child while they attend our program and the rules that we expect them to follow:

1. Respect everyone.
2. Keep my hands to myself.
3. Follow directions given by my mentor and staff.
4. Use materials and spaces responsibly.
5. Keep a positive attitude.

BEHAVIOR CONSEQUENCES

Being a scholar at the HOPE Program is a privilege and complying with the expectations of the program is a requirement. In the case that scholars’ behavior is not in compliance with the expectations laid out above, we will take the following steps as consequences:
1. Scholar must have a discussion about their behavior with a staff member
2. If behavior does not change, scholar loses their privileges to participate in
activities and must write out the expectations that were violated.
3. If scholar still has not changed their behavior, we will call home to make
parents aware of the situation.*
4. If after a call home behavior still has not changed, the scholar will be
suspended for one week.
If behavior does not improve after steps 1-4 have been taken, longer suspension or possible expulsion will be discussed by the staff. If scholar were to get aggressive, we would relocate the child to a room where they can avoid harming themselves or others. If the behavior begins to threaten the safety of anyone at the program, the scholar will immediately be taken home and given a week suspension, further action will be discussed by the staff. At no point will an adult put their hands on a child, unprompted and without consent.

SCHOLAR EXPECTATIONS AND BEHAVIOR CONSEQUENCES *

By checking this box, I am aware of the expectations of my child lined out above and will support and accept any consequences that may come from my child not complying with the behavioral expectations.

CHILD SAFETY AND LIABILITY AGREEMENT *

At the HOPE Program, our priority is always to our scholars safety and that of their families, our mentors, and our staff.
- All volunteers go through a training covering mentorship, policies, child safety
- All volunteers go through a background check.
- Volunteers who provide transportation for their scholar must provide proof of drivers insurance
- Parents must provide written consent to their child's mentor providing transportation.
- Downtown Community Church and the HOPE Program maintains liability insurance coverage to protect its participants while participating in the program at 231 E Palmer Ave
- A copy of our volunteer child safety code of ethics can be viewed upon request

For my child to participate, it is agreed by checking below, I will trust the staff and volunteers have and will always uphold all child safety policies and outside of that, in the event my child is injured or disabled of a temporary or permanent nature (i.e. falling while playing sports) or willingly leaves the property while participating in the HOPE Program, I will waive all claims or liabilities against Downtown Community Church, their staff and volunteers.

MEDIA RELEASE AGREEMENT

I give permission for photos and videos to be taken and used of my child for HOPE promotional purposes and Downtown Community Church promotional purposes.

PARENT COMMITMENT AGREEMENT *

As the parent, I certify and take full responsibility for the information provided being correct to the best of my knowledge. I accept that my child’s enrollment in this program requires a level of commitment from myself. I will make sure that my child arrives on time when I drop them off or that they are where they need to be if being picked up. I will answer phone calls or messages from the HOPE Program Team with information about my child. I understand that if my child misses more than 3 weeks of the HOPE Program, then their spot is at risk of being passed on to another child on the waiting list.

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