South Sudanese Enrichment for Families
Moms studying sat bridges.jpg

Saturday Bridges - Registration Form

Whole-family programming & community connections

Saturday Bridges - Registration Form

 

To participate in Saturday Bridges Program, please complete this form. It will help SSEF keep you informed and serve you and your children better.

About You
Adult 1 Name *
Adult 1 Name
Adult 1 Phone *
Adult 1 Phone
Adult 2 Name
Adult 2 Name
Adult 2 Phone
Adult 2 Phone
Street Address *
Street Address
About your Kids
(fill in details for each child participating please!)
Child 1 Name
Child 1 Name
Child 2 Name
Child 2 Name
Child 3 Name
Child 3 Name
Child 4 Name
Child 4 Name
Child 5 Name
Child 5 Name
Health and Safety
If yes, please provide details in the box below. Your child's well-being is our highest concern!
If you answered YES to the question above, please provide details here:
Name of Adult Caretaker
Name of Adult Caretaker
If you answered YES to the question above, what is their name and phone number, in case we need to reach them?
Adult Caretaker Phone
Adult Caretaker Phone
Waivers and Permissions
Waiver of Liability *
I, the undersigned, as a legal adult or parent/legal guardian of a minor, do hereby consent to my/my child’s/children’s participation in South Sudanese Enrichment for Families’ Saturday Bridges Program. I also agree to forever release South Sudanese Enrichment for Families, and all their employees, agents,board members, volunteers and any and all individuals and organizations assisting or participating in South Sudanese Enrichment for Families’ Saturday Bridges Program from any and all claims, rights of action and causes of action that may have arisen in the past, or may arise in the future, directly or indirectly, from personal injuries to myself/my child or property damage resulting from my/my child’s participation in South Sudanese Enrichment for Families’ Saturday Bridges Program. I also promise, to indemnify, defend, and hold harmless the Releasees against any and all legal claims and proceedings of any description that may have been asserted in the past, or may be asserted in the future, directly or indirectly, arising from personal injuries to myself/my child or property damage resulting form my/my child’s participation in South Sudanese Enrichment for Families’ Saturday Bridges Program. I further affirm that I have read this Consent and Release Form and that that I understand the contents of this Form. I understand that my/my child’s participation in these programs is voluntary and that I/my child are free to choose not to participate in said programs. By checking this box, I affirm that I have decided to allow myself/my child to participate in South Sudanese Enrichment for Families’ Saturday Bridges Program with full knowledge that the Releasees will not be liable to anyone for personal injuries and property damage I/my child may suffer in South Sudanese Enrichment for Families’ Saturday Bridges Program.
Photo Permission *
Please share your preferences: Do you want your child’s/children’s picture used in South Sudanese Enrichment for Families’ marketing materials, website, social media sites and local newspapers?

Thank you for registering for Saturday Bridges!