South Sudanese Enrichment for Families
Moms studying sat bridges.jpg

Saturday Bridges - Registration Form

Whole-family programming & community connections

The Bridges Program - 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
Father Name *
Father Name
Father date of birth
Father date of birth
Father Phone *
Father Phone
Mother Name
Mother Name
Mother date of birth
Mother date of birth
Mother Phone
Mother Phone
Address of family or individual *
Address of family or individual
About your Kids
(fill in details for each child participating please!)
Child Name
Child Name
Child Date of Birth *
Child Date of Birth
Just enter the Month, the Date and then the Year -ex. 2015- of the birth date for your child here!
Child Gender *
Child School Address
Child School Address
Would this child like to go to sleep away Camp next summer?
How many weeks? *
Use the arrow to chose YES or NO. If YES, please provide details in the box below. Your child's well-being is our highest concern!
Health and Safety
If you answered YES to the question above, please provide details here:
Use the arrows to choose YES or NO
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
Schedule for the Saturday Bridges Program:
Upcoming Details Programs Activities
Has your family participated in the Saturday Program?
Please explain
Does anyone in your family need tutoring?
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 maybe asserted in the future, directly or indirectly, arising 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 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. I have read the waiver above and I understand and accept the terms stated.
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!