Graffiti Kids After School Fall 2020 Application

I certify this child does not require an IEP, 504 Plan, and does not have special needs or require special care. If your child has an IEP, 504 Plan, or has special needs, please contact the Children's Director, Tonya, at [email protected] or 212-473-0044.

I understand if I am late picking up my child from Graffiti Kids After School, then I am required to pay an additional $5.00 for every 5 minutes after 5:30 pm. The additional payment must be paid within 3 program days of the late pickup date in order for my child to continue attending the after school program.

I understand that acceptable behavior is a condition of my child’s enrollment in Graffiti Kids After School. I understand my child must follow the rules, policies, and procedures outlined in the Parent Orientation Packet. Unacceptable behavior will be corrected verbally, with time-outs, with meetings with parent/guardian, and lastly through suspension/expulsion from Graffiti Kids After School with no refund eligibility. Unacceptable behavior includes violating Graffiti Kids After School COVID-19 policies.

I understand that there is a non-refundable $60 registration/supply fee with the application.

I have read and will comply with the policies outlined in the Parent Handbook (link below).

I, the parent or guardian of the above-named child, acknowledge that participation in Graffiti Kids After School may include active indoor and/or outdoor activities including games, sports, movement, activities, etc. Likewise, though supervised, children will be interacting with one another. Such activities necessarily involve inherent risks and dangers, including illness, physical injury and damage to or loss of personal property. I further acknowledge that the programs and/or events operated by Graffiti Community Ministries, Inc. are administered in part by volunteers, in addition to paid, trained professionals. In consideration for accepting the registration of my child and permitting the voluntary participation of my child in its programs and/or events, I, to the extent permissible by applicable law, (for myself as well as for my child and his/her heirs and assigns) hereby assume all risks and responsibilities in any way associated with this program and/or event and I release, discharge, and hold harmless Graffiti Community Ministries, Inc., East 7th Baptist Church-Graffiti, and their respective directors, officers, employees, volunteers, agents and other representatives or affiliates (including, without limitation, the participating churches, organizations participating through such churches, sponsors, game or event workers, officials, facilities, and other volunteers) (hereafter, the “Non-Profit Parties”) from and against any and all liability, claims or actions arising out of or relating to the illness, physical injury, death, damage to or loss of personal property and all related expenses in connection with the program and/or event, whether caused by the negligence of the Non-Profit Parties or otherwise, and whether or not such harms were reasonably foreseeable, that may result to my child while participating in any related operated program and/or event, including, without limitation, any illness or injury caused by any negligence of any official, referee or coach while performing his/her duties during any practice or game. I acknowledge that some programs and/or events may involve strenuous physical activity, and with this knowledge, I attest that my child is physically fit, prepared and capable to participate in this program and/or event, and that he/she is free from any health-related condition that will or ought to restrict his/her participation in this program and/or event.

I understand that in the event of an emergency and medical intervention is needed, I give permission for my child to receive emergency medical treatment from a physician or dentist. I understand that all reasonable safety precautions will be taken at all times by Graffiti Community Ministries, Inc. and its staff during Graffiti Kids After School. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Graffiti Community Ministries, Inc., its partners, affiliates, leaders, employees, and volunteer staff responsible or liable for damages, losses, diseases, or injuries incurred at the program. Should officials, representatives or volunteers determine, in their sole discretion, that completion or participation in any aspect of the program and/or event may be injurious to my child’s health, or should my child become ill or injured, I consent to his/her removal and treatment for such illness or injury at the direction of such officials, representatives and/or volunteers, which may include, without limitation, hospitalization and ordering of injections, anesthesia or surgery for the child, by a duly licensed medical doctor, clinic or hospital.

I give my permission, voluntarily and without compensation or time restrictions, for the use of any visual/audio images of my child and his/her name in broadcasts, telecasts, publicity, websites, or written accounts of any Graffiti Community Ministries, Inc. event, without notification to me or my child. I agree that Graffiti Community Ministries, Inc. owns such visual/audio images and all rights related to such images with full power of disposition for non-profit purposes.

I give my permission for my child to travel from his/her school to Graffiti Church and off campus with Graffiti Kids After School to Tompkins Square Park playgrounds when weather permits. (Note: We are NOT picking up from schools or playing at the park until further notice due to health and safety guidelines.)

I understand that Graffiti Community Ministries, Inc. is not authorized to dispense or administer any over-the-counter or prescription medication.

I understand that Graffiti Community Ministries, Inc. is a Christian organization; therefore Christian values will be taught and upheld as part of daily activities.

I understand that the supply fee paid for Graffiti Kids After School is non-refundable; no exceptions.

I understand that the pathology and transfer of COVID-19 is still not completely understood. To the extent they are understood, I understand that it is not possible for Graffiti Community Ministries, Inc. to ensure social distancing and other best practices from all participants at all times. I understand that there is a risk that my child or I may contract COVID-19 from participating in Graffiti Kids After School. I understand it is my responsibility, and the responsibility of other parents to ensure all COVID-19 related guidelines and policies applicable to children and parents are being followed. I hereby additionally release, discharge and hold harmless the Non Profit Parties against any and all liability, claims or actions arising out of or relating to any contraction of COVID-19, which may result in illness or death and all related expenses.