AGAPE Youth Center

Information and Registration Form

First Baptist Comunidad Cristiana's AGAPE Youth Center (AYC) is hosting an afterschool and summer program for kids Kindergarten - 12th grade for 2025.

Our summer program for 2025 will begin on Tuesday, June 24th and will end on Tuesday, August 5th and is for kids ages kindergarten through 12 years old. We will meet Tuesdays and Wednesdays from 11 AM to 3:30 PM.

There will be a limited number of student leaders for the summer program aged 12-18 years old. Student leaders participating in the summer program will have additional days and hours they will need to be present. Refer to the student leader contract for details.

To enroll, please complete the registration form for each child and sign the waivers below.
If you have any questions about AYC, please contact the church office at (509) 248-4434 or Youth Director, Stacey Sutton, at (816) 328-4192.

Please complete these forms promptly. We must have this documentation for your child to participate.

Media Release

This media release is for the AGAPE Youth Center. Youth may be photographed and their photos posted to websites such as Facebook, Instagram or Twitter. Youth may also be photographed and televised during local newscasts.

Signatures below include permission for my child/youth to be photographed as part of the AGAPE Youth Center afterschool program.

Registration Form and Media Release

Child 1

Child 1 First Name

Child 1 Last Name

Birthdate

Age

Grade

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Allergies

Medications

Dietary Restrictions

Child 2

Child 2 First Name

Child 2 Last Name

Birthdate

Age

Grade

Allergies

Medications

Dietary Restrictions

Child 3

Child 3 First Name

Child 3 Last Name

Birthdate

Age

Grade

Allergies

Medications

Dietary Restrictions

Child 4

Child 4 First Name

Child 4 Last Name

Birthdate

Age

Grade

Allergies

Medications

Dietary Restrictions

Parent or Guardian

Parent or Guardian First Name

Parent or Guardian Last Name

Parent Phone Number

Signature

Date Input

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

AGAPE Youth Center

Hold Harmless Agreement

I hereby consent to the participation of my child in the AGAPE Youth Center program. I fully understand that any participation in the AGAPE Youth Center afterschool/summer programs exposes my child to the risk of personal injury or property damage. I hereby acknowledge that my child is voluntarily participating in this program and I agree to assume any such risks.

This form must be signed in order for the child to participate in the AGAPE Youth Center.

On behalf of my child and in consideration for being permitted to participate in the program, I, my agents, heirs, marital community, if any, and legal representatives hereby release, promise to defend, indemnify, and agree(s) to protect, save and otherwise hold harmless FBCC and the AGAPE Youth Center, it's boards, elected and appointed officials and employees, and agents from and against all claims, demands, and causes of action of any kind or nature, including the cost of defense, or liability arising from or relating to this program, the grant of the registration, or any use of FBCC facilities related to this registration and/or actions in connection with my participation in this program including but not limited to personal injury, property damage or death, unless caused solely by the negligence of the FBCC.

BY SIGNING, I ACKNOWLEDGE I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT IT IS A FULL RELEASE OF ALL LIABILITY AND I SIGN IT ON MY OWN FREE WILL.

Parent or Guardian Initials

Signature

AGAPE Youth Center

Transportation Agreement

Due to our program growing in both the number of children in the program and the number that need transportation, this transportation agreement must be put into place in order for the program to continue to run smoothly and effectively. Thank you for your cooperation, so we can get everyone to the program on time. Below mainly
applies to those who will be getting a ride to and from the program via our van, but number 8 applies to all kids in the program:

1. Your contact information will be given to our van driver in case there is an issue at pick up or drop off.

2. Please have children ready to go and looking for the van at least 15 minutes
before the scheduled pick-up time.

3. We will wait only 3 minutes at each location for the child before moving on to the next spot.

4. It takes about 45 minutes to 1 hour for all the kids to be dropped off. Your child will be dropped off in reverse order of how they were picked up. Please let us know if your child needs to be home by a certain time.

5. If a child cannot be home alone, someone needs to be home upon their arrival
consistently. If there isn’t someone home on time consistently then we will not be
able to bring that child home and another ride needs to be arranged.

6. Please let us know if your child will not be riding in the van like normal or has any
changes in location of pick up/drop off. Also, please let me know if your child has
friends that would also like to come along because we will need their parents’
permission to attend.

7. Sometimes we will be doing field trips where all the kids are transported to
another location. Signing this, is you giving your permission for us to transport them.

8. All children must follow the same rules and expectations in the van as at the program (kindness, respect, and positive attitude *see below). Children can get warnings in the van as well as may have to be given an assigned seat depending on the situation. If the behavior is severe enough, dangerous, or violent, your child may be suspended from the program and/or unable to ride in the van any further.

9. If these above guidelines are not followed or are violated multiple times, that may result in us not being able to pick up/drop off your child for a period of time, or indefinitely, depending on the situation because this could prevent us from getting all the kids to the program on time.

I understand these transportation guidelines and agree to follow them.

Parent or Guardian Initials

Signature

AGAPE Youth Center

Authorized People to Pick Up My Child

Below are the authorized people who can pick up my child from AYC functions who have not already been documented in other registration material:

First Name

Last Name

Phone Number

Relationship to Child

First Name

Last Name

Phone Number

Relationship to Child

First Name

Last Name

Phone Number

Relationship to Child

First Name

Last Name

Phone Number

Relationship to Child

I understand that ONLY those listed on this sheet or other registration material can pick up my child. If someone comes to pick up my child who isn't on this sheet or documented elsewhere, AYC will not be able to release that child to that person unless we get the expressed permission of the parent/guardian who filled out this paperwork. Other authorized people for pick up can be added to this document, but it must be dated and re-signed for any additions.

Parent or Guardian Initials

Signature

Other Miscellaneous Agreements

Please do not bring or allow your child to come to AYC if they are sick (fever, coughing, runny nose) because we want to minimize the spread of illness.

Also, if your child requires special care or supervision because of behavioral struggles or other reasons, we may not be able to accommodate them in the program due to limited staffing. We will try to do the best that we can but may have to say “no” if we don’t have the staff to support your child.

Parent or Guardian Initials

Signature

AGAPE Youth Center

Rules and Expectations

1. Show Kindness
- Being polite by saying “please, thank you”
- Offering to help others
- Taking turns, sharing

2. Show Respect
- By listening and not talking when others are talking
- When a leader asks you to do something, do it
- Ask permission before leaving an area
- Take care of property, clean up your trash
- No bullying/name calling, fighting, yelling or cussing

3. Positive Attitude
- Try new activities, believe that you can do it!
- Ask to talk to a leader if you have a question or are having a hard day
- No complaining or whining
- Have FUN!

Phone Policy

Disciplinary Process
1. Verbal warning; reminder of rules.
2. Verbal warning, talk about how the child can change their behavior.
3. Call parents and correct behavior.
4. Call parents and take home.

If a child is taken home 3 times because of behavior then they will not be able to return to the program. We desire for children to want to be here, which is shown by them choosing to follow directions and to have fun.

NOTE: We will work with children who are choosing unacceptable behavior, helping to guide them to choose the appropriate behavior. Leaders do have the right, however, to skip steps in the disciplinary process if they decide it is necessary. For example, blatant disrespect and refusal to do what is asked and running away from leaders will result in immediately being sent home.

I have read and understand these rules and expectations and have gone over these rules and expectations with my child/children, and they understand and agree to follow them.

Parent or Guardian Initials

Signature

AGAPE Youth Center

Information and Registration Form

Media Release

Registration Form and Media Release

Child 1

Child 2

Child 3

Child 4

Parent or Guardian

AGAPE Youth Center

Hold Harmless Agreement

Parent or Guardian Initials

AGAPE Youth Center

Transportation Agreement

Parent or Guardian Initials

AGAPE Youth Center

Authorized People to Pick Up My Child

Parent or Guardian Initials

Other Miscellaneous Agreements

Parent or Guardian Initials

AGAPE Youth Center

Rules and Expectations

Parent or Guardian Initials

Grant Data Collection