SPARK registration form

Faith Mennonite Church SPARK Participant Form October 2017-May 2018
SPARK! is an after school program run by volunteers from Faith Mennonite Church, UMEI and MD Bennie student leaders in grades 7&8.  The program runs from 3:00 – 4:45 p.m. at Faith Mennonite Church at 269 Sherk Street.  Participants will be met at Margaret D. Bennie School by an adult volunteer and walked to the church at the end of the school day.  The children will play outside, followed by a snack.  Each day includes a craft, a math and a writing activity.  If a child has homework, they may choose to work on it.  Volunteers will be present to help with homework and to assist your child in understanding the concepts they are learning at school. Pick up will be at 4:45 p.m. and we ask that if someone else will be picking up your child that you notify us in advance.  Enrollment is limited to 24 participants and 6 student leaders, so REGISTER SOON!  
Name of participant/student leader:  
Birth date:
Full Address    
Parent/Guardian/Caregiver name (s):  
Circle the number where parent/guardian may best be reached at during program time:
Home/residence phone:                                   Cell phone:                       Work phone:   
Allergies or other medical condition that leaders should be aware of?  YES/NO
If yes, please list and explain:  
E-mail address:  
All reasonable precautions for the safety and health of the participant will be taken. He/she will be properly supervised in activities. In the event of accident or sickness, Faith Mennonite Church, its staff and volunteers are released from any liability.    
Contact person (not parent) in case of emergency and parents/guardians/caregivers cannot be reached: Name:                                                                                           Phone:   
Parent/Guardian Signature:  
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