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Oasis Church Registration Form for Avenue941 beginning August 29th on M/W from 2:30-5:30pm
MASH Unit at Oasis Church Fall 2022 - This form must be completed for each student individually.
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* Indicates required question
Email
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Your email
Where or from whom did you hear about this opportunity?
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Your answer
Parent of Guardian's First Name
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Your answer
Parent or Guardian's Last Name
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Your answer
Relationship to the student
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Your answer
Parent or Guardian's Phone Number
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Your answer
Alternate Phone Number of other family member who may pick up student
Your answer
Parent or Guardian's Email Address
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Your answer
The best way to reach me is
Email
Phone Call
Text
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What is/are the names of the adult(s) who will be picking this student up after homework help?
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Your answer
Student First Name
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Your answer
Student Last Name
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Your answer
Student Grade Level
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1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Student Birthday
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MM
/
DD
/
YYYY
Student School Name
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Your answer
By registering your child, you give permission to us to access FOCUS to monitor grades and school work. We will need your student's FOCUS log-in information so that we can help them log in to complete their work. Type username here (usually this is the student ID number which starts with 415)
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Your answer
What is your student's FOCUS log-in PASSWORD? (sometimes this is the student six digit bday)
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Your answer
Is your student able to attend every week on Mondays and Wednesdays (regular attendance is required).
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Yes
No
If no, please end registration now as we only have space for students who can attend regularly
Does your student have transportation or a way to and from Oasis Church?
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Yes
No
We often provide snack and/or dinner. Does your student have any food allergies that we should be aware of?
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Your answer
Does your student need any medication or have any medical issues or health concerns that we should be aware of?
Your answer
What does your student need most from a program like this in your opinion?
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Math help
Reading help
Academic support in general
A mentor and/or tutor
Community, friends
A safe place to go after school
Spiritual counsel
Do you want to be included in our partnerships with other nonprofit organizations? If so, which of the following services would you like to be connected with and/or do you have need of?
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None
Food Services
Transportation Services
Housing Services
Pregnancy Services
Substance Abuse Services
Other
Required
I understand that by completing this questionnaire, that this is a faith-based program, that I am granting access to FOCUS and that my student will have pictures and videos taken of them as part of community building and social media.
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Yes
No
Send me a copy of my responses.
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