Gulf Coast Parent Registration Form for Avenue941 on Mon/Wed from 2:30-6pm
MASH Unit at Gulf Coast Church for 2022-2023 school year -  This form must be completed for each student individually. 
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Email *
Where or from whom did you hear about this opportunity? *
Parent of Guardian's First Name *
Parent or Guardian's Last Name *
Relationship to the student *
Parent or Guardian's Phone Number *
Parent or Guardian's Email Address *
The best way to reach me is
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What is/are the names of the adult(s) who will be picking this student up after homework help? *
Student's First Name *
Student's Last Name *
Student's Grade Level *
Student's Birthday *
MM
/
DD
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YYYY
Student's School Name *
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 (sometimes is the student ID number) *
What is your student's FOCUS log-in PASSWORD? (sometimes is the student six digit bday) *
Is your student able to attend every week on Mondays AND Wednesdays  (regular attendance is required). *
Does your student have transportation or a way to and from Gulf Coast Church? *
We often provide snack. Does your student have any food allergies that we should be aware of? *
Does your student need any medication or have any medical issues or health concerns that we should be aware of? *
What does your student need most from a program like this in your opinion? *
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? *
Required
I understand by registering my student that this is a faith-based program, that I am granting the Avenue941 team access to FOCUS and that my student may have pictures and videos taken of them as part of community building and social media. *
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