PCA ALL4KIDS Program Registration
PCA Community Organization
501(c)(3) non profit Organization
TAX ID 81-3657254

Open Enrollment: May 1st- August 31st, 2021
Class Time: TBA Fall 2021

Address: 4915 Walnut Grove Ave, San Gabriel, CA 91776
Contact us at 1 (855) 543-7722 (KIDSPCA) or Info@PCANPO.org

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ALL4KIDS REGISTRATION
First, Last Name *
Participant 1
Participant Birthday *
Participant 1
MM
/
DD
/
YYYY
First, Last Name
Participants 2
Participant Birthday
Participant 2
MM
/
DD
/
YYYY
First, Last Name
Participants 3
Participant Birthday
Participant 3
MM
/
DD
/
YYYY
Mother: First, Last Name *
Legal Guardian or Parents
Mother: Email
Mother: Cell Phone # *
Mother: Work Phone #
Father: First, Last Name *
Legal Guardian or Parents
Father: Email
Father: Cell Phone # *
Father: Work Phone #
Resident Address *
Street Address, City, State, & Zip code
Program Interested *
Captionless Image
Required
Dietary restrictions *
Volunteer ONE Get ONE
VOGO or Volunteer One, Get One is a great way to volunteer and earn a free event or earn ALL4KIDS Lessons. Volunteers assist with community outreach, fundraising event,  setup, registration, on-course support, and tear down and generally make the event safer and more enjoyable.  Volunteer today!
VOLUNTEER
Show Your Support! There are may ways to spend your time helping our nonprofit. We value the energy, enthusiasm and talent that volunteers bring and look forward to meeting you!
COVID-19 Screening Agreement *
I agree to read and complete PCA's COVID-19 self-screening assessment before each volunteer shift. PCA works in alignment with Public Health – Los Angeles County to fight community transmission of COVID-19. Staff, volunteers, and visitors are asked to stay at home if they have COVID-19, feel at all unwell, or have been exposed to people who have COVID-19 or its symptoms. This screening tool, adapted from the California State Department of Health, helps folks identify if they fall under those categories.
Required
Liability Release *
I hereby release, indemnify, and hold harmless PCA, its officers, directors, and employees, and the organizers, sponsors, and supervisors of all PCA activities from any and all liability in connection with any injury I may sustain (including any injury caused by negligence) in conjunction with volunteering with PCA.
Required
 Media Release *
In signing below, I agree to be photographed, videotaped, and/or recorded while participating with PCA. I understand that PCA will own rights to and may use this media (photographs, videos, audio recordings, and/or my statements), in whole or part, in PCA materials such as printed publications, the PCA website (www.PCANPO.org), videos, social media, grant proposals, and promotional materials to support PCA and its programs. As far as I know, what I say and do in this media will not violate the rights of any other person or company. If I no longer want my photos and/or story to be used, I agree to contact the PCA Communications Department at Pioneerofchineseamerican@gmail.com or PCA phone #. Once requested, PCA will not create new materials using participants’ media – but we may continue to use already printed materials until we can make replacements.
Required
501(c)(3) non profit Organization
REMINDERS:  All sections marked with * are required. You may mark sections not applicable to you with N/A. QUESTIONS? ALL4KIDS Coordinator: 1 (855) 543-7722 (KIDSPCA) , or Info@PCANPO.org, 4915 Walnut Grove Ave, San Gabriel, CA 91765
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