Afterschool Registration
Event Duration: October 23, 2023 - June 25, 2024
Monday through Friday 2:30m - 6:00pm
Address: 401 South Avenue Syracuse, NY 13204
Contact Us: (315) 474-6823 or receptionist@smnfswcc.org  

Please answer each question accurately or your application will be denied.
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Parent/Guardian First Name *
Parent/Guardian Last Name
 *
Street Address *
City, State *
Zip Code *
Phone Number
 *
Email *
Child's First Name ( must complete separate application for any additional children) *
Child's Last Name *
Child Date of Birth *
MM
/
DD
/
YYYY
Child Age *
Child Current School *
Emergency Contact Name *
Emergency Contact Phone Number *
How Will Your Child(ren) Get Home?  *
Required
Child's Interests/Hobbies *
Required
Can Your Child Swim? *
Dietary restrictions/Food Allergy *
Required
Any Allergies/Medication/Health Conditions: *
Required
Code of Conduct
Rules:
  • Identification is required to enter the building
  • NO children under the age of 5 years old allowed in the facility unsupervised by an adult
  • All pants must be worn at waist height
  • All children must be dressed appropriately (up to the discretion of staff)
  • Absolutely NO sleeping on the premises 
  • Absolutely NO disrespect toward staff will be tolerated (After 3 infractions, you will be barred from the building until further notice)
  • No loitering on the premises
  • No soliciting on the premises
  • No drug sales anywhere in or around the building (parking lot included)
  • No gambling anywhere in or around the building
  • All youth should be picked up by 6:00pm. Otherwise, SCC has the right to call DSS
  • No foul language
  • No defacing property
  • No one under the influence of drugs or alcohol will be allowed in the building
  • No weapons of any kind
  • No horseplay or fighting
  • No smoking in or on the property
  • No running in the building (excluding the gymnasium)
  • No threatening or intimidating peers, staff, or guests
  • No stealing , destroying, misusing, or defacing anyone's property
  • Must comply with all safety regulations
  • Report to management of all suspicious, unethical, or illegal activity 
  • Must give proper advance notice when unable to report to program on time 

I have fully read and understand the rules and expectations listed above. I have read and explained the importance of abiding by the code of conduct to my child(ren). If my child does not adhere, I understand that my child's privileges( field trips, activities, and enrollment) can be revoked. I have also been informed that there are cameras on the premises. 
 *
Required
Waiver and Release of Liability
I hereby give permission for my child(ren) to participate in the Syracuse Community Connections (the "SCC") After School Camp.

Participation in any program which involves physical activities exposes the youth to certain risks and dangers. Accidents and injuries are always a possibility, and it is impossible to foresee and protect the youth from all conceivable dangers. 

I hereby affirm that my child(ren) has/have no conditions that would make it unsafe for him/her/them to participate in camp activities and/or program(s).

I understand that we are still amid a global pandemic and that the highly contagious nature of COVID-19, and the fact that individuals infected with COVID-19 may be asymptomatic, creates risk of infection from any activity involving contact with others. I understand and acknowledge that I am responsible for reviewing SCC's health and safety protocols for After School Camp and ensuring that I and my child(ren) follow those protocols. I acknowledge that SCC has implemented reasonable preventative protocols , policies, and procedures designed to reduce the spread of COVID-19 during camp. I voluntarily assume the risk that my child(ren) may be exposed to or infected by COVID-19 while attending camp.

I understand that SCC may exclude my child(ren) from camp if I or my child(ren) fail to abide by the SCC's health and safety protocols, disrupt, impede, or interfere with the operations of camp, or threaten the health, safety, or welfare of the other participants of camp staff, and that no refund of any donations will be made in such circumstances. 


I have read, understand, and accept the "Waiver and Release of Liability" policies. I am 18 years or older and responsible for the participant(s). *
Required
Medical Consent

I understand that SCC will make every effort to contact me in case of an emergency. I give permission for SCC to administer any medications needed and to provide and arrange for the consent to any necessary medical treatment for my child(ren) while at camp, including onsite and offsite emergency care. I accept responsibility for the costs of all such medical treatment.
 *
Photography Release

In consideration of child(ren)'s participation at camp, and without any further consideration from SCC, I hereby grant permission to SCC, staff, and affiliates to utilize my child(ren)'s appearance, performance, or voice in all manner and media throughout the world for the purpose of promotion, reporting, or publication. SCC may use my child(ren)'s likeness , voice, and biographical material in connection with publication, promotion, exhibition, and distribution of such material. I understand no royalty fee or any other compensation of any kind shall become payable to me by reason of such release andd use of any photography.
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