Summer Enrichment 2021 - Volunteer Registration
Program Dates: Monday, June 28th thru Thursday, August 6th 2021 at Millennium Middle School

* Please note that our ability to meet in person this summer is contingent upon any state/district regulations and approvals. If at any point the district or state determines that safety guidelines no longer permit in-person activities, we are obligated to follow their recommendations. I will always do my best to keep you posted on any changing or evolving decisions.

|  CONTACT  |

[Doreen Brant, South Lyon Area Youth Assistance Caseworker]
brantd@oakgov.com
(248) 766-9408
(248) 573-8189

[Sue Collins-Schroeder, South Lyon Area Youth Assistance Secretary]
slayasecretary@gmail.com
(248) 573-8189

[Jenny Cort, Summer Enrichment Program Coordinator]
admin@slsummerenrichment.org

[Marcie Kryka, Summer Enrichment Program Director]
director@slsummerenrichment.org

[Youth Assistance Website]
http://www.slcs.us/youth_assistance.php

[Summer Enrichment Website]
http://slsummerenrichment.org

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Participant Name *
Birth Date *
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Age *
Grade in Fall 2021 *
My student is volunteering for... *
Gender *
T-Shirt Size *
Parent/Guardian Name(s) *
Full Home Address *
Primary Phone Number *
Secondary Phone Number
Does your student have a method of communication by which staff may contact him/her? If yes, please provide it in the space below (call, text, email, etc.) *
Does your student have permission to leave campus for our daily lunch period, 12:00-1:00? (If yes, please be sure to download the permission slip on our website from the Volunteer Registration page.) *
Parent Email #1 *
Parent Email #2
Additional Emergency Contact(s)
Consent and Release
I grant permission for my child to participate in the South Lyon Area Youth Assistance (SLAYA) Summer Enrichment Program and Summer Enrichment, including all on-site and off-site activities.  SLAYA is authorized to consent to emergency medical treatment if the need arises while the child is in the program. I agree to pay all costs incurred to provide medical care. I understand that SLAYA, its officers, directors, agents, and representatives, and employees, whether voluntary or employed, assume no responsibility for any injury suffered by or medical emergency occurring to this child in the course of the program. On behalf of myself and this child and to the full extent permitted by law, I hereby release exonerate, and discharge SLAYA and its officers, directors, agents, representatives, and employees, whether voluntary or employed, for any and all liability, damages, actions, or causes of action for any injuries suffered by or medical emergency occurring to this child while enrolled in the program.

In addition, I understand and agree that SLAYA and/or its officers, directors, contractors, agents, and representatives will and are hereby authorized to make audio and/or video recordings, capture photographs, and edit footage of the Summer Program activities. On behalf of myself and this child, I hereby authorize SLAYA without payment to myself or on behalf of this child, to record this child’s picture, video, and voice on photographs, films, and tapes, to edit these recordings at its discretion, and to incorporate these recordings into movie and sound films, broadcasts programs, public relations and advertising materials, Facebook, Instagram, YouTube, Zoom, and additional social media platforms.


Parent Digital Signature and Date

I hereby agree/consent to the above. In lieu of handwritten signature, I have provided my full typed name and date below.
Sign by Typing Full Name (Parent/Guardian) *
Today's Date *
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Volunteer Oath - Virtual Consent
"I understand that I must follow the school dress code when volunteering Youth Assistance. I must wear SLAYA Summer Program t-shirts, & appropriate shorts or pants.

I also understand that I must arrive on time and be ready to be a mentor and a leader in the classroom for which I am assigned. Meaning that I will speak appropriately, listen to staff members and do what I can to better the participants’ Summer Enrichment experience.

I understand that if I do not follow what is stated above, I will be given a warning. If the warning does not change the choices I was making, I will kindly be asked to leave the program as a volunteer until I can be a positive mentor.

I am ready for a great summer!"

Volunteer Digital Signature and Date

I hereby agree/consent to the above. In lieu of handwritten signature, I have provided my full typed name and date below.
Sign by Typing Full Name (Student Volunteer) *
Today's Date *
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