Stronger Sons Enrollment - Stronger Than My Father

Emergency Contact(s)

Emergency Contact Full Name

Emergency Contact Relationship

Emergency Contact Phone

Emergency Contact(s)

Pick-Up Authorizations

Individual Full Name

Pick-Up Authorizations

Is your child up to date on immunizations?

Yes No Not Sure

Health Insurance Provider

Does your child have any allergies?

Yes No

Please explain allergies

Does your child have any medical or behavioral conditions?

Yes No

Please explain medical or behavioral conditions

Any dietary restrictions?

Yes No

Please explain dietary restrictions.

What areas would you like your son to grow in?

Why do you want your son to participate?

Is your child currently experiencing any challenges at home or school?

What are your favorite activities?

What is your favorite subject in school?

What career are you interested in?

What is one goal you have for your future?

What kind of leader do you want to become?

Medical Authorization

I authorize Stronger Than My Father to seek emergency medical treatment if needed.

Photo/Media Release

I give permission for my child to be photographed/video recorded for program use.

Data & Academic Tracking Consent

I give permission for Stronger Than My Father to review academic and participation data for program improvement.

Program Expectations Agreement

I understand the expectations of participation and commit to supporting my child’s involvement.