Registration Form

First name/Nombre

Last name/Apellido

Email

Student ID Number/Numero de Identificacion de Estudiante

Date of Birth/Fecha de Nacimiento

School /Escuela

Parent/Guardian Full Name- Nombre de Padres

Parent/Guardian Phone Number- Email de Padres

Does the student have any siblings?/ El estudiante tiene hermanos(as)?

Yes

No

This program runs Monday through Friday 8am-2pm. Does your child require aftercare provided by the Boys and Girls Club available 2pm-6pm? Note that a separate registration must be completed.

Yes

No

Este programa funciona de lunes a viernes de 8:00 a 14:00. ¿Su hijo/a necesita el servicio de guardería del Boys and Girls Club, disponible de 14:00 a 18:00? Tenga en cuenta que se requiere registrars

Yes

No

If yes, you must fill out an additional registration form for each high school or middle school student. If no, please provide each additional child’s name, student #, DOB and School Name below. -

Si contesto si, necesita llenar este mismo formulario para cada estudiante por separado.

Does your child have health insurance?/Su hijo(a) tiene seguro medico?

Yes

No

If yes, please provide the name and policy number for your child:

If no, would you be interested in finding out more about insurance/health care options?/Si no, esta interesado en recibir opciones?

Yes

No

Mentorship Programming/Programas de tutoria: Select from the following options if your child would like to participate in mentorship programming./Seleccionar

LVMPD’s DREAM Program (co-ed).

R3demption Community (R3C)’s R3deemed Program (co-ed).

City of Las Vegas’s My Brother’s Keeper Program (males only).

The Embracing Project’s Girls Circle Program (females only).

Does your child have any allergies?/Su hijo(a) tiene alguna alergia?

Yes

No

If yes, what allergies does your child have?/ Si contesto si, cuales son las alergias?

The COOL Program will be partnering with The Harbor to connect families to free resources, supports and services they may need. Would you like your information to be provided?

Yes

No

El programa COOL se asocia con la organizacion 'The Harbor' para conectar a familias con recursos, apoyo o servicios que puedan ser utiles. Le gustaria recibir informacion adicional?

Yes

No

Sports Programming: (Please be aware all children participating in sports programming will require a current sports physical to be provided prior to participation) Select from the following options:

Football

Basketball

Volleyball

Weight Training

Yoga

Science, Technology, Engineering and Mathematics (STEM) Programming: Select from the following options:/ Programas de ciencias, tecnologia, educacion y matematics. Por favor seleccione:

VFF’s Minecraft Madness Program

UNR’s Skin Care Science Lab Program

UNR’s Hydroponics with Microprocessors Program

UNR’s Junior Master Gardner Program

UNR’s Plant Science Program

Nevada Esports Education League (NEEL)’s Esports in Education and Careers Program

Transitioning Boys into Men & Girls into Women

All children participating in Sports Programming will require a current sports physical prior to participation. Please review the following options below and select one.

My child will not be participating in sports programming.

My child will be participating sports programming and I will provide a sports physical from our own physician.

My child will be participating and I would like assistance from the Vegas Force Foundation to obtain a sports physical.

Please select from the following Life & College/Job Readiness Programming: /Programas de vida y para preparacion universitaria y preparacion profesional:

JS Firm Las Vegas’ Adulting 101 Program

UNLV’s Early Outreach Level Up Your Future Program

Jeremy Benton’s World System Builder Program

TheHublv’s Healthy Relationships Program

Todos los estudiantes que desean participar en deportes durante el programa necesitan tener un examen fisico antes de comenzar. Por favor seleccione una opcion

El/la estudiante si participara en deportes y yo obtendre el examen fisico de mi doctor

El/la estudiante si participara en deportes y necesito asistencia de Vegas Force Foundation para completar el examen fisico

El estudiante no participara en deportes

Deportes- Por favor tenga en cuenta que todos los estudiantes que participan en los deportes necesitan tener un examen fisico antes de comenzar. Por favor seleccione los deportes de la lista:

Yoga

Futbol Americano

Baloncesto

Voleibol

Entrenamiento

Music, Arts & Culture Programming: Select from the following options if your child would like to participate in Music, Arts & Culture programming./ Por favor seleccione programas de cultura:

William Bannister’s The Political Power of Hip Hop Program

Gary Gutierrez’s Houdini Wraps Program

UNR’s Painting Practices Program

VFF’s Next Up Podcast Program

BlackQueen Productions’ Ignite and Defy; Inspirational Dance and Leadership Program

Clark County Poet Laureate’s Poetry Class Program

Please select from the following Health & Wellness Programming:/Por favor seleccione los programas de salud y bienestar:

NV Care Coalition’s Resilience Through Adversity Program

UNR’s Nutrition Education Workshop

UNR’s Food SPAN Curriculum

Mingo Health Solutions’ Life Hacks 101 Program

Be a SHERO Foundation’s SHERO Spirit Program

Mother's Against Drunk Driving Power of Youth

I, as the participant or parent or legal guardian of the above-named child(ren), hereby give permission for his/her/their participation in the above-listed activity(ies).

Yes

I authorize, without my prior approval, the rendering of any emergency medical treatment that may become necessary due to his/her/my participation in the activity(ies).

I agree

I have read this release and fully understand its terms. I execute the release voluntarily and with full knowledge of its significance and consequences.

I agree

I have read, understand, and agree to the media release provided.

I agree

I have read, understand, and agree to the sports release provided.

I agree

Vegas Force Foundation

1.COOL Summer Registration Form

2.Event Policies

COOL Summer- Free