PowerUp for Middle School Registration

upcoming events!

Registration will reopen in February for spring, 2019 events in Greeley, Windsor, and throughout Weld County, Colorado!

See the program page for more information.

Para registrarse en español, haga clic aquí.

Para información del programa en español, haga clic aquí.

Name of parent or guardian *
Name of parent or guardian
Each child must be registered by a parent or guardian
Name of participating student *
Name of participating student
Please provide her legal name. (You may include a preferred nickname in parentheses.)
Parent or guardian phone number *
Parent or guardian phone number
To be used in the event of an emergency
Additional emergency contact name *
Additional emergency contact name
Additional emergency contact phone number
Additional emergency contact phone number
Please fill in "none" or write in allergies to medications or foods
T-shirt size
100% preshrunk cotton, Inches= dimensions of shirt laid flat
Name of parent or guardian signing consent form for child participation
Name of parent or guardian signing consent form for child participation
You have read parent/guardian consent information below this form and consent to your child's participation *
By clicking this button, you agree that as the parent or guardian indicated above, you have read all the consent information provided below, have no questions, and hereby give permission for your child to participate in the program.
Registration fee *
Please select the registration fee you will pay with a credit/debit card. This is a one time fee that covers all 3 afternoon sessions. We're sorry, but we cannot accept checks. After clicking "Submit Registration," you'll be brought to the payment page.
Name on credit card
Name on credit card
Please enter the name on the credit or debit card used to pay registration fee.

AFTER FILLING IN FORM AND CLICKING ORANGE "SUBMIT REGISTRATION" BUTTON,

click inside the white box under "Fee amount" to select your payment. This fee covers all 3 afternoon sessions. Even though this amount won't appear in the white box, it will transfer to PayPal when you click the yellow "Pay Now" button. You don't need a PayPal account, just click the gray button on PayPal that says "Pay with debit/credit card." Thank you!

 
Fee amount
 

After we receive your form submission and payment, we will notify you by e-mail.

Thank you!


PowerUp for Middle School Consent Information

By indicating your consent for your child to participate in the PowerUp for Middle School program while registering online, you verify the following:

1.    You are the parent or guardian of the child registered to participate.

2.    You have reviewed the detailed curriculum on the program page of the website, have read all the consent information here, and have no concerns about your child learning about listed topics and other related topics.

3.    Your registered child is a 5th, 6th, or 7th grade girl.

4.    You understand that this program’s purpose is only educational and not therapeutic. If program facilitators identify a need that may benefit from psychological evaluation or therapy, referral information but not therapy will be given.

5.    You understand the following rules for participant conduct that will optimize the learning experience: respectful, nondisruptive behavior, following program facilitator directions, and keeping cellphones on silent and in a pocket or bag. If any of these rules are violated, you will be called to come and pick up your child.

6.    You agree to have a parent or guardian sign in and sign out your child everyday at the registration desk and to pick up your child each day by 5:20 PM.

7.    You will not hold program facilitators or the Greeley Recreation Center liable for accidents or injuries.

8.    Your child will be provided food and if she has food insensitivities or allergies, it is her responsibility to ask about ingredients in all food she chooses to ingest, and you have discussed this responsibility with her.

9.    You are aware that program facilitators are mandatory reporters of child abuse and neglect.

10.    You permit utilization of photographs or videos of your child taken during her involvement in the program for promotional purposes and waive all rights of compensation.

11.    One of our goals is to learn how to improve the program and assess how well we provide empowering life-skill education. By consenting, you agree to have your child participate in group verbal surveys and to fill out personal anonymous surveys during the program, indicating things such as understanding of the topics and enjoyment of the activities. You also agree to do a quick online anonymous parent-guardian survey after the program. Lastly, you permit us to use summaries of any survey data or anonymous participant quotes in research studies, on our website, or in print materials, etc.