Student Enrollment Form

Student Enrollment Form: 2026-2027 Program Year

Please Select for the 2026-2027 School Year

Program Location(Required)

Heritage Academy - Hapeville, GA (Atlanta Public Schools)

William M. Boyd Elementary - Atlanta, GA (Atlanta Public Schools)

Fickett Elementary - Atlanta, GA (Atlanta Public Schools)

Emma Hutchinson Elementary - Atlanta, GA (Atlanta Public Schools)

Arthur W. Christopher Community Center - Charleston, SC (Charleston County School District)

2026-2027 Program Information

Program begins 8/24/2026
Program starts daily at 2:45 and ends at 5:45
Note: Dismissal/pick-up begins no earlier than 5:15 and ends at 5:45. Student pick-up after 5:45 may result in dismissal from the program.

2026-2027 Program Information

Program begins 8/17/2026
Program starts daily at 2:15 and ends at 5:15
Note: Dismissal/pick-up begins no earlier than 4:45 and ends at 5:15. Student pick-up after 5:15 may result in dismissal from the program.

What elementary school does your child attend?(Required)

Charleston Development Academy

Other

Grade(Required)

WINGS Programs are NOT accepting Pre-K students at this time.

Student Information

Student's Name(Required)

Student First Student Middle Student Last

Student's Date of Birth(Required)

Student's Race(Required)

Black or African American

White or Caucasian

Asian or Pacific Islander

Native American or Alaska Native

Biracial

Multiracial

A race not listed here

Student's Ethnicity(Required)

Hispanic or Latino

Non-Hispanic or Latino

Primary Language Spoken at Home(Required)

English

Spanish

Other

Student's Gender(Required)

Female

Male

Home Address(Required)

Street Address City State ZIP Code

Parent/Guardian Contact Information

Parent/Guardian Name(Required)

Parent First Parent Last

Parent/Guardian Cell Phone(Required)

Parent/Guardian Home Phone

Parent/Guardian Email(Required)

Enter Email Confirm Email

Parent/Guardian 2 Name

Parent 2 First Name Parent 2 Last Name

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 Home Phone

Parent/Guardian 2 Email

Other Important Information

Will your child ride the CCSD school bus to the Center's nearest stop (Line & Flood St)?(Required)

A WINGS Leader will meet all students who are dropped of at the Line St & Flood St stop, next to Charleston Development Academy, and walk with them to the Center. PLEASE NOTE: Pick-up after WINGS is required. The bus will NOT be running after WINGS.

Yes

Not sure yet

How Will Your Student(s) Get Home After WINGS?(Required)

Your choice of transportation indicates your child's main mode of transportation for the year. If your child walks or bikes home, they must be in 3rd grade or above to walk or bike alone. For kindergarten to 2nd grade students who walk or bike, they must be accompanied by an older sibling or adult. Any temporary changes to transportation require notification before 5:00 pm.

Pick-up

Walk/Bike

Authorized Pick-Up People

Please list people who you authorize to pick up your child from WINGS and list what their relationship is to you/child/family.

Pick-Up Person 1(Required)

Pick-Up 1 First Name Pick-Up 1 Last Name Relationship 1 to Student

Pick-Up Person 2

Pick-Up 2 First Name Pick-Up 2 Last Name Relationship 2 to Student

Pick-Up Person 3

Pick-Up 3 First Name Pick-Up 3 Last Name Relationship 3 to Student

Emergency Contact(Required)

Emer Contact First Emer Contact Last

Emergency Contact Phone(Required)

Emergency Contact Relationship to Student(Required)

Student's Known Allergies and/or Medications

Supporting Your Child's Experience(Required)

Does your child have an Individualized Education Program (IEP) or receive any school-based support services?

Yes

Prefer not to answer

What supports or strategies help your child be successful?(Required)

This information is optional and will not impact acceptance into the program

Why did you choose WINGS?(Required)

Consent & Waivers

As the Adult checking the consent box below: (1) I am giving up substantial actual or potential rights in order to allow the child to participate in WINGS; (2) I have signed this Agreement without any inducement or assurance of any nature, and with full appreciation of the risks inherent in WINGS; (3) I have fully read the Agreement in its entirety, have paid particular attention to the bolded language, and have had an opportunity to have all my questions answered regarding the scope or intent of this Agreement prior to acceptance; (4) I, as a parent or legal guardian, have the right and authority to enter into this Agreement, and to bind myself, and my child participating in WINGS to the terms of this Agreement; (5) I have explained this Agreement to the child, who understands his/her obligations.

Consent(Required)

I Agree to the Wings for Kids Program Participation Waiver for Charleston County School District

In consideration for the Child’s ability to participate in the Wings for Kids After School Program (“WINGS”) operating at Arthur W. Christopher Community Center (“AWCCC”), in partnership with the City of Charleston for the 2026-27 school year, the Parent or Legal Guardian (“Adult”) signing this Agreement agrees as follows:

1. It is a privilege, not a right, to participate in WINGS. The privilege may be revoked at any time, for any reason, that does not violate Federal, State, or District laws, policies, or procedures.

2. WINGS is a free after school program and there is no cost to parents/families including in-kind or monetary donations. WINGS is not a licensed child care provider and therefore is exempt from any local, state, or federal child care licensing regulations.

3. WINGS provides an engaging, safe space after school, and supports the social and emotional well-being of children.

4. Designated program times of WINGS shall be communicated with parents/families. WINGS is only responsible for the child during the designated program times. Upon dismissal from the program, whether by car, bus, or walking, I release WINGS and the City of Charleston from any responsibility and/or liability that may result once the child is no longer present in WINGS during designated program times.

5. I have been given ample opportunity to ask questions about the environment in which the child will be and the activities in which the child will participate during attendance in the program. The Adult understands the nature of the program, activities, and lessons at WINGS, including the inherent or potential risks of after school programming, such as bodily contact during athletics or playground time and the use of tools and materials in arts class. By this Agreement, the child and Adult are deemed to fully assume all such risks and understand and agree to the fullest extent allowed by law they are waiving and releasing any potential future claim (including reasonable attorneys’ fees) they might otherwise have been able to assert against WINGS, the City of Charleston, or any Board or Council Member, employee, agent, volunteer of WINGS, or the City of Charleston “(“Released Parties”) by or on behalf of the child or any parent, administrator, executor, trustee, guardian, or family member.

6. WINGS provides field trips throughout the year. I give permission for the child to attend such field trips or excursions. I understand WINGS shall provide notice when children are going on these trips and I must provide 48 hours advance notice if my child is not allowed to attend a specific trip. This Agreement may be photocopied as field trip permission. I grant permission for the child to be transported to and from WINGS and to and from field trips or other excursions by car, bus, or walking, whether directly by WINGS or contracted service with another company/organization (i.e. Samson Trailways). The Adult completely releases and forever discharges WINGS, the City of Charleston, and WINGS board and City council members, employees, affiliates, agents, and volunteers, from all potential claims, demands, injuries, and damages of any nature whatsoever, including medical expenses, court costs, legal expenses, and attorney’s fees, which the Adult or child has, and are related in any way to transportation services.

7. The child is in sufficiently good health and physical condition to participate in WINGS, and voluntarily chooses to participate in WINGS.

8. Any pre-existing health or medical condition shall be provided to WINGS by a licensed medical practitioner with a statement that the child has been physically examined and is deemed to be in sufficiently good health and fitness so that the child may fully participate in WINGS. Documentation must be provided prior to participation in WINGS.

9. Emergency medical information regarding the child is on file with WINGS. The Adult agrees to provide updated medical information during the course of the child’s participation in WINGS. If an injury or medical emergency occurs during WINGS, WINGS employees, volunteers, agents have my express permission to administer or to authorize the administration of urgent or emergency care, including the transportation of the child to an urgent care or emergency care provider. In such circumstances, notice to me and/or the Emergency Contact of the injury or medical emergency may be delayed. Therefore, any urgent or emergency medical care provider has my express authority to conduct diagnostic or anesthetic procedures, and/or to provide medical care or treatment (including surgery), as they may deem reasonable or necessary under all existing circumstances. I also consent to WINGS, the District, and/or the school to release any and all information for the purposes of such medical care and/or for insurance purposes. All costs and expenses associated with such care are solely my responsibility.

10. The child shall comply with the instructions and directions of WINGS staff, volunteers, agents, and instructors. During the child’s participation in WINGS, including any academic and/or other activities, the child shall comply with all applicable District, school, and WINGS Codes of Conduct. The child shall generally conduct himself/herself at all times in keeping with the highest moral and ethical standards so as to reflect positively on himself/herself, WINGS, the District, and School. Failure to meet these obligations may, in the discretion of WINGS, result in immediate removal from WINGS. Should the violation of these obligations also result in bodily injury or property damage during WINGS, the Adult will (a) pay to restore or replace any property damaged as a result of the child’s violation, (b) pay any damages caused to bodily injury to an individual, and (c) defend, protect, and hold WINGS and the City of Charleston harmless from such property damage or bodily injury claims.

11. The Adult understands WINGS does not condone, authorize, or engage in any type of corporal punishment.

12. Employees, agents, or volunteers of WINGS, members of the press or media, or other persons who may attend or participate in WINGS activities, may photograph, videotape, or take statements from the child. Such photographs, videotapes, recordings, or written statements may be published or reproduced in a manner showing the child’s name, face, likeness, voice, thoughts, beliefs, or appearance to third parties, including, without limitation, webcasts, television, motion pictures, films, newspapers, yearbooks, and magazines. Such published or reproduced items, whether or not for a profit, may be used for security, training, advertising, news, publicity, promotional, informational, or any other lawful purpose. I hereby authorize and consent to any such publications or reproductions, without compensation, and without reservation or limitation. If I do not consent to any such publications or reproductions I will notify WINGS in writing.

13. I authorize and approve the school district and/or school in which the child attends, to release the following data to WINGS for the purposes of grant reporting, research and evaluation purposes, and/or monitoring child achievement: (a) Demographic data (including but not limited to, race/ethnicity, grade level, school name); (b) Limited English Proficiency (LEP) status; (c) Exceptional Children (EC) and/or Gifted (AIG) status; (d) course grades; (e) standardized test score, levels, proficiency occurring throughout the year; (f) attendance data; (g) behavior data (including suspensions); (h) promotion/retention; (i) student identification number. I also authorize and agree to the release of identifiable child data from the two previous school years to WINGS.

14. WINGS engages in research and evaluation and may ask participants to complete surveys to help WINGS evaluate its program. All collected data will be confidential. Participation is not mandatory. I acknowledge that I understand this information about program evaluation and agree to allow the child to participate in such research. I acknowledge that I understand and agree to allow WINGS to share the child's data (as outlined in #13) to third parties, specifically and only for, education and research purposes (including South Carolina Afterschool Alliance and researchers such as Public Profit). If I prefer the child not to participate, I will notify WINGS in writing.

15. This Agreement shall be governed by the laws of the State of South Carolina. This Agreement is to be broadly construed to enforce the purposes and agreements set forth above, and shall not be construed against the Released Parties solely on the basis that this Agreement was drafted by WINGS. If any part of this Agreement is deemed invalid or ineffective, all other provisions shall remain in force. No oral modification of this Agreement, or alleged change or modification of its terms by subsequent conduct or oral statements, is allowed. This Agreement contains the sole and exclusive understanding of the parties, with no other representation relied upon by the Adult or child in determining whether to execute this Agreement or in agreeing to participate in WINGS.

As the Adult signing below: (1) I am giving up substantial actual or potential rights in order to allow the child to participate in WINGS; (2) I have signed this Agreement without any inducement or assurance of any nature, and with full appreciation of the risks inherent in WINGS; (3) I have fully read the Agreement in its entirety, have paid particular attention to the bolded language, and have no question regarding the scope or intent of this Agreement; (4) I, as a parent or legal guardian, have the right and authority to enter into this Agreement, and to bind myself, the child, and any other family member, personal representative, trustee, or guardian to the terms of this Agreement; (5) I have explained this Agreement to the child, who understands his/her obligations.

Date(Required)

Consent(Required)

I Agree to the Wings for Kids Program Participation Waiver for Atlanta Public Schools

In consideration for the Child as named above (the “Child”) to participate in the Wings for Kids After School Program (“WINGS”) operating in Atlanta Public Schools District (“District”), for the 2026-27 school year, the Parent or Legal Guardian (“Adult”) signing Participation Waiver (the “Waiver”) agrees as follows:

1. It is a privilege, not a right, to participate in WINGS. The privilege may be revoked at any time, for any reason, that does not violate Federal, State or District laws, policies, or procedures.

2. WINGS is a free after- school program and there is no cost to parents/families including in-kind or monetary donations. WINGS is not a licensed child care provider, and therefore is exempt from any local, state, or federal child care licensing regulations.

3. WINGS provides an engaging, safe space after school, and supports the social and emotional well-being of children.

4. Designated program times of WINGS shall be communicated with parents/families. WINGS is responsible for the dismissal of all WINGS students. Once students are enrolled in the WINGS program, a sign-out process is established for each child. This process allows the parent or guardian to list themselves and any additional adults responsible for signing the student out. Students are only released to adults listed on the pick-up list. Adults' identification is verified through ID or Driver's license. Once the guardian and our program coordinator implement the dismissal plan, it shall be communicated to the School to ensure everyone is aware.

5. I have been given ample opportunity to ask questions about the environment in which the child will be and the activities in which the child will participate during attendance in the program. The Adult understands the nature of the program, activities, and lessons at WINGS, including the inherent or potential risks of after school programming, such as: bodily contact during athletics or playground time and use of tools and materials in arts class. In consideration for the privilege of participating in the WINGS program, I hereby agree to release, indemnify, and hold harmless Atlanta Independent School System, its Board of Education, Atlanta Public Schools, its officers, employees, agents, and affiliates (“APS Indemnitees”) and WINGS, its owners, officers, employees, agents, and affiliates (“WINGS Indemnitees”) from any and all claims, demands, actions, or causes of action arising out of or related to any loss, damage, or injury, including death, that may be sustained by me or any party affiliated with me, whether caused by the negligence of the released parties or otherwise.

6. WINGS provides field trips throughout the year. I give permission for the child to attend such field trips or excursions. I understand WINGS shall provide notice when children are going on these trips and if my child is not permitted to participate in any field trip or excursion, I must decline my child’s participation at least 48 hours in advance of the scheduled trip or excursion. This Agreement may be photocopied as field trip permission. I grant permission for the child to be transported to and from WINGS and to and from field trips or other excursions by car, bus, or walking, whether directly by WINGS or contracted service with another company/organization approved by WINGS (i.e. Samson Trailways). The Adult completely releases and forever discharges the board members, officers, employees, affiliates, agents, and/or volunteers of WINGS, the Atlanta Independent School System, and the Atlanta Board of Education from all potential claims, demands, injuries, and damages of any nature whatsoever, including medical expenses, court costs, legal expenses, and attorney’s fees, which the Adult or child has, and which are related in any way to transportation services.

7. The child is in sufficiently good health and physical condition to participate in WINGS, and voluntarily chooses to participate in WINGS.

8. Any pre-existing health or medical condition shall be provided to WINGS by a licensed medical practitioner with a statement that the child has been physically examined and is deemed to be in sufficiently good health and fitness so that the child may fully participate in WINGS. Documentation must be provided prior to participation in WINGS.

9. Emergency medical information regarding the child is on file with WINGS. The Adult agrees to provide updated medical information during the course of the child’s participation in WINGS. If an injury or medical emergency occurs during WINGS, WINGS employees, volunteers, and agents have the Adult’s express permission to administer or to authorize the administration of urgent or emergency care, including the transportation of the child to an urgent care or emergency care provider. In such circumstances, notice to the Adult and/or the Emergency Contact of the injury or medical emergency may be delayed, however, by the signature below, the Adult authorizes the emergency care provider to administer life- saving treatment to the child if needed. All costs and expenses associated with such care are solely the Adult’s responsibility.

10. The child shall comply with the instruction and directions of WINGS staff, volunteers, agents, and instructors. During the child’s participation in WINGS, including any academic and/or other activities, the child shall comply with all applicable District, School, and WINGS Codes of Conduct. The child shall generally conduct himself/herself at all times in keeping with the highest moral and ethical standards so as to reflect positively on himself/herself, WINGS, the District, and School. Failure to meet these obligations may, in the discretion of WINGS, result in immediate removal from WINGS. Should the violation of these obligations also result in bodily injury or property damage during WINGS, the Adult will (a) pay to restore or replace any property damaged as a result of the child’s violation, (b) pay any damages caused due to bodily injury to an individual, and (c) defend, protect, and hold WINGS, the District, and the School harmless from such property damage or bodily injury claims.

11. The Adult understands WINGS does not condone, authorize, or engage in any type of corporal punishment.

12. Employees, agents, or volunteers of WINGS, members of the press or media, or other persons who may attend or participate in WINGS activities, may photograph, videotape, or take statements from the child. Such photographs, videotapes, recordings, or written statements may be published or reproduced in a manner showing the child’s name, face, likeness, voice, thoughts, beliefs, or appearance to third parties, including, without limitation, webcasts, television, motion pictures, films, newspapers, yearbooks, and magazines. Such published or reproduced items, whether or not for a profit, may be used for security, training, advertising, news, publicity, promotional, informational, or any other lawful purpose. I hereby authorize and consent to any such publications or reproductions, without compensation, and without reservation or limitation. If I do not consent to any such publications or reproductions I will notify WINGS in writing.

13. I authorize and approve the District and/or School to release the following data to WINGS for the purposes of grant reporting, research and evaluation purposes, and/or monitoring child achievement: (a) Demographic data (including but not limited to, race/ethnicity, grade level, school name); (b) Limited English Proficiency (LEP) status; (c) Exceptional Children (EC) and/or Gifted (AIG) status; (d) course grades; (e) standardized test score, levels, proficiency occurring throughout the year; (f) attendance data; (g) behavior data (including suspensions); (h) promotion/retention; (i) student identification number. I also authorize and agree to the release of identifiable child data from the two previous school years to WINGS.

14. WINGS engages in research and evaluation and may ask participants to complete surveys to help WINGS evaluate its program. All collected data will be confidential. Participation is not mandatory.
_______I acknowledge that I understand this information about program evaluation and agree to allow the child to participate in such research.
_______I prefer my child not participate and am opting out of participation in research and evaluation surveys.

15. This Agreement shall be governed by the laws of the State of Georgia. This Agreement is to be broadly construed to enforce the purposes and agreements set forth above, and shall not be construed against the Released Parties solely on the basis that this Agreement was drafted by WINGS. If any part of this Agreement is deemed invalid or ineffective, all other provisions shall remain in force. No oral modification of this Agreement, or alleged change or modification of its terms by subsequent conduct or oral statements, is allowed. This Agreement contains the sole and exclusive understanding of the parties, with no other representation relied upon by the Adult or child in determining whether to execute this Agreement or in agreeing to participate in WINGS.

As the Adult signing below: (1) I am giving up substantial actual or potential rights in order to allow the child to participate in WINGS; (2) I have signed this Agreement without any inducement or assurance of any nature, and with full appreciation of the risks inherent in WINGS; (3) I have fully read the Agreement in its entirety, have paid particular attention to the bolded language, and have had an opportunity to have all my questions answered prior to signing question regarding the scope or intent of this Agreement; (4) I, as a parent or legal guardian, have the right and authority to enter into this Agreement, and to bind myself, and my child participating in WINGS to the terms of this Agreement; (5) I have explained this Agreement to the child, who understands his/her obligation.

Date(Required)

Research & Evaluation Consent(Required)

WINGS engages in research and evaluation and may ask participants to complete surveys to help WINGS evaluate its program. All collected data will be confidential. Participation is not mandatory.

I acknowledge that I understand this information about program evaluation and agree to allow the child to participate in such research.

I prefer my child not participate and am opting out of participation in research and evaluation surveys.

21st Century Community Learning Center & WINGS

Date

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