After School Program

Greetings!

Welcome to the 2022-2023 academic school year. School has been different in past years, with part of that time being self-guided and outside of the classroom. Rickenbacker Woods seeks to help relieve some of the uncertainty surrounding your child's education needs.

We're now accepting applications to enroll your 1st to 6th grade students into our award winning after school program, the "Inborn Excellence Initiative".

Our program provides Homework & Technology Help, Literacy and Mathematics Programming, Social Skills Exercises, Activities (Art, Science Experiments, Planting, Games, Movies, etc), Field Trips at No Cost to Parents and Snacks are Provided.

The health and safety of our visitors, students, and staff is extremely important to us. We will conduct temperature checks upon arrival and require masks if/when deemed necessary per local guidelines.

Interested? Please apply below. Questions? Call 614.427.3201 or email rickenbackerwoods@gmail.com for more information.

Please complete the following information:

* Indicates required field

Child's Name *

First

Last

Gender *

Female Male

Student’s Date of Birth *

Student’s Age *

Race *

Ethnicity *

Hispanic Non-Hispanic

School *

Grade *

Name of Student's Teacher *

If you have more than one child, please provide information for additional children below:

Child's Name *

First

Last

Gender *

Female Male

Student’s Date of Birth *

Student’s Age *

Race *

Ethnicity *

Hispanic Non-Hispanic

School *

Grade *

Name of Student's Teacher *

Child's Name *

First

Last

Gender *

Female Male

Student's Date of Birth *

Student's Age *

Race *

Ethnicity *

Hispanic Non-Hispanic

School *

Grade *

Name of Student's Teacher *

Name of Parent(s) /Guardian(s) *

First

Last

Name of Parent(s) /Guardian(s) *

First

Last

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Work Number *

Cellphone Number *

Parent's Email Address *

Note: If any of the above information changes, please notify the Rickenbacker Woods office immediately

EMERGENCY CONTACT INFORMATION

List two emergency contacts other than those listed above:

Name *

First

Last

Relationship *

Phone Number *

Alternate Phone Number *

Name *

First

Last

Relationship *

Phone Number *

Alternate Phone Number *

Medical Problems/Allergies/Food Restrictions

Does your child have any food, medication or environmental allergies? *

Yes No

If yes, please explain below: *

Does your child have a special health or medical condition? *

Yes No

If yes, please explain below: *

Is your child currently using any medication? *

Yes No

If yes, please explain below: *

Is your child restricted from eating any foods due to religious or other reasons? *

Yes No

If yes, please list restricted foods: *

**If emergency medical care is necessary and I cannot be reached, I authorize the Rickenbacker Woods Foundation to act on my behalf in granting permission for my child to receive emergency medical treatment. Parents are responsible for all expenses incurred as the result of medical treatment.

Parent/Legal Guardian Signature *

Date *

CHECK-OUT AUTHORIZATION

The following individuals are authorized to check-out the above named student from all Rickenbacker Woods/Inborn Excellence Initiative activities.

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Relationship *

Add additional names if needed: *

Please note, if anyone is PROHIBITED from contacting or checking
out the student.

Specify the individual(s) below:

Name *

First

Last

Name *

First

Last

Parent/Legal Guardian Signature *

Relationship *

Date *

HOLD HARMLESS RELEASE

I hereby waive, release, absolve, indemnify, and agree to hold harmless the Rickenbacker Woods Foundation, the State of Ohio, Capital University, the Columbus Urban League and other partners associated with the Inborn Excellence Initiative; all directors, officers, organizers, sponsors, supervisory staff, participants, and any other affiliates; for, from, and against all liability because of any bodily injury, or property damage, known or unknown, which may occur or result from the participation of the above named child in any and all activities whether the result of negligence or for any other cause of the Rickenbacker Woods Foundation. I individually, and as a parent/guardian for my child, have read this release and understood all the terms. I execute it voluntarily and with full knowledge of its significance.

Parent/Guardian Signature: *

Date *

COVID-19 RELEASE

The Novel Coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. The Rickenbacker Woods Foundation (RWF) has put in place preventative measures to reduce the spread of COVID-19; however, the RWF cannot guarantee that you/your child will not become infected with COVID-19. Further, attending the RWF or the event listed within this contract could increase you/your child's risk of contracting COVID-19.
I individually, and as a parent/guardian for my child, have read this release and understood all the terms. I execute it voluntarily and with full knowledge of its significance.

Parent/Guardian Signature: *

Date *

AUTHORIZATION TO PRODUCE AND USE AUDIO/VISUAL MATERIALS

I hereby voluntary and without compensation authorize the Rickenbacker Woods Foundation, the City of Columbus & Capital University to produce photographs, movies, videotapes, audio-tapes, and Power Point Presentations of the below named student. This authorization is given on the condition that the materials taken or produced will be used for the purpose of community education or program promotion. I understand Rickenbacker Woods Foundation, the City of Columbus, Capital University and its partners will not use these materials for compensation. I understand that this grant of permission shall only be revoked by a written instrument delivered to the Executive Director of the Rickenbacker Woods Foundation. This consent shall remain in effect, unless revoked.

Parent/Guardian Signature *

Date *

I agree to receiving marketing and promotional materials *

Submit

INborn Exellence after school Program

​EMERGENCY CONTACT INFORMATION

Medical Problems/Allergies/Food Restrictions

CHECK-OUT AUTHORIZATION

HOLD HARMLESS RELEASE

COVID-19 RELEASE

AUTHORIZATION TO PRODUCE AND USE AUDIO/VISUAL MATERIALS​

EMERGENCY CONTACT INFORMATION

AUTHORIZATION TO PRODUCE AND USE AUDIO/VISUAL MATERIALS