After School Program

Greetings!
Thank you for considering the Inborn Excellence Initiative at Rickenbacker Woods Foundation for your child's enrichment and development. We look forward to having your child join us for a fun and educational experience!

About the Program
The Inborn Excellence Initiative Award-Winning After School Program is a fantastic opportunity for 4th, 5th, and 6th-grade students to engage in a fun, enriching, and educational experience outside of regular school hours. Our program aims to provide a safe and supportive environment where children can learn, grow, and have fun with their peers.
Program Details:

Grade Levels: 4th, 5th, and 6th graders
Days: Mondays, Wednesdays, and Fridays
Time: 4:00 PM - 7:00 PM (Doors open at 3:30 PM)

What We Offer:

Enrichment: Our program offers a variety of enrichment activities designed to stimulate your child's creativity and learning.
Life Skills: We focus on teaching essential life skills that will benefit your child throughout their life.
STEAM Activities: Engage in exciting Science, Technology, Engineering, Arts, and Mathematics activities.
Snacks: Nutritious snacks are provided to keep your child energized.
NO COST Excursions: We organize educational and fun outings at no additional cost to parents/guardians.
Fun: Your child will have a blast while learning and growing with their peers.

Interested? Please apply below.
Contact Information:
If you have any questions or need more information, please don't hesitate to reach out to us:

Phone: 614.427.3201
Email: rickenbackerwoods@gmail.com

We are excited to welcome your child to our program and provide them with a memorable and enriching after-school experience!

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