After School Program

Greetings!
Welcome to the 2020-2021 academic school year. We know life has been quite interesting the past few months. Rickenbacker Woods seeks to help relieve some of the uncertainty surrounding your child's education needs. We invite you to enroll your 2nd through 5th grade students in our award winning after school program, the "Inborn Excellence Initiative". New this year is our parent/guardian focused programming. We have teamed up with the Columbus Urban League to offer their "Workforce Empowerment University and Financial Literacy" course.

In August our facility was inspected by the Columbus Health Department and Columbus Fire Department for compliance; we passed both inspections. We will conduct daily temperature checks on both students and staff; also masks are mandatory.

Both of these programs will operate through 2021 and are offered at no cost to you*. We are appreciative to Governor Mike DeWine's office of Faith Based and Community Initiatives for their strong support of the Rickenbacker Woods Foundation and its initiatives.
Interested? Please apply below. Questions? Call 614.427.3201 or email rickenbackerwoods@gmail.com for more information.
*Applicants must meet State of Ohio income eligibility guidelines. Please download and complete the eligibility form below and return to rickenbackerwoods@gmail.com.

odjfs_earmark_non-assistance_participant_self_attestation_application_7-22-19.docx
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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 *

COLUMBUS URBAN LEAGUE "WORKFORCE EMPOWERMENT UNIVERSITY"

Parents of Program Participants are Eligible for Financial Education and Career Readiness classes from the Columbus Urban League's "Workforce Empowerment University" which will be held at Rickenbacker Woods on Tuesdays and Thursdays. If you are interested, please indicate this below, and your information will be forwarded to the Columbus Urban League so that they can contact you with more information.

I would like to attend the Columbus Urban League's Workforce Empowerment University *

Yes No

If yes, please read and sign below:
I would like to enroll in the Columbus Urban League's "Workforce Empowerment University" and authorize Rickenbacker Woods Foundation to share the information on this application with them for that purpose.

Participant Signature *

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

COLUMBUS URBAN LEAGUE "WORKFORCE EMPOWERMENT UNIVERSITY"

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