2020 D-REC2U Summer Virtual Program Registration Form

About this registration form:

This form needs to be completed, separately for each child who will attend the program. Please complete the entire registration form. If the form is incomplete, your child may not be fully registered. This is a registration form, not an application, your child is registered immediately and you do not have to wait for an acceptance letter. If we have questions about the registration form, we will contact you. Please check the box at the bottom of the form to receive a copy of your form. If you have any questions, please call 313-628-0967.

General Information

Please complete all of the required fields. Required fields are marked with an asterisk (*).

Registration Date*

Todays date

Parent Last Name*

Please input the last name of the main parental contact. If there is an additional parent contact, please add in the extra information section.

Parent First Name*

Please input the first name of the main parental contact. If there is an additional parent contact, please add in the extra information section.

Address*

Number and Street Name

City*

Zip Code*

Phone Number*

Is this a Cell Phone?*

Select

Additional Phone Number

Email Address*

Current School*

What school does your child currently attend?

Grade of Student 2019-2020 School Year*

Participant Last Name*

Please input the last name of the participant that will attend the program.

Participant FIrst Name*

Please input the first name of the participant that will attend the program.

Gender of Participant*

Select or enter value

Participant Date of Birth*

Please give in the form mm/dd/yyyy

Age of Participant*

The age of the participant on June 24, 2020.

Device*

Please tell us what type of device you will be using to interact with the programming. You can select more than one.

Select

Special Programming

During the summer, there will be general and special programming. Every registrant will be able to participate in general programming but special programming will be limited. Please let us know if you are interested in special programming so that we can get you the additional information that is needed.

Authoring Program*

Some youth will have the opportunity to become published authors this year. Are you interested in signing your child up for this program? All materials will be provided. Only the firs 200 children will be able to participate. For more information, click this link: https://writebrainbooks.com/images/wbb_at_home_packages_b.pdf

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Detroit Piston's*

The Detroit Piston's will offer different types of programming throughout the summer. Are you interested in participating in this type of programming? Bounce along with this link to see more: www.Pistonsacademy.com/virtual

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Math Enrichment*

We have acquired some help from the NBA as well as MANGO Math. There will be session that will boost math skills and get your child math ready for the new school year. Are you interested in signing your child up for this program? Check out NBA Math Hoops and MANGO Math at these two sites: NBA Math Hoops: http://www.nbamathhoops.org/ and MANGO Math: https://www.mangomath.com/

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Leisure Activities

We have other activities that can be done at anytime during the day to fill in down times for your child. Would you be interested in doing any of the following activities? Check all that apply.

Select

Outdoor Reading Program*

We are encouraging reading and physical activity for every age group. We have three facets of reading for this program. Reading circles for the younger ages, read and walk for older ages and The Walking Classroom for elementary - highschoolers. Check out the information on The Walking Classroom here: https://www.thewalkingclassroom.org/

Select

Medical Information

Medical Restrictions*

Does the participant have any medical needs or restrictions. If there are no medical restrictions please type none.

Accommodations Needed*

Are any accommodations needed for you child on a regular basis.

Yes

If Yes, what is needed?

Allergies*

Yes

List Allergies*

Please list allergies, if none, please type none.

If Yes, is EPI Pen needed?

Emergency Contact Name*

Emergency Contact Phone Number*

Relationship to Participant

Extra Information

Please list any additional information that you would want us to know about your child.

Waiver

Waiver Acceptance*

I will not hold the city of Detroit Recreation Department or any of the instructors or volunteers responsible for any injury that may occur. I further maintain that my child is in good physical condition; and I have notified the instructor of any minor ailments that my child may have. I agree not to send my child to class unless he/she is physically able to participate in all activities. I understand that falsification of information given on this registration form may result in removal of my child from the program. Also, that continuous problems related to my child’s discipline will be considered grounds for dismissal.

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Photo/Video Release*

I hereby authorize and consent to the City of Detroit and anyone it may authorize to interview, photograph, film and video tape my child and or publish, at any time in the future, quotes, photos or film/video footage, with or without my child's name, for any promotion, publicity, advertising or trade purpose.

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