Summer Program Application & Registration Form

Summer Program Application & Registration Form - 2026

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SFUSD ExCEL AFTER SCHOOL PROGRAM INFORMATION: SUMMER 2026 & SCHOOL YEAR 2026-2027

CLICK HERE to view program and application information

ExCEL Enrollment Form

SFUSD ExCEL After School Programs is pleased to offer daily after school programs for students at all SFUSD elementary and middle school sites and two high school sites. Each school site selects a community-based organization to operate the ExCEL program and provide high quality after school experiences for our students.

Purpose of the Programs

The purpose of the after school program is to provide students with academic enrichment opportunities which are designed to compliment students’ regular academic program and provide a safe environment for students. After school programs are designed in collaboration with the schools that the students attend and in alignment with SFUSD guidelines.

How are the programs funded?

All of the SFUSD ExCEL After School Programs in elementary, TK-8, and middle schools are available at low or no cost to families thanks to state and federal grant funds as well as SFUSD’s Expanded Learning Opportunity Program funding and the Department of Children, Youth & Families (DCYF).

SFUSD ExCEL After School Programs in high schools are available at low cost to families at high schools who qualify for state, federal and local grants.

In SFUSD, ExCEL After School Programs are operated through a contract with a Lead Agency, Community Based Organization provider who operates the program in partnership with the school day, funded by a combination of family fees, city, state and federal grants that have a range of requirements and are subject to change from year to year.

While SFUSD is committed to expanding after school programming to meet the needs of all students, the California Department of Education (CDE) also has specific requirements related to Expanded Learning Opportunity Program funding that include providing access to focal populations. For competitive grants like ASES and 21st Century, the California Department of Education (CDE) selects the school sites that receive grants, determines the grant amount, and the number of students served by the grant.

In addition to the local, state and federal grants, Community Youth Center of San Francisco (CYC) also contributes resources, both in-kind and in-cash, in order to serve more families and/or provide more enrichment opportunities for students.

Each school site receiving after school funding is required to:

Operate an after school program with an end time 9 hours after the start time of school. (ie. an 8:40 start school would end after school program at 5:40). For ASES and 21st CCLC-funded sites, programs must operate at least 15 hours/week and until 6pm each day. For ASSETs-funded sites, programs must operate at least 15 hours a week.
Provide academic, enrichment, recreation and physical activities
Provide a nutritious meal
Operate with student-to-staff ratio that will not exceed twenty-to-one (20:1) for grades 1-12 and 10:1 for grades TK/K

Priority for Program Slots

If the demand for ExCEL Programs at a school site exceeds the program capacity, based on California Ed Code, priority enrollment goes to students who are identified by the program as:

Youth experiencing homelessness
Youth in foster care
Low income youth
English language learners
Students who attend the school site location of the after school program

Early Release for the Program

Per State grant guidelines, enrolled elementary & middle school students are expected to attend the program every day until 6pm. Early release from the program can be arranged. Whenever you pick up your child, prior to the end of the program, please be aware that the staff are REQUIRED to give you a code to use on the ExCEL Sign Out Sheet.

Fee based Programs

All ExCEL after school programs in elementary and middle schools are fee based programs. SFUSD has a district wide co-payment fee structure for ALL ExCEL elementary/TK-8 and middle after school programs.

The monthly co-payment fee will be waived for a family with a child in the program who is a homeless youth or for a child who is in foster care
The monthly co-payment fee will be waived for a family that is eligible for Free or Reduced lunch except for those co-payments required by local, state or federal tuition subsidy programs. Families should complete the SFUSD Meal Application on an annual basis to be eligible for the monthly co payment fee waiver. If a family completes the application online, an eligibility letter can be printed from a family’s online account. If a family completes a paper application, an eligibility letter will be sent to the house.
A family that is not eligible for free/reduced lunch may pay a co-payment fee on a sliding scale from $50- $634.25/month.

Americans with Disabilities Act (ADA)

Unlike the school day, which is required to comply with the Individuals with Disabilities Education Act (IDEA), the after school program must comply with Americans with Disabilities Act (ADA). Services and activities provided by a public entity to the public, whether directly or through an agency, must be accessible to students with disabilities with reasonable accommodations (e.g. federal, state and local disabilities rights such as Section 504). Enrollment in the program can include a query if a student needs additional support, but cannot use that information to influence enrollment. If a student has a 504 Plan or an Individual Educational Program (IEP) Plan, the ExCEL program may request access to that information in order to identify what reasonable accommodations can be made to support students' access to the program.

Family Educational Records Privacy Act (“FERPA”)

ExCEL After School Programs complies at all times with the requirements of the Family Educational Records Privacy Act (“FERPA”) and relevant state law regarding the confidentiality and handling of student records, including but not limited to California Education Code sections 49073 and sequential. ExCEL After School Programs shall only access and use confidential student information for the performance of duties on behalf of SFUSD under this Agreement, prior written parent consent, or other provision of federal and state law permitting access to confidential student information. ExCEL After School Programs shall not use confidential student data for any purpose other than providing services to the District pursuant to this Agreement. ExCEL After School Programs shall not re-disclose confidential student information to any third party without the prior written consent of the District and any such re-disclosure shall be consistent with state and federal law.

Safe and Supportive Environments - Interventions and Supports for Behavior

In collaboration with the school day, ExCEL programs must ensure policies and protocols within its program that are sufficient to ensure staff, student and family safety. ExCEL programs are required to document injury, referral and crisis incidents. Each agency will share their interventions and supports for behavior with staff, students and families. Interventions and supports for behavior should include universal practices across the program to promote a safe and supportive community and include an internal process for managing challenging behavior that may result in alternative consequences (e.g. Restorative Circles), Tier II intervention (e.g. behavior contract), or break from the program.

The Safe and Supportive Schools Resolution (SFUSD Board Policy 5144)

The most effective alternative to suspension is the prevention of concerning behaviors through the intentional creation of a positive, relationship-based school community. Through the Safe and Supportive Schools Resolution, SFUSD has committed to providing staff with tools to positively engage students through full implementation of School-Wide Positive Behavior Intervention and Support (SWPBIS) and Restorative Practices (RP), including Trauma-informed Practices that establish high behavior expectations of students in a bias free and culturally competent school community. SFUSD is committed to supporting students through behavior interventions and alternatives to dismissal, suspension or other sanctions that require removal from the educational setting in all cases except those where the immediate safety of students or staff is threatened or the behavior in question is such that the disruption to the educational environment can only be remedied by removal.

Overview of the Three Tiered Behavioral Matrices

SFUSD has worked with school and community stakeholders to develop three tiered behavioral matrices, required by Board Policy 5144 (Discipline) and 5144.1 (Suspension and Expulsion/Due Process) to offer alternatives to suspension referral. These matrices outline interventions for students that can be used to address unwanted student behaviors, and were designed to address disproportionate suspension of African American and Latinx students by helping school sites to identify appropriate and effective alternative approaches to punitive discipline. There are 3 different matrices included in the SFUSD Student and Family Handbook organized based on the types of student behavior being addressed.

Matrix of Supports/Interventions for Defiance and Disruptive Behaviors
Matrix of Supports/Interventions for Serious Behaviors
Matrix of Supports/Interventions for High Risk Behaviors

SFUSD ExCEL Program Funding & Priority/ Free Access Information: ELOP & Other State-funded Expanded Learning Programs

ExCEL Programs are part of SFUSD’s Expanded Learning Opportunities Program (ELOP) which provides state funding for after school and summer programs available for TK-6th grade SFUSD students to participate across all SFUSD elementary, middle and K-8 schools through ExCEL program partners

All SFUSD students are invited to participate
Priority access will be offered to students enrolled in an SFUSD school as TK-6th grade who meet one or more of the criteria noted below (per the California Department of Education):

Qualify for Free/Reduced school meal benefits, as determined by the Multipurpose Family Income Form, or
Designated English Language Learner, or
Designated foster or homeless youth

In addition to priority access, FREE after school programming will be offered to students who

Qualify for Free/Reduced school meal benefits or
Designated foster or homeless youth

Note: ELOP priority is based on verified documentation on file with SFUSD confirming the above criteria

For more CYC program information, please refer to our Parent Handbook or website at

www.cycsf.org.

Before you begin

I acknowledge that I have reviewed the program and application information

Questions: Email asp@cycsf.org or call (415) 775-2636

PARTICIPANT INFORMATION

For legal compliance, CYC requires a parent/legal guardian to complete and sign this application if the applicant is under 18 years of age. Please select the below:

I attest that I am over 18 years old and am legally able to complete this application form myselfI attest that my child is under 18 years old and I am their legal parent/guardian authorized to complete this application form for my child

I would like to apply and register for the below program

Participant First Name

Participant Middle Name (Optional)

Participant Last Name

Participant Preferred Name

Participant Email (If available)

Participant Cell Phone (If available)

Participant Date of Birth

mm/dd/yyyy

Grade in Fall 2026

If Grade In Fall Other:

School Currently Attending

If Other

Participant Street Address

Apartment / Unit / Suite / Floor Number

City

State

Zip Code

PARENT/GUARDIAN INFORMATION (1st Emergency Contact)

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone Number

Relationship to Minor

If Relation Other

2nd Emergency Contact Information

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Email

Emergency Contact Phone Number

Emergency Contact Relationship to Minor

If Emergency Contact Relationship Other

Would you like to add another emergency contact

Another Emergency Contact

Another Emergency Contact First Name

Another Emergency Contact Last Name

Another Emergency Contact Email

Another Emergency Contact Phone Number

Another Emergency Contact Relationship to Minor

If Another Emergency Contact Relationship Other

END OF DAY ARRANGEMENTS FOR IN-PERSON PROGRAMS: Children must be picked up by program end time. Late pick up fee of $2 per minute if late. Please check all that apply

My child walks or takes the bus home. I give permission for my child to sign themselves outMy child will be picked-up each day and I give permission for my child to sign themselves outMy child will be picked-up each day AND ONLY PARENT/GUARDIAN may sign them out. (MUST fill out Authorized Pick Up fields.)Not ApplicableOther

If End Of Day Arrangement other:

Authorized Pickup First Name

Authorized Pickup Last name

Authorized Pickup Email

Authorized Pickup Phone Number

Authorized Pickup Relationship

If Authorized Pickup Relationship Other

Would you like to add another authorized pickup

Another Authorized Pickup First Name

Another Authorized Pickup Last Name

Another Authorized Pickup Email

Another Authorized Pickup Phone Number

Another Authorized Pickup Relationship

If Another Authorized pickup Relationship Other

PARTICIPANT DEMOGRAPHIC INFORMATION

Race/Ethnicity

Specify Race/Ethnicity

English Fluency

Primary Language

Primary Language Other

Gender

Gay/Lesbian/Bisexual

Special Needs

Please Specify

Housing Status

SFUSD ExCEL Program Funding & Priority/ Free Access Information: ELOP & Other State-funded Expanded Learning Programs

All SFUSD students are invited to participate
Priority access will be offered to students enrolled in an SFUSD school as TK-6th grade who meet one or more of the criteria noted below (per the California Department of Education):

Qualify for Free/Reduced school meal benefits, as determined by the Multipurpose Family Income Form, or
Designated English Language Learner, or
Designated foster or homeless youth

In addition to priority access, FREE after school programming will be offered to students who

Qualify for Free/Reduced school meal benefits or
Designated foster or homeless youth

Note: ELOP priority is based on verified documentation on file with SFUSD confirming the above criteria

Please review ELOP information above and checkmark what is applicable for your family (Check one selection)

I acknowledge that my youth qualifies for PRIORITY ACCESS and FREE after school programming based on the above ELOP criteriaI acknowledge that my youth qualifies for PRIORITY ACCESS ONLY based on the above ELOP criteriaI acknowledge that my youth does NOT qualify for FREE/PRIORITY enrollment based on the above ELOP criteria

Other priority considerations (Check all that apply)

My youth is identified through a school site specific process based on but not limited to: academic need, truancy, socio-emotional needs, CCT referral.My youth is currently enrolled in CYC’s After School Program.

My youth attends the school site location of the after school program.

My youth will commit to attending the full duration of program, five days a week.

None of the above/Not applicableOther

If Other

HOUSEHOLD INCOME INFORMATION

Household Size

Annual Household Income

Round to the nearest whole dollar

SFUSD Multipurpose Family Income (MFI) Form: Please complete and upload the MFI Verification Form if you would like to apply for free or sliding scale fees for any of CYC's fee based programs. You may upload other financial documents for verification or contact our office if you have any questions.
https://www.sfusd.edu/services/health-wellness/nutrition-school-meals/apply

Please Select One:

My child is eligible for fee waivers due to Free & Reduced Lunch Qualification or is a Foster/Homeless Youth (Please upload current school year's Free/Reduced Lunch letter verification to be eligible).

My child is eligible for Free & Reduced Lunch and I will provide the Free/Reduced Lunch verification letter at a later date. I understand I will not be eligible for the fee waivers until this is submitted.My child is not eligible for fee waivers but is interested in applying for sliding scale fees. (We will send you a Financial Assistance Application).My child will pay the full registration and program fee.Not Applicable. The Program is free.

Please Upload the File

RELEASE AND AUTHORIZATION FOR MEDICAL TREATMENT

Please provide the following

Health Insurance Company

Please Type "NONE" if you have no insurance.

Policy/Group Number

Doctor Name

Doctor Phone Number

Please list medical conditions (i.e. asthma, heart condition, allergies, seizures, diabetes, etc.) and list name, dosage, and purpose of medications currently being taken by minor:

Emergency Medical Treatment Authorization

I authorize CYC After School Program Staff to furnish and/or obtain emergency medical treatment which may be necessary for my child during the ProgramI DO NOT authorize CYC After School Program Staff to furnish and/or obtain emergency medical treatment which may be necessary for my child during the Program

CYC Progressive Response Policy, Waiver, and Limited Liability

CYC believes that emotional and physical safety is really important and we strive to create a safe and supportive place for children, youth and their families. We are required to document any injuries, referrals and crisis situations. To ensure a safe and supportive community all program managers, directors and coordinators are trained in restorative practices, guidelines and procedures and use them to manage behaviors. Parents/ guardians are notified of agency policies and protocols upon program acceptance and/or during program orientation and are given opportunities to comment and ask questions.

CYC’s progressive response process and outline:

Issues and behaviors are communicated with parents/ guardians often or as needed. Referrals to the school care team will be made if necessary for further support.
Restorative circles will be used and behavior agreements will be reviewed and written up for more support. Parents/guardians will be asked to be present at all meetings to ensure clear communication of agreements
If agreements are broken, or if a student is physically hurting themselves or others, discussions for suspension may be made.

It is under the discretion of the Director, Program Manager or Site Coordinator to redirect the child and family to services that may provide more support after a number of unsuccessful attempts to accommodate the child without undermining the quality of the program.

I acknowledge that I have reviewed, understand, and CONSENT to the program policies and information.I acknowledge that I have reviewed, understand, and DO NOT CONSENT to the information above. I understand that this disqualifies my child from participating in CYC programming and that I cannot continue with this application.

Family Educational Records Privacy Act (“FERPA”)

SFUSD ExCEL ASP PERMISSION TO EVALUATE PROGRAMS & TRACK STUDENT PROGRESS & PERMISSION TO ACCESS

SFUSD EXCEL ASP PERMISSION TO EVALUATE PROGRAMS & TRACK STUDENT PROGRESS: During your child’s attendance in the after school program, he/ she may benefit from aligned support across the school day into after school program. By clicking the below, I give permission for the after school program staff to review my child’s school data (test scores, reports cards and other performance indices), for the purpose of providing targeted academic instruction and assessing the academic effectiveness of the after school program. I also give permission for the staff to monitor my child’s progress and to require my child to complete evaluation surveys for the purpose of determining program effectiveness.

ExCEL After School Programs shall not re-disclose confidential student information to any third party without the prior written consent of the District and any such re-disclosure shall be consistent with state and federal law.

I acknowledge that I have reviewed, understand, and CONSENT to the information above.I acknowledge that I have reviewed, understand, and DO NOT CONSENT to the information above. I understand that this disqualifies my child from participating in CYC programming and that I cannot continue with this application.

ONLINE PLATFORM / VIRTUAL LEARNING

I understand that I or my child may be participating in an online platform utilizing video and audio chat with instructors as well as other program participants. I understand the classes may be recorded and used for educational purposes. I understand foul images, audio, or chat will not be condoned and agree to follow community agreements and high standards of digital citizenship.

I consent for myself and/or my child to participate in virtual or in-person classes and activities offered by Community Youth Center of SFI DO NOT consent and understand that my child will NOT be able to participate in CYC programs

PERMISSION TO ACCESS 504 PLAN OR INDIVIDUALIZED EDUCATION PLAN (IEP)

PERMISSION TO ACCESS 504 PLAN OR INDIVIDUALIZED EDUCATION PLAN (IEP): By clicking below, I authorize the exchange of information for my child described below between the San Francisco Unified School District and the Community Youth Center of San Francisco (CYC) to access my child's 504 Plan and Individualized Education Plan (IEP). I understand this authorization expires at the end of school year.

Restrictions: Providers who receive this information may not release it to someone else unless another authorization form is signed.

Your Rights: You may refuse to sign this form. You may cancel it at anytime by informing the San Francisco Unified School District in writing. If you cancel your permission to allow the release of information about you/your child, it will go into effect immediately (unless someone already released information). You have the right to receive a copy of this Authorization.

I acknowledge that I have reviewed, understand, and CONSENT to the information above.I acknowledge that I have reviewed, understand, and DO NOT CONSENT to the information above. This does not disqualify my child from participating in CYC programming and I may continue with this application.

AUTHORIZATION FOR RELEASE OF CONFIDENTIAL INFORMATION

The San Francisco Department of Children, Youth, and Their Families (DCYF) funds our agency and the services we provide. To fulfill the requirements of this funding, we share information about the participants in our services with DCYF. DCYF and the San Francisco Unified School District (SFUSD) maintain a shared, secure database to record information about services provided to San Francisco youth by DCYF’s grantees in order to facilitate outreach and enrollment and track program use and impact. As a DCYF grantee, our agency has access to the shared database to both see and report data about the youth we serve. The data that we report to DCYF is also shared with SFUSD.

By signing this form, you authorize

Our agency to share information about your child’s participation in our program (or your participation, if you are 18 years of age or older) with authorized staff at DCYF and SFUSD for the purposes described above. The information that our agency reports to DCYF includes:

Person information, such as name, date of birth, and address:
Demographic information, such as race/ethnicity and gender identity;
Education information, such as school name and grade level;
Participation in activities and services, such as dates of attendance dates and hours attended; and
Anonymous and voluntary youth experience surveys.

SFUSD to share certain information about your child (or you, if you are 18 years of age or older) with authorized staff from our program as a DCYF grantee. The information that SFUSD reports to DCYF includes:

Personal information, such as name, date of birth, and address;
Education information, such as school name and grade level; and
Dates of attendance in SFUSD or an SFUSD school.

DCYF, SFUSD, or our agency will not publicly report any information that we provide in a way that may be used to identify your child (or you, if you are 18 years of age or older).

Restrictions: All information that we provide or access that is related to an SFUSD student is protected by federal and state laws that govern the use, disclosure and re-disclosure of student education records. Parties other than DCYF, SFUSD and our agency will not have access to any personally identifiable information that is reported into the database, except to the extent that the parties have obtained prior written authorization from you or have followed SFUSD policies and procedures to obtain access to such information.

Expiration: This authorization expires on June 30, 2029 when our current funding cycle ends.

Your Rights: You may refuse to sign this form. You may cancel it at any time by information our agency in writing. If you cancel your permission allowing us to release information to DCYF and SFUSD, and SFUSD to our agency, it will go into effect immediately, unless the information has already been released. You have a right to receive a copy of this form.

I acknowledge that I have reviewed, understand, and CONSENT to the information above.I acknowledge that I have reviewed, understand, and DO NOT CONSENT to the information above. This does not disqualify my child from participating in CYC programming and I may continue with this application.

PHOTOGRAPHY AND MEDIA RELEASE

During you or your child's attendance in the CYC and/or ExCEL After School Program, s/he/they may participate in activities that are being photographed or videotaped; these photographs/video recordings may be used for promotional purposes.

By not submitting an opt out form, I authorize the SFUSD, San Francisco Department of Children, Youth, and Their Families (DCYF), CYC, or any third party it has approved to photograph or videotape myself and/or my child during CYC and/or After School program activities and to edit or use any photographs or recordings at the sole discretion of the named entities as stated above. I understand that I and my child shall have no legal right or interest arising from the recording, including economic interest. I also agree to release and hold harmless the SFUSD, DCYF, CYC, or any third party it has approved from and against all claims, demands, damages, and liabilities arising out of or use of the recording.

PHOTOGRAPHY AND MEDIA RELEASE: By clicking below, I agree to the below:

I acknowledge that I have reviewed, understand, and CONSENT to the information above.I acknowledge that I have reviewed, understand, and DO NOT CONSENT to the information above. This does not disqualify my child from participating in CYC programming and I may continue with this application.

CYC LIABILITY RELEASE AND WAIVER AGREEMENT

In consideration for permission to participate in Community Youth Center of San Francisco (CYC) programs and activities, each person signing below hereby stipulates and agrees:

1. ASSUMPTION OF RISK

I represent that I am physically sound and am able to participate in CYC programs and related activities. I VOLUNTARILY AND FREELY CHOOSE TO ASSUME ALL RISKS AND DANGERS, including the risk of injury or death that may be associated with, or result from, my participation. I shall promptly notify CYC in writing of any changes in my health that might call into question the appropriateness of me continuing to participate.

2. RELEASE FROM LIABILITY
I agree, for myself and my heirs, to fully and forever discharge and release CYC, their officers, directors, agents and employees from any and all liabilities, claims, demands, actions and causes of action whatsoever whether known or unknown based upon any injuries, costs, loss of services, expenses, actions and causes of action, whether caused by their NEGLIGENCE or for any other reason, on the account of, or in any way resulting from, personal injuries, conscious suffering, death or property damage to myself or to any other person or property, in any way connected with my preparation or practice for, or participation in, the activities. I agree that this Liability Release and Waiver Agreement shall include my participation in any and all sports activities sponsored by the Releasees including, but not limited to, practice sessions, instructional sessions, activities directed by a coach or a team representative and/or promotion activities.

3. COVENANT NOT TO SUE
I agree, for myself and all my heirs, not to sue Releasees, not to initiate to assist the prosecution of any claim for damages or case of action which I or my heirs may have by reason of personal injury or death to participation or destruction to participant’s property arising from Releasees’ activities.

4. INDEMNITY AGREEMENT
I agree, for myself and my heirs, to indemnify and hold harmless the Releasees from any loss, claims, action, causes of action, or proceedings of any kind which may be initiated by me or by any other person, entity or organization, including demands, judgments, costs, loss of services, expenses, or reimbursement of counsel fees incurred by participant or by the Releasees from activities contemplated by this agreement. I give permission to Releases to obtain on my behalf any emergency medical treatment. In case of sickness, accident or injury, Releasees have my express permission to secure, at my expense, such medical treatment as is deemed necessary in the sole discretion of Releasees.

5. CONTINUATION OF OBLIGATIONS
I agree, for myself and my heirs, that the above provisions, including ASSUMPTION OF RISK, RELEASE FROM LIABILITY, COVENANT NOT TO SUE & INDEMNITY AGREEMENT shall continue in full force and effect now and at all future times when participant is involved in the activities. In the event of any dispute or controversy arising with respect to this Release and Liability Agreement, its interpretation, application and/or extinction, said dispute or controversy will be resolved by binding arbitration proceedings conducted by the American Arbitration Association (“AAA”) in San Francisco, California, pursuant to the commercial arbitration AAA rules then in effect.

6. CYC MEDIA RELEASE
CYC may from time to time, capture photographs and video of our participants at all related sponsor CYC activities in action. Therefore, we request that you agree with the terms of our media release. I hereby grant Community Youth Center of San Francisco the unrestricted right and permission to copyright and use, re-use, publish, and republish photographic portraits, pictures, videos or audio recordings of me or in which I may be includes intact or in part, composite or distorted in character or form, without restriction as to changes or transformations in conjunction with my own or a fictitious name, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known for illustration, art, promotion, advertising, trade, or any other purpose whatsoever, as well as any publication thereof..

I HEREBY ACKNOWLEDGE THAT I HAVE FULLY READ EACH OF THE ABOVE PROVISIONS AND FULLY UNDERSTAND AND AGREE WITH EACH PROVISION. I HAVE HAD THE OPPORTUNITY TO HAVE COUNSEL OF MY CHOICE REVIEW IT WITH ME. I HAVE READ AND FULLY UNDERSTAND AND ACCEPT EACH OF THE PROVISIONS OF THIS AGREEMENT. I HEREBY EXPRESSLY WAIVE THE PROVISIONS OF CALIFORNIA CIVIL CODE SECTION 1542 WHICH PROVIDES AS FOLLOWS: CERTAIN CLAIMS NOT AFFECTED BY GENERAL RELEASE. A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM, MUST HAVE MATERIALLY AFFECTED HIS SETTLEMENT WITH THE DEBTOR.

I HEREIN UNDERSTAND AND AGREE that all rights under Section 1542 of the California Civil Code are expressly waived and that this Release releases all injuries, damages, or losses to the person and property, real or personal, whether known or unknown, foreseeable, unforeseeable, patent or latent, which she/he may have against another party or parties herein released. I hereby declare that I am over the age of 18, unless my guardian has signed below.

I acknowledge that I have reviewed, understand, and CONSENT to the program policies and information.

I acknowledge that I have reviewed, understand, and DO NOT CONSENT to the information above. I understand that this disqualifies my child from participating in CYC programming and that I cannot continue with this application.

PLEASE SIGN BELOW:

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This section requires consent/permission for participation. Please contact our office if you do not agree or have questions.

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