Completed Forms Are Due by Friday, September 25, 2015, along with the $100 fee for October

Dear Parents,

This is your registration packet for the 2015 Youth Rocks Afterschool Program at the Woody Guthrie Center. Please return completed forms to:

Woody Guthrie Center

Attn: Becky Hawkes

102 East Brady St.

Tulsa, Ok 74103

918-574-2710
Enrollment:

Completed Forms Are Due by Friday, September 25, 2015, along with the $100 fee for October.
Financial Aid:

For those seeking financial aid, please attach a copy of your free/reduced lunch determination letter.

Youth Rocks Afterschool Program Tuition Policy
Tuition and Fees
Tuition for the 2015 Youth Rocks Afterschool Program is $100 per month with discounts for members and families enrolling more than one child; discounts cannot be combined.

Payments are due on the 1^st of each month. Payments can be made via cash, card, or check made payable to The Woody Guthrie Center.

This program is made possible thanks to generous donations from the following:
Frederic Dorwart Lawyers

Kathy Taylor and Bill Lobeck

Ben Abney

Jack Allen Family Education Foundation

Clay Bennett

Marian and Dennis Bires

Blue Cross Blue Shield of Oklahoma

Steve Bradshaw

Brune Law Firm

John Bumgarner

Mike and Pate Case

Sam Combs

Joe Craft

Jeff and Judy Davis

Sheldon Detrick

Frederic Dorwart, Lawyers

Jim East

Frank and Gayle Eby

Drew and Linda Edmondson

Philip Eller

Dan Ellinor

Margaret Erling

Mark and Beverly Funke, Bank SNB

William R. and Sharon K. Grimm

Jay Helm

Robert and Jan Henry

Bill Inhofe

John Kennedy

Ken and Janet Levit

The Meinders Foundation

Melvin and Jasmine Moran

ONE Gas

The Michael T. Peyton Family

Kip and Gail Richards

John and Charlotte Richels

Riggs, Abney, Neal, Turpen, Orbison and Lewis

Davis Riggs

Susan Savage and Steve Kelley

Lee Allan Smith

Renzi Stone

Barry Switzer

Jill and Robert Thomas

Susan and William Thomas

Frosty and Gayla Turpen

Blake and Donna Wade

Peter Walter

William Warren

Williams Companies​

Youth Rocks Afterschool Registration Form
Child’s Name:_________________________________ Birthdate:_____________________

Home Address:_________________________________________________________________

Phone:______________________ Shirt Size:___________ Grade:_________________
Parent/Guardian:_______________________________________________________________

Address if different:_____________________________________________________________

Email Address:_________________________________________________________________

Business Name / Address:________________________________________________________

Work Phone:_______________________________

Member Number (if applicable):__________________________________________________

Woody Guthrie Center

102 East Brady St. Tulsa, OK 74103

Tulsa, OK 74103

Youth Rocks Afterschool Program

Authorization & Consent

Child’s Name:_________________________________ Date:__________________

I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, WGC staff may have my child transported to the nearest appropriate medical facility to secure the necessary medical treatment for my child.
Parent Signature:_______________________________
Child’s Physician:_______________________________ Physician’s Phone:_______________
Physician’s Address:_______________________________________________________________________
Health Insurance Provider:______________________________________________________________
Policy:_____________________________________
Please answer the following questions.

Does your child have any allergies:________________________________________________

If yes, please explain (Symptoms, Medication)______________________________________
Parent Signature:________________________________________

Woody Guthrie Center

102 East Brady St. Tulsa, OK 74103

Tulsa, OK 74103

Photo and Image Release Form
In consideration of the furtherance of the purpose, objectives, and work of The Woody Guthrie Center, (I) the undersigned, hereby grant permission to The Woody Guthrie Center and its agents to take photographs and/or video recordings, and/or audio recordings of my child(ren)
______________________________________________________________________________
to use for educational or promotional purposes. My child’s name or personal information is never included with his/her photo without additional written permission.
Signature:_______________________________________ Date:___________________
Address:_______________________________________________________________________
City, State, Zip:__________________________________________________________________

Woody Guthrie Center

102 East Brady St. Tulsa, OK 74103

Tulsa, OK 74103