Project Fighting Chance Enrollment Form

Check all the activities of interest./Consulta todas las actividades de interés.

Programs of Interest?

Student (s) Information/Información del estudiante (s)

Full Name/Nombre Completo

Birth Date/Fecha de nacimiento +

Grade/Calificación

Gender/Género

School/Escuela

Student ID#/Alumno ID#

Full Name/Nombre Completo

Birth Date/Fecha de nacimiento +

Grade/Calificación

Gender/Género

School /Escuela

Student ID#/Alumno ID# *

Full Name/Nombre Completo

Birth Date/Fecha de nacimiento +

Grade/Calificación

Gender/Género

School/Escuela

Student ID#/Alumno ID#

Full Name/Nombre Completo

Birth Date/Fecha de nacimiento +

Grade/Calificación

Gender/Género

School/Escuela

Student ID#/Alumno ID#

School district your student(s) attends?/¿Distrito escolar al que asiste su(s) estudiante(s)?

Household / Adult Primary Contact /Contacto principal del hogar/adulto

Relationship to Participants:/Relación con los participantes:

Mother/Madre

Father/Padre

Guardian/Guardián

Other/Otro Other/Otro

First Name/Nombre de pila

Last Name/Apellido

Address/DIRECCIÓN

City/Ciudad

State/Estado

Zip

Phone/Teléfono

Email Address/Dirección de correo electrónico

Funders require this information:/Los financiadores requieren esta información:

Race/Ethnicity/Raza/Etnia

	Check at least one item/Marque al menos un elemento
American Indian/Alaska Indian	Check at least one item/Marque al menos un elemento
Black/African-American	Check at least one item/Marque al menos un elemento
Hispanic/Latino	Check at least one item/Marque al menos un elemento
White	Check at least one item/Marque al menos un elemento
Asian	Check at least one item/Marque al menos un elemento
Native Hawaiian/Pacific Islander	Check at least one item/Marque al menos un elemento
Other	Check at least one item/Marque al menos un elemento

If checked other, please explain:/Si marcó otro, explique:

Household size:/Tamaño del hogar: *

Household Annual Income?/¿Ingreso anual del hogar?

	Choose one/Elige uno.
$0-$16,000	Choose one/Elige uno.
$16,100-$25,000	Choose one/Elige uno.
$25,100-$40,000	Choose one/Elige uno.
$41,000-$60,000	Choose one/Elige uno.
$61,000-$75,000	Choose one/Elige uno.
$75,000 and up	Choose one/Elige uno.

Household/Familiar

	Select one:/Seleccione uno:
Two-Parent/biparental	Select one:/Seleccione uno:
Single- Parent Mother/Madre soltera	Select one:/Seleccione uno:
Single- Parent Father/Padre soltero	Select one:/Seleccione uno:

Emergency Contact Information– Alternate Pickup/Release/Información de contacto de emergencia: recogida/liberación alternativa

First Name/Nombre de pila

Last Name/Apellido

Work Phone Number/Número de teléfono del trabajo *

Cellphone Number/Número Celular

Relationship to Child/Relación con el niño

Medical Release Information/Información de autorización médica

Physician Name/Nombre del médico

Health Insurance/Seguro de salud

Policy Number/Número de póliza

Phone Number/Número de teléfono

Preferred Hospital/Hospital preferido

Additional children's medical information./Información médica adicional para niños.

Please list any medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures). Indique cualquier problema médico, incluido cualquier que requiera medicación de mantenimiento (es decir, diabetes, asma, convulsiones).

Is your child(ren) presently being treated for an injury or sickness or taking any form of medication for any reason? ¿Su(s) hijo(s) están siendo tratados actualmente por una lesión o enfermedad o están tomando algún tipo de medicamento por algún motivo?

No

if Yes explain/en caso afirmativo explicar if Yes explain/en caso afirmativo explicar

Is your child(ren) allergic to any medication?/¿Su hijo(s) es alérgico a algún medicamento? *

No

if Yes explain//en caso afirmativo explicar if Yes explain//en caso afirmativo explicar

Meal and Snack Information /Información sobre comidas y refrigerios

Is your child(ren) allergic to any food?/¿Su hijo(s) es alérgico a algún alimento? *

No

if Yes explain/en caso afirmativo explicar if Yes explain/en caso afirmativo explicar

Does your child require a special diet?/¿Su hijo requiere una dieta especial? *

No

if Yes explain/en caso afirmativo explicar if Yes explain/en caso afirmativo explicar

Parent Expectations and Opportunity Agreement/Acuerdo de oportunidades y expectativas para los padres

Project Fighting Chance (PFC) has designed an extraordinary program that allows students to grow physically, intellectually, socially, and emotionally. Although we have assembled a great team of professional staff and coaches, your involvement as a Parent/Guardian remains vital to your child(ren) 's increased success at PFC. The following are expectations and opportunities to contribute to your child's growth and development while participating in the program:
Parent expectations.
1. Submit a copy of your child(ren) quarterly academic grade report to program staff.
2. Attend monthly parent meetings
3. Join the PFC GroupMe announcement app
4. Be encouraging, supportive, and optimistic about my child's full participation in the program
5. Encourage my child to be responsible and prepared for homework and tutoring sessions
6. To inform PFC of special needs, physical and mental developmental challenges, and concerns.
Parent Opportunities
1. Volunteer your services and talents to PFC when possible
2. Participation in fundraising activities and events to keep program participation fee zero to minimal cost. 3. Advocate and serve as an ambassador for the organization.
I have read and agree to my best ability to meet and participate in the above-listed expectations and opportunities.

	Yes or No.
I have read and agree.	Yes or No.

Project Fighting Chance (PFC) has designed an extraordinary program that allows students to grow physically, intellectually, socially, and emotionally. Although we have assembled a great team of professional staff and coaches, your involvement as a Parent/Guardian remains vital to your child(ren) 's increased success at PFC. The following are expectations and opportunities to contribute to your child's growth and development while participating in the program:
Parent expectations.
1. Submit a copy of your child(ren) quarterly academic grade report to program staff.
2. Attend monthly parent meetings
3. Join the PFC GroupMe announcement app
4. Be encouraging, supportive, and optimistic about my child's full participation in the program
5. Encourage my child to be responsible and prepared for homework and tutoring sessions
6. To inform PFC of special needs, physical and mental developmental challenges, and concerns.
Parent Opportunities
1. Volunteer your services and talents to PFC when possible
2. Participation in fundraising activities and events to keep program participation fee zero to minimal cost. 3. Advocate and serve as an ambassador for the organization.
I have read and agree to my best ability to meet and participate in the above-listed expectations and opportunities.

	Yes or No.
I have read and agree.	Yes or No.

Liability Release and Parental Consent /Liberación de responsabilidad y consentimiento de los padres

Liability Release and Parental Consent Form *

I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or which may hereafter occur to my child(ren) as a result of participation in said program. This release is intended to discharge in advance Project Fighting Chance and San Bernardino Unified School District and each organization's officials, officers, employees, volunteers, and agents from liability, even though that liability may arise out of perceived negligence on the part of persons mentioned above. It is understood that some experiential, academic, recreational, and fitness activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks. It is further understood and agreed that this waiver, release, and risk assumption would be binding on my heirs and assignees.

Formulario de exención de responsabilidad y consentimiento de los padres *

Por la presente renuncio, libero y descargo cualquier y todos los reclamos por daños por lesiones personales, daños a la propiedad o que puedan ocurrirle a mi(s) hijo(s) en el futuro como resultado de la participación en dicho programa. Este comunicado tiene como objetivo eximir de antemano a Project Fighting Chance y al Distrito Escolar Unificado de San Bernardino y a los funcionarios, funcionarios, empleados, voluntarios y agentes de cada organización de toda responsabilidad, incluso si esa responsabilidad puede surgir de una negligencia percibida por parte de las personas mencionadas anteriormente. . Se entiende que algunas actividades experienciales, académicas, recreativas y de acondicionamiento físico involucran un elemento de riesgo o peligro de accidentes, y conociendo esos riesgos, por la presente asumo esos riesgos. Además, se entiende y acuerda que esta renuncia, liberación y asunción de riesgos serán vinculantes para mis herederos y cesionarios.

Parental Consent *

I understand that I will be notified in the case of a medical emergency involving my child. If I cannot be reached, I authorize the calling of a doctor and the provision of necessary medical services if my child is injured or becomes ill. At this moment, I consent to have my child(ren)treated by emergency medical personnel, a physician, or a surgeon, in case of sudden illness or injury while participating in the above activity. It is understood that the program will provide no medical insurance for such treatment and that the cost thereof will be at my expense. I have read and understood the initial registration liability release and parental consent form and agree to all its terms and conditions.

Consentimiento paterno *

Entiendo que se me notificará en caso de una emergencia médica que involucre a mi hijo. Si no pueden localizarme, autorizo la llamada de un médico y la prestación de los servicios médicos necesarios si mi hijo se lesiona o se enferma. En este momento, doy mi consentimiento para que mi(s) hijo(s)sea(n)tratado(s) por personal médico de emergencia, un médico o un cirujano, en caso de enfermedad o lesión repentina mientras participo en la actividad anterior. Se entiende que el programa no proporcionará seguro médico para dicho tratamiento y que el costo del mismo correrá por mi cuenta. He leído y comprendido la exención de responsabilidad del registro inicial y el formulario de consentimiento de los padres y acepto todos sus términos y condiciones.

Photo Release *

I, with this, permit my child to be photographed during the PFC summer boxing fitness and enrichment. I understand the photos will be used to keep a journal of activities, to share during power point presentations and reports to our donors, and for promotional purposes, including flyers, brochures, newspapers, and the internet. I understand that although my child's photograph may be used for advertising, their identity will not be disclosed. I do not expect compensation; all photos are Project Fighting Chance's and its affiliate's property.

Lanzamiento de fotos *

Yo, con esto, permito que mi hijo sea fotografiado durante el entrenamiento y enriquecimiento de boxeo de verano de PFC. Entiendo que las fotografías se utilizarán para llevar un diario de actividades, para compartir durante presentaciones en PowerPoint e informes a nuestros donantes y con fines promocionales, incluidos volantes, folletos, periódicos e Internet. Entiendo que aunque la fotografía de mi hijo pueda usarse con fines publicitarios, su identidad no será revelada. No espero compensación; Todas las fotos son propiedad de Project Fighting Chance y sus afiliados.

Transportation Release *

I hereby give permission for the transportation of my children to the official PFC Fieldtrip by modes of transportation agreed to by the PFC administration.

Liberación de transporte *

Por la presente doy permiso para el transporte de mis hijos al viaje oficial de PFC mediante los modos de transporte acordados por la administración de PFC.

Check to receive PFC information via email.

Marque para recibir información de PFC por correo electrónico.

About Project Fighting Chance

P.F.C. is a comprehensive, year-round, free after-school enrichment program that includes its
signature and award-winning F.I.G.H.T.S. (Faith in God Heals Troubled Souls) Boxing
Program. Our mission is to reframe the life narrative of children and youth from “at-risk.”
to “future leaders” through after-school enrichment and youth development boxing
programs. P.F.C. earned the distinguished honor of being named the 2020 California
Nonprofit of the Year.

P.F.C.’s after-school enrichment programming incorporates evidenced-based practices,
mentorship, Social Emotional Learning, and Resiliency training. Projecting Fighting
Chance programs and services are culturally responsive and trauma-informed. The
F.I.G.H.T.S. Boxing Program has produced thirteen National Champions, two U.S.
Olympic Trial participants, an Olympic Team Alternate, and four Junior Olympic Gold
Medalists. P.F.C., since its inception in 1999, has provided services to more than six
Thousand children and youth.

P.F.C. es un programa de enriquecimiento extracurricular gratuito, integral y gratuito durante todo el año que incluye sufirma y galardonada F.I.G.H.T.S. (La fe en Dios sana las almas atribuladas) Boxeo Programa. Nuestra misión es replantear la narrativa de vida de niños y jóvenes “en riesgo”. a “futuros líderes” a través del enriquecimiento después de la escuela y el desarrollo juvenil del boxeo programas. P.F.C. obtuvo el distinguido honor de ser nombrado California 2020 Organización sin fines de lucro del año.La programación de enriquecimiento extraescolar de P.F.C. incorpora prácticas basadas en evidencia, tutoría, aprendizaje socioemocional y capacitación en resiliencia. Proyectar Luchar Los programas y servicios de Chance son culturalmente receptivos y están informados sobre el trauma. El LUCHAS El Programa de Boxeo ha producido trece campeones nacionales, dos estadounidenses.Participantes de la prueba olímpica, un equipo olímpico suplente y cuatro medallas de oro olímpicas juveniles Medallistas. P.F.C., desde sus inicios en 1999, ha brindado servicios a más de seis Mil niños y jóvenes.

Ruben Campos Community Center at Nunez Park

1717 W 5th Street

San San Bernardino,Ca

If you have questions, please email director@projectfightingchance.org. Or call us at (English and Spanish) (909) 567-2864