A note to prospective participants and parents

We take COVID-19 very seriously. Informed by guidelines from the CDC, we have implemented a robust COVID-19 programming policy (Spanish version: Póliza de Programación de COVID-19 para el Otoño) that prioritizes the health and safety of our participants, volunteers, and staff. Despite these precautions, we cannot completely eliminate the risk of COVID-19. All participants and volunteers are required to sign and submit our COVID-19 liability waiver (Spanish version: Exención de responsabilidad por Coronavirus/COVID-19). If you would like information on our program options before filling out the form below, please see our Programs page.


Registration Form

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Does your child have any special medical or behavioral conditions (i.e. asthma, allergies, diabetes, hyperactivity, attention-deficit-disorder, depression, etc.)? Please list condition, treatment protocol (if any) and related information.
Who else (besides parents/emergency contact listed above) is permitted to pick up your child, if anyone?
I hereby give my child permission to attend the Abundant Life Tutoring Program, to include any field trips.

I hereby authorize the staff to provide transportation to and from field trip events that may include transportation in church vans, rented vans, or the staff and volunteers’ personal vehicles.

I understand that the staff and volunteers will not be responsible for my child(ren) once tutoring and field trips are over.

I hereby authorize the staff to act for me in securing medical assistance or emergency treatment for my child, if it should become necessary.

I also authorize the staff to administer medication(s) to my child if needed; these medications may include but are not limited to Tylenol, antibiotic ointments, Benedryl cream, Pepto Bismol, and Hydrocortisone Cream.

With this, I release Charlottesville Abundant Life Ministries, their staff and volunteers, from any claims or liabilities resulting from injuries that may be sustained or medical treatment received.

I understand that my child may be photographed or video-taped during special events or daily activities of the Abundant Life Tutoring Program. I consent to the use of any and all pictures or videos in a promotional or educational context.

I authorize the release of my child’s first name and grade in the caption or description of the picture. I understand that all pictures will be displayed in a tasteful manner, and will be used only in accordance with the values of Charlottesville Abundant Life Ministries.

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