BUILDING OUR FUTURE WITH A SPIRIT OF SELFLESS PRIDE
REGISTRATION
Unity Community Development Corporation
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Joliet IL
UNITY HOMEWORK HELP CENTER PROGRAM
Your name:
Student name:
Student Grade:
Student Age:
Your email address:
City:
Participant Address:
 State:
Zip:
Home Phone:
 Cell Phone:
Emergency Contact Person:
Relationship:
Emergency Phone:
This check box must be checked.          

I give my son/daughter permission to participate in the Homework Help Center Program. I understand safety precautions will be
provided. I waive all responsibility of Unity CDC and the participating organizations from any and all injuries my child may sustain
while participating in the recreational programs.  In case of injury I give my permission to the Site Manager/or assigned counselor
to administer basic first aid and contact emergency services for my child.  Unity CDC will not be responsible for transportation to
and from the Homework Help Center.

Unity provides technology for use as a tool to enhance its Homework Help Center.  Appropriate use and access to the computer
Network and Internet offer great opportunities and resources.  Inappropriate use on behalf of my child will result in discontinued
use of the computer lab.

I give Unity CDC permission to use my son/daughter photo in program publication for advertisement only.
CLICK THE SUBMIT BUTTON WHEN ALL FIELDS ARE COMPLETE
COMPLETE ALL FIELDS AND CLICK THE SUBMIT BUTTON
REGISTRATION
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