Living in Purpose After School Students 2025-2026

Thank you for signing up for the Living in Purpose Afterschool Program (1st–8th Grade)!
We’re excited to partner with you in building a bright future for your child. The program runs Monday–Thursday, 4:30 PM–6:30 PM during the school year.
Questions? Contact Kamilah Freeman at kamilahfreeman@livinginpurpose.org or 646-208-7467.

Let’s make this an amazing year together!

Please enter Student's Name and information below. Guardian's email address & number can be entered.

Your name *

Email address *

Phone number *

Address *

Birthdate *

Gender *

Grade *

School *

Medical note-Please provide any medical concerns for the safety of your child *

Including any behavioral and learning disadvantages for the proper care of your child. N/A if not.

Guardian's First and Last Name *

Emergency contact name and phone. *

Do you give permission for your child(ren) to take part in media or photos during Living in Purpose program? Please type yes or no. *

REPORT CARD SUBMISSION *

In order to help with educational assessments your student last report card will be required. Please bring a copy of this to our center on the first day of afterschool, or send via email to kamilahfreeman@livinginpurpose.org. To agree that you will submit please sign your name below.

PARENT VOLUNTEERISM *

All guardians will be required to volunteer (donations or time) twice a month during the duration the student is enrolled in the Living in Purpose Program. To agree that you can volunteer please sign your name below.

Is your student facing any struggles that we can help with? Educational, personal, social, or others? *

Please let us know other areas we can support your student with. We have resources and would like to be apart of your student village in everyway to help them turn any potential pain into purpose.

Any additional Information needed to support student summit it here. *

Please type N/A if not.

Liability Wavier *

I agree not to hold the Living in Purpose Afterschool Program liable for any injuries or accidents that may occur while my child is under the care and supervision of the program. I understand that reasonable safety precautions will be taken, and I give my consent for my child to participate.

Living In Purpose Code of Conduct *

Each participate must read and agree to the Code of Conduct. Living in Purpose Code of Conduct: https://docs.google.com/document/d/1F5qXLVZuHG0M54NM4E1_OYYEX8o1fg22/edit?usp=sharing&ouid=116618556694373964228&rtpof=true&sd=true

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