SHOCKTOWN’S YES COMMUNITY PROGRAM, INC.

Student Registration

Please answer every question marked with a *. It takes about five minutes, and you can do it from your phone. If you have more than one child, register them one at a time.

1. Which program are you registering for?

Goodman ElementarySeptember 14 – October 7, 2026Worsham ElementaryOctober 19 – November 11, 2026

2. About your child

Child’s first nameChild’s last nameDate of birthThe program is for children aged 5 to 12.Grade this school year

Does your child have any medical conditions the program should know about?Program staff read this in an emergency, so please include anything that affects safe participation. YES is not staffed to give medical or one-to-one care — if your child needs support beyond what the program gives everyone, tell us here and we will call you to talk it through before the season starts.YesNo

Does your child have any food allergies, intolerances or foods they must not be given?The program serves food and snacks at some sessions. Whoever hands it out reads this first, so please tell us even if it is a preference rather than an allergy.YesNo

3. Parent or guardian

Your first nameYour last nameI am the child’sYour emergency phone numberThis is the number we call if something happens to your child during the program.

Weekly update numberWhere we text program news, reminders and schedule changes.

Same as my emergency number

Your email address

Second emergency contact

Somebody else we can call if we cannot reach you. Optional — but if you fill in one box, please fill in all three.

Their full nameTheir relationship to your childTheir phone number

Street addressCityZIP code

4. Who may pick your child up?People allowed to collect your childOne full name per line. Leave this blank and we will list you.

5. About your child (for program reporting)

SexRace and ethnicityCheck every one that applies. Many families check more than one — for example Hispanic or Latino together with a race.Household income (optional)Single-parent household (optional)

These last two are optional and used only for program reporting. You may skip them.

6. PermissionsI give permission for my child to take part in the YES Community Program. *I confirm the information on this form is correct and that I am the child’s parent or legal guardian.

Parent/Guardian Waiver, Consent & Participation AgreementThis is one agreement. Please take the time to read all of it. Ticking the box at the end is your confirmation that you have read it and agree to every part — you cannot submit the registration without it.

NAM INFORMATION SHARING AUTHORIZATION

THIS AGREEMENT INCLUDES AN AUTHORIZATION TO SHARE INFORMATION WITH NORTHWEST ASSISTANCE MINISTRIES (NAM). BY AGREEING, YOU AUTHORIZE THE PROGRAM TO SHARE YOUR CHILD'S NAME AND YOUR TELEPHONE NUMBER AND EMAIL ADDRESS WITH NAM — AND NOTHING ELSE.

ShockTown's YES Community Program, Inc. works with Northwest Assistance Ministries (NAM) to connect participating families with available community resources, services, and assistance programs.

I authorize ShockTown's YES Community Program, Inc. to share only the following with Northwest Assistance Ministries (NAM):

• My child's name • Parent/legal guardian telephone number • Parent/legal guardian email address

My home address, medical information, school records, program assessments, and other personal information will NOT be shared under this authorization.

This authorization is valid only during my child's current YES Community Program session and automatically ends when my child's participation in the program ends.

I may revoke this authorization at any time by providing written notice to ShockTown's YES Community Program, Inc. To ask where to send it, call the YES Program Director at (713) 591-5301. Revocation will not affect information that was shared before the organization received my written notice.

MEDIA RELEASE AND PROGRAM PARTICIPATION REQUIREMENT

THIS AGREEMENT INCLUDES A MEDIA RELEASE. BY AGREEING, YOU GIVE PERMISSION FOR PHOTOGRAPHS, VIDEO, AND AUDIO OF YOUR CHILD TO BE TAKEN DURING THE PROGRAM AND USED BY THE PROGRAM.

I understand that photographs and video recordings are an important part of ShockTown's YES Community Program, Inc.'s program documentation, community outreach, fundraising, grant reporting, and efforts to obtain continued financial support for the free services provided to participating youth.

By enrolling my child in the YES Community Program, I understand that photographs, video recordings, and/or audio recordings of my child may be taken during program activities, educational sessions, special events, and ceremonies.

I authorize ShockTown's YES Community Program, Inc. to use my child's image, likeness, voice, and/or recorded participation in photographs, video recordings, and audio recordings for legitimate nonprofit purposes, including social media, the organization's website, program promotion, fundraising, grant applications and grant reporting, presentations, educational and informational materials, and communications with community partners, donors, supporters, and prospective funders.

I understand that YES provides its youth program free of charge to participating families and relies upon grants, donations, fundraising, partnerships, and community support to operate and continue providing these services. Photographs and videos help YES document its activities, demonstrate program impact, and communicate its work to supporters and funders.

I UNDERSTAND THAT AGREEMENT TO THIS MEDIA RELEASE IS A CONDITION OF ENROLLMENT AND PARTICIPATION IN THE YES COMMUNITY PROGRAM. IF I AM NOT WILLING TO AGREE TO IT, MY CHILD CANNOT BE ENROLLED.

The program is run by a small number of staff and volunteers, and photographs and video are taken of groups of children during activities. YES cannot reliably keep one child out of every photograph and every video taken across a season, and it will not put the burden of that on a child or on a volunteer holding a camera. That is why this permission is required of everyone rather than asked of each family.

If you would like to talk about this before enrolling, call the YES Program Director at (713) 591-5301.

ASSUMPTION OF RISK AND RELEASE OF LIABILITY

I understand that participation in youth sports, recreational activities, physical exercises, games, and related program activities involves inherent risks, including but not limited to falls, collisions, physical contact, illness, bodily injury, serious injury, and, in rare circumstances, death.

I voluntarily assume the inherent risks associated with my child's participation in these activities.

I hereby release and hold harmless ShockTown's YES Community Program, Inc., its officers, directors, employees, volunteers, and agents from claims, demands, or causes of action arising out of or related to my child's participation in program activities, to the extent permitted by Texas law.

I UNDERSTAND AND AGREE THAT THIS RELEASE COVERS CLAIMS CAUSED BY THE NEGLIGENCE OF SHOCKTOWN'S YES COMMUNITY PROGRAM, INC., ITS OFFICERS, DIRECTORS, EMPLOYEES, VOLUNTEERS, AND AGENTS. I AM GIVING UP MY RIGHT, AND MY CHILD'S RIGHT, TO SUE THEM FOR THEIR OWN NEGLIGENCE — INCLUDING NEGLIGENT SUPERVISION, NEGLIGENT INSTRUCTION OR COACHING, NEGLIGENT SELECTION OR TRAINING OF STAFF AND VOLUNTEERS, AND NEGLIGENT CARE OF EQUIPMENT OR FACILITIES.

THIS RELEASE DOES NOT COVER GROSS NEGLIGENCE OR INTENTIONAL OR WILLFUL MISCONDUCT, AND NOTHING IN THIS AGREEMENT WAIVES ANY RIGHT THAT CANNOT LEGALLY BE WAIVED UNDER TEXAS LAW.

I have read this release. I understand that it gives up certain legal claims, including claims arising from the program's own negligence, as described above, and I agree to it voluntarily.

MEDICAL TREATMENT AUTHORIZATION

In the event of an injury, illness, or medical emergency involving my child, I authorize ShockTown's YES Community Program, Inc. and its authorized staff or volunteers to provide or obtain reasonable emergency assistance, including basic first aid, contacting 911 or emergency medical services, arranging emergency transportation when medically necessary, and seeking emergency evaluation or treatment from qualified medical professionals.

I understand that reasonable efforts will be made to contact me or my child's emergency contact as soon as practical. However, when immediate action is reasonably necessary to protect my child's health or safety, emergency assistance may be obtained before I am reached.

I understand that this authorization does not authorize YES staff or volunteers to routinely administer prescription or over-the-counter medication to my child unless separately authorized and permitted by applicable program policy and law.

WHAT THE PROGRAM IS NOT STAFFED TO PROVIDE

ShockTown's YES Community Program, Inc. is a nonprofit organization run by staff and volunteers. They are not doctors, nurses, therapists, or trained personal-care attendants, and the program is not licensed, certified, or staffed to provide medical care, nursing care, routine medication, behavioral intervention, or one-to-one personal assistance.

The program supervises participants during scheduled activities and will obtain emergency assistance as described above. Beyond that, it cannot take responsibility for care it is not qualified to give.

If my child has a medical condition, an allergy requiring emergency medication, a disability, or any other need that calls for care, supervision, or assistance beyond what the program provides to participants generally, I agree to tell the program before my child attends, by calling call the YES Program Director at (713) 591-5301.

The program will then talk with me about what my child needs and what the program can safely provide. Where the program cannot safely meet that need with its own staff and volunteers, I understand that I may be asked to remain on site with my child, or to arrange for another adult I designate to remain with my child, so that my child can take part.

I understand that a need I do not tell the program about is one the program cannot plan for, and that my child may not be able to participate safely on a given day as a result.

IMPORTANT PROGRAM NOTICE — NOT A CHILD-CARE PROGRAM

ShockTown's YES Community Program, Inc. is not a daycare, summer camp, licensed child-care facility, or substitute for daycare or after-school child-care services. The program is not licensed by the State of Texas as a child-care operation.

YES provides scheduled and structured youth sports, leadership, mentoring, crime-prevention, safety-education, and related activities.

Parents/legal guardians understand that the program is not intended to provide general child-care services outside of scheduled YES program activities.

SUPERVISION PERIOD

YES supervision is limited to the child's participation in scheduled YES program activities and begins when the child is properly checked into or released to the YES Community Program in accordance with the applicable school/program procedure.

YES supervision ends when the child is properly released at the conclusion of the scheduled program session in accordance with the program's approved dismissal or parent/guardian pickup procedure.

Parents/legal guardians are responsible for timely pickup and for complying with all applicable school and YES arrival, dismissal, and pickup procedures.

PROGRAM PARTICIPATION

Participation in the YES Community Program is voluntary.

I understand that my child may participate in sports, games, exercises, recreational activities, leadership activities, mentoring, and interactive educational activities.

I agree to provide YES with relevant information concerning any restriction that would affect my child's safe participation in program activities.

I understand that I am responsible for determining whether my child is physically capable of participating and for obtaining medical clearance when medically necessary or recommended by my child's healthcare provider.

EMERGENCY CONTACT INFORMATION

I acknowledge that I have provided current emergency contact information for my child.

I agree to promptly notify program staff if my child's emergency contact information changes, including changes to telephone numbers or persons authorized to be contacted. To report a change, call the YES Program Director at (713) 591-5301 or tell program staff at drop-off or pick-up.

I understand that YES will rely upon the information provided to the program during an emergency and that inaccurate or outdated information may prevent or delay the program from reaching me or another authorized emergency contact.

CODE OF CONDUCT — RULES FOR KIDS

1. Respect Others: Treat teammates, coaches, mentors, volunteers, and other participants with kindness and respect. Bullying, teasing, threatening behavior, or disrespect is not allowed. 2. Follow Instructions: Listen to coaches, mentors, and program staff and follow instructions during activities. 3. Wear Appropriate Sports Attire: Wear comfortable athletic clothing and closed-toe athletic shoes appropriate for physical activity. Avoid jeans, sandals, or other clothing or footwear that may interfere with safe participation. 4. Stay Safe: Use equipment properly, remain within designated program areas, and follow safety instructions. 5. Be Inclusive: Encourage and support teammates. Do not intentionally exclude or mistreat other participants. 6. Practice Good Sportsmanship: Be respectful whether winning or losing. Celebrate accomplishments and learn from mistakes. 7. Participate Actively: Give your best effort, participate appropriately, and remain engaged in program activities. 8. Electronic Devices: Phones and personal electronic devices should remain put away during activities unless permission is provided by program staff. 9. Be On Time: Arrive promptly and be prepared to participate.

CODE OF CONDUCT — RULES FOR PARENTS/GUARDIANS

1. Be Supportive: Encourage your child and other participants positively and appropriately. 2. Respect Staff and Volunteers: Treat coaches, mentors, volunteers, staff members, school personnel, participants, and other families respectfully. 3. Model Appropriate Behavior: Demonstrate sportsmanship, respect, and appropriate conduct. 4. Dress Appropriately: When attending or volunteering at program activities, wear clothing appropriate for the environment and activities. 5. No Sideline Coaching: Allow YES coaches, mentors, and program staff to lead activities and provide instruction. 6. Be Punctual: Ensure your child arrives as required and is picked up promptly at the conclusion of the program. 7. Communicate Concerns Appropriately: Questions or concerns should be addressed privately with program staff rather than disrupting program activities. 8. Follow Program Policies: Comply with applicable YES and school safety, attendance, arrival, dismissal, and participation requirements. 9. Avoid Disruptions: Avoid conduct, conversations, or other activity that interferes with the program or participants.

CONSEQUENCES FOR VIOLATIONS — PARTICIPANTS

Program staff may use progressive corrective action when appropriate: verbal warning, then temporary removal from the activity, then parent/guardian notification, then dismissal from the program.

However, serious misconduct — including violence, threats, serious bullying, possession of prohibited or dangerous items, intentionally leaving designated program areas without authorization, or conduct that creates an immediate safety risk — may result in immediate removal from an activity or dismissal from the program without completing every progressive disciplinary step.

CONSEQUENCES FOR VIOLATIONS — PARENTS/GUARDIANS

Program staff may use a verbal warning, then a private discussion with program staff, then removal from program events.

Serious, threatening, unsafe, or substantially disruptive behavior may result in immediate removal from a program activity or event.

PARENT/LEGAL GUARDIAN ACKNOWLEDGMENT

By electronically submitting this agreement, I certify that:

• I am the child's parent or legal guardian, or I otherwise have legal authority to provide the permissions and authorizations contained in this agreement. • I have read and understand this Parent/Guardian Waiver, Consent & Participation Agreement. • I have had the opportunity to review its terms before agreeing. • I understand the assumption-of-risk and release-of-liability provisions. • I understand the YES Community Program is not a licensed child-care operation or substitute for daycare or after-school child care. • I understand and agree to the Media Release and Program Participation Requirement. • I authorize the NAM information sharing described above. • I understand that every part of this agreement applies, and that my child cannot take part in the program without it.

I have read this entire Parent/Guardian Waiver, Consent & Participation Agreement — including the NAM information sharing authorization, the Media Release, and the release of liability for the program's own negligence — I understand it, and I agree to all of it on behalf of my child and myself. *