TUTORING / MENTORSHIP /  ACADEMIC ENRICHMENT / FAMILY FUN

100% FREE

Tailored Educational Services 

To Help Your Child Reach Their Full Potential!!!

SATURDAY - 6/29/2019

Poetry / Abstract Thinking Workshop

SUNDAY - 7/14/2019

Hip Hop Dance Choreography / Kayaking

SUNDAY - 7/28/ 2019

Coney Island / Luna Park

SUNDAY - 8/11/2019

Boating and 4-D Movie

SATURDAY - 8/30/2019

Annual Talent Show / Back to School Giveaway!

Herbert Von King Park


Call (718) 310-3521 or visit youthpotential.org under PROGRAMS to register your child today.

Availability is Limited

PARENTAL CONSENT FORM

(SUNDAY) (AUGUST, 11 2019)

PARENT NOTIFICATION / CONSENT FORM Trip Date: August, 11 2019 (SUNDAY) Trip Coordinator: Mr. Omar Bowens / Ms. Latoya Bey / Mr. Arthur King (Youth Potential Academy Staff) Destination: Loeb Boathouse / Central Park 4-D Movie Theater Departure Site: Corner of Marcy Avenue and Gates Avenue Departure Time: 11:00 AM Please attempt to Arrive at: 10:45AM Return Site: Corner of Marcy Avenue and Gates Avenue (Brooklyn, NY) Return Time: 6:00PM (Approx.) Mode of Transportation: YPA Chartered Bus Purpose of Trip: To provide youth enriching boating and 4-D experience activity coupled with positive mentoring support. (YPA Love and Laughter Course) Specific Clothing/Equipment Required for this Trip: Comfortable Summer Clothing. Weather is expected to be 83 degrees. This trip will include the following physical and sports activities: Row Boating and 4-D Movie Experience (Supervised)(Life Jackets Provided) a) I understand that there are risks of injury associated with the above-listed physical and sports activities and I consent to my child’s participation in all these activities except for the following: Please Specify any limitations in the NOTES Section below. b) Please indicate below any permanent or temporary medical or other conditions, including special dietary and medication needs, or the need for visual or auditory aids, which should be known about your child: Please Specify any Medical Conditions in the NOTES Section c) I agree that in the event of an emergency injury or illness, the staff member(s) in charge of the trip may act on my behalf and at my expense in obtaining medical treatment for my child. d) I understand that my child is expected to behave responsibly and to follow the organization’s discipline code and policies. e) I agree and understand that I am responsible for the actions of my child. I release Youth Potential Academy from all claims and liability that arise in connection with the trip or participation in the program, except if due to the negligence of Youth Potential Academy staff and volunteers. f) I understand that I am responsible for getting my child to and from the departure and return sites identified above. (Unless other arrangements are made with Youth Potential Academy) *If you DO NOT give your child consent to walk home from the departure site, you will be notified by telephone call and text (1) hour before our expected time to return. If you are not present, when we arrive, or if no one is able to make contact with you or the additional contact, a staff member WILL remain with your child while continuously attempting to make contact for a reasonable and substantial amount of time. If no contact can be established, proper authorities will be contacted. I understand that my child shall be accompanied by a staff member(s) during the trip, including while traveling from the departure site to the destination site, and from the destination site to the return site. g) I understand that alcoholic beverages and/or illegal drugs are prohibited and have discussed this prohibition with my child. I understand that if my child is found in possession of these substances, he/she will be subject to school organizational disciplinary procedures and possible criminal prosecution. h) I understand that youth who violate Youth Potential Academy’s Disciplinary code may be excluded in the future. I) By submitting this Form, I give my permission for my child to participate in this trip and receive cash prizes. Media Release / Terms of Use By signing this form, I hereby give Youth Potential Academy, Inc., the perpetual, non-exclusive, royalty-free right and license to: Record my child’s participation and appearance on digital or film photography, video, audio or any other medium (collectively, the Recordings). Reproduce, distribute, publicly display and/or publicly perform, in print, electronic or any other medium, copies of the Recordings, in whole or in part. I am voluntarily making this grant of rights. Reproduce, distribute, publicly display and/or publicly perform, in print, electronic or any other medium, copies of writings, in whole or in part, that were developed by my child. I am voluntarily making this grant of rights. I further agree to release and forever discharge Youth Potential Academy, Inc., its agents, employees and designated representatives from any and all claims in law or equity that I, my heirs, or personal representatives have or shall have arising out of Recordings. This release is governed in accordance with the laws of New York.
Parent / Caregiver Name *
Parent / Caregiver Name


TUTORING / MENTORSHIP /  ACADEMIC ENRICHMENT / FAMILY FUN

100% FREE

Tailored Educational Services 

To Help Your Child Reach Their Full Potential!!!

SATURDAY - 6/29/2019

Poetry / Abstract Thinking Workshop

SUNDAY - 7/14/2019

Hip Hop Dance Choreography / Kayaking

SUNDAY - 7/28/ 2019

Coney Island / Luna Park

SUNDAY - 8/11/2019

Boating and 4-D Movie

SATURDAY - 8/30/2019

Annual Talent Show / Back to School Giveaway!

Herbert Von King Park


Call (718) 310-3521 or visit youthpotential.org under PROGRAMS to register your child today.

Availability is Limited