Afterschool and Summer Camp Registration

.*Asterisks denote where input is required!

*Afterschool / Summer Camp Site Name:
    Note: If you have more than one site, each site will need its own registration form.

  

*Site Address:

  

*City: *State:  *ZIP Code: 

     Very important: Please use a local address where you can accept UPS deliveries.
     We cannot accept P.O. Boxes.  Please don't forget your suite number.

*Site Coordinator's Name:

*Area Code:     *Phone/Cell Number: 

*E-mail Address:

Best Way to Contact Me:

Please list each STUDENT GROUP for which you would like a JA program:

Adult Group Leader/Teacher	Student Grade Level(s)	Estimated Number of Students
Ex. Mrs. Sheila Washington	Ex.  3rd - 5th	Ex.  22

.Additional Requests:

How did you hear about JA?

Can you make a donation to JA?  YOU ARE NOT REQUIRED TO DONATE.

I am unable to make a donation and I understand I am not required to.

I want to donate by purchasing my JA Kits.  Please invoice me $100 per JA Kit.

I want to make a donation of some other amount.  Please send me a pledge card.

I am interested in attending one of JA's fundraising events.  Please send me information.

Please Read the Terms of Agreement:

1.      Junior Achievement of Greater New Orleans, Inc. Shall

• Provide in package form the JA curriculum and all materials necessary for its implementation, herein called JA Kits.

• Provide JA curriculum training to the persons who will teach the JA curriculum, herein called Staff.

• Confer regularly with Partnering Agency to assess the progress of teaching the JA curriculum.

• Provide JA curriculum support as needed, including but not limited to answering questions and ordering additional JA Kit materials.

• Reclaim any unused JA Kits (if any) around the end of the service term.

2.      Partnering Agency Shall:

• Work with JA to develop opportunities for JA curriculum to be taught.

• Provide to JA a list of ‘student groups’ of 15 students or more and the ‘student group’ grade level(s) to be used in ordering JA Kits.

• Undertake reasonable measures to ensure the good condition of JA Kits received, including but not limited to the proper usage of the JA Kit as outlined in the JA Kit’s curriculum guide.

• Supply Staff who will teach the JA curriculum.

• Work with JA to provide JA curriculum training to the Staff, either by an on-site training at Partnering Agency’s location or an online format.

• Assign Staff to student groups where the JA curriculum will be taught.

• Confer regularly with JA to assess the progress of Staff in implementing the JA curriculum.

• Cooperate with JA’s requests (if any) to visit Partnering Agency during program implementation.  Purposes of visit may include quality assurance, JA staff training, photographing program implementation (with Partnering Agency permission), etc.

• Cooperate with JA’s verification process (a letter mailed from a 3^rd party to seek verification that Partnering Agency correctly implemented JA curriculum).

• Cooperate with JA in the reclaiming of any unused JA Kits (if any) around the end of the service term.

3.      Other

• Compensation:  JA will provide JA Kit(s).  While actual cost to JA is $10 per student, no fee will be assessed for this contract.  Donations are appreciated.

Indicate that you have read and understand Junior Achievement’s Terms of Agreement as stated above and will abide by these terms by choosing “Yes, I agree” below, typing in your name, then clicking the “Submit” button.

*Do you agree?  You must select 'Yes, I Agree' to receive JA programs.

I Have Not Agreed Yes, I Agree

*Electronic Signature:   *Date: 

Once you submit, someone from JA will contact you soon regarding your registration and to schedule a staff training (if applicable).