Cool Kids Conserve - Afterschool Program

Youth & Family Angler Program

First Name *

Last Name *

Address

Street Address

City

State

Postal code

Phone *

Email *

Date of birth *

What school and grade does the youth attend?

Does your youth know how to swim?

Do you have more than one child attending the program? If so please list their names, date of birth and grade.

Please list any allergies or accommodations needed *

This program is open to families with youth grades K-8th grade, and is offered in partnership with our local, state and national agencies to promote wellness, connection, and care across generations. Participants are under the instruction and guidance of We Cope Inc and participating facilitators. Do you agree to participate?

Please acknowledge and express assumption of risk where the any and all participants acknowledges understanding the nature program and the risks involved, and chooses voluntarily to accept those risks. All participants will hold a harmless agreement where you will not to hold any parties including but not limited to We C.O.P.E. Inc and all associates responsible for any loss that may result from participation in this service.