Student Information

Student First Name

Student Last Name

Current School

Student's Anticipated High School Graduation Year

Our Summer Program is only open to students 11 years of age or older. If your student is currently under the age of 11, please subscribe to our newsletter to be notified when your student is eligible.

Student Date of Birth

Student Race/Ethnicity

Student Phone

Student Gender

How did you hear about us?

Returning Student

My child heard about it or a friend told me

Received your text or email

Poster or flyer at school

Google

Saw a poster at church or in neighborhood

Are you a returning student?

Yes

Schedule Preferences

The summer program is offered five days a week.

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone

Preferred Language

Parent/Guardian Email

Relationship to Student

Parent/Guardian Address

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact #1

First Name

Last Name

Phone/Mobile

Relationship to Student

Is this person authorized to pickup the student?

Yes

Emergency Contact #2

First Name

Last Name

Phone/Mobile

Relationship to Student

Is this person authorized to pickup the student?

Yes

Ok! We are almost at the end. This section is about our policies at the Hope Center and your student's health forms:

Out of School Time Family & Youth Handbook

Please review our Out of School Time (OST) Family & Youth Handbook which can be found in the PDF below. Please note that HOPE Center for the Arts is an extension of Hope for Youth & Families.

Download the Out of School Time Family & Youth Handbook.

Select all:

I understand the program conduct policy as outlined in the OST Family & Youth Handbook and that my child is expected to follow the behavior guidelines as outlined. I further understand that suspension or termination can occur if the conduct policy is violated.

I have reviewed and agree to all policies outlined in this registration and in the OST Family & Youth Handbook.

SEZP Universal Consent

If you student attends a SEZP school, please review the following document and choose the response that applies to you and your student. Please note, this consent form is part of our grant funding from SEZP.

Download the 2026 Universal Consent Form here.

Select all that apply:

I agree to allow my child to complete a short survey about their experience in this program called the Survey of Academic and Youth Outcomes (SAYO-Y), which asks about program experience and future plans. (optional) All of this data is private and is only used to improve after-school and summer programs. The data is only shared with organizations working on the citywide project: Springfield Empowerment Zone Partnership, Boston After School & Beyond, the National Insititute on Out-of-School Time. These organizations will not publish anything that includes your child's name. All information is reported in groups. Other after-school and summer programs in this project may review your child's information to confirm whether your child is enrolled in their program. However, these programs will not be able to review your child's survey responses about their experience at this program.

I have read this form and agree to let my student participate in this citywide project and in video/photography.

I have read this form and agree to let my student participate in this citywide project, but NOT in video/photography.

I have read this form and do not agree to let my student participate in this citywide project or in video/photography.

Program Release Expectations

Please review student release options and choose all that apply to your student.

Please choose your students dismissal option:

I will ensure that the student will be picked up promptly at dismissal time by myself or one of the contacts indicated above.

I GIVE Hope for Youth & Families, Inc./HOPE Center for the Arts PERMISSION for my student to BE DISMISSED WITHOUT SUPERVISION to walk or bike home.

I understand that it is my responsibility to communicate any changes in transportation arrangements to HYF.

Media Release and Photo/Video Consent

As part of the Hope Center for the Arts program, students will participate in photography, videography, and media production activities that are integral to their arts education curriculum. By enrolling in this program, parents/guardians grant permission for their student to be photographed and recorded during regular program activities, including but not limited to classes, rehearsals, performances, Community Spotlight presentations, and collaborative projects. These images and videos may be used by Hope For Youth & Families for educational purposes, program documentation, promotional materials, social media, website content, grant applications, and community outreach to showcase student achievements and program impact. Students will also create their own photo and video content as part of their coursework in visual arts and media production. We are committed to representing students respectfully and in contexts that celebrate their creativity and growth.

If you would like your student to be opt-ed out of having them be photographed, videoed, or in other media such as podcast, vlogs, and marketing materials, please email Tatiana at Tatiana@hyff.org.

Student Health Form

Hope for Youth & Families, Inc. will not handle, store, or provide medication of any kind to the students in our care. With several hundred registrants and no clear daily attendance pattern it is not possible for us to catalog, store, and maintain medication for all those who need it. Students who take medication on site must be capable of storing it and taking it on their own without the assistance of a staff member. Students with inhalers and epi-pens are encouraged to keep them with their personal belongings in case they are needed.

I agree to the following:

I authorize the HYF/HOPE staff to furnish and/or obtain emergency medical treatment, which may be necessary for my child during the program. In the event of an emergency at which time I cannot be reached, I give consent to transport my child by ambulance to a medical facility for treatment, and I will take full responsibility for this action and agree to pay any expenses incurred for this transaction and treatment. I hereby give my consent to any emergency facility and physician to administer medical treatment to my child according to the physician or facility's discretion. I understand the medication policy outlined above and take full responsibility for ensuring that my child arrives each day with any proper medication necessary and in the proper storage containers. I further understand that if my child arrives to the program without necessary medications such as an asthma inhaler, my child will not be able to participate in any physical activity during the program.

Please list any health conditions or allergies that we should be aware of such as asthma, seizures, diabetes, allergies, etc. Please list any medications that the student will have with them during the program such as an inhaler or an EpiPen.

Release of Liability

I understand the nature of the program and that participation is voluntary. I understand that the provider of the program that I have chosen in this registration process, will not be held responsible for loss, damage, illness, or injury to person or property as a result of participation in the program. I hereby release and discharge the Hope for Youth and Families, Inc. and their officers employees, agents, and volunteers from any and all claims for injury, illness, death, loss or damage as a result of participation in the program.

I understand

This is the last part! You are almost there. Thank you for all of this.

By signing below, I affirm the information provided in this form is true and accurate to the best of my ability.

Your Signature

Sign Here

Please type your first name:

Please type your last name:

Relationship to participant:

Student Information

Student First Name

Student Last Name

Current School

Student Date of Birth

Student Gender

Student's Anticipated High School Graduation Year

Student Race/Ethnicity

Student Phone

Schedule Preferences

The after school program is offered five days a week.

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone

Preferred Language

Parent/Guardian Email

Relationship to Student

Parent/Guardian Address

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact #1

First Name

Last Name

Phone/Mobile

Relationship to Student

Is this person authorized to pickup the student?

Yes

Emergency Contact #2

First Name

Last Name

Phone/Mobile

Relationship to Student

Is this person authorized to pickup the student?

Yes

Thank you for all of this! We have just a bit more information for you.

The first is Transportation:

Our HOPE Van will pick up students at the schools listed below. All times are estimated – our van may encounter normal delays:

TAG Middle School (at 2:20pm)
Springfield Conservatory of the Arts (around 2:50pm)
South End Middle School (around 3;00pm)
Impact Middle School (around 3:15pm)
Legacy Academy (around 3:15pm)
Veritas Middle School (around 3:40pm, around 1:20 on Wednesdays)

We recommend students from the following schools use the free PVTA to get from school to the Center or family provided transportation:

Duggan Academy
Sci-Tech High School
Putnam Vocational
Central High School
Renaissance School
Aspire Academy

All other schools need to coordinate their own transportation with their student to the Center:

Aspire Academy
Baystate Academy
Commerce High School
Discovery High School
Forest Park Middle School
Hampden Charter Middle School
Hampden Charter High School
Homeschool
John F Kennedy Middle School
Kiley Middle School
Libertas
Phoenix Charter Academy
Rise Academy / Rise Prep High School at Van Sickle
Sci-Tech High School
Springfield Conservatory High School
Springfield Honors Academy
Springfield International Charter
Springfield Lyceum College Prep
Springfield Prep Charter
Springfield Virtual School
STEM Middle School
Van Sickle Academy
Van Sickle Prep
Veritas Prep High School
Zanetti Middle School

Please call our office at 413-285-8886 with any questions or concerns.

Please choose how your student will arrive to HOPE Center for the Arts:

My student attends one of the schools where the HOPE Van picks up and I grant them permission to take the HOPE Center van to the HOPE Center for afterschool, Monday through Thursday. I understand that if this changes, I must contact the office at 413-285-8886.

My student attends Kiley and I grant them permission to take the PVTA bus with the chaperone. I understand that if this changes, I must contact the office at 413-285-8886.

My student will be transported to the Center by an alternative method (PVTA, carpool, walking, family transport method, etc.)

Ok! We are almost at the end. This section is about our policies at the Hope Center and your student's health forms:

Out of School Time Family & Youth Handbook

Please review our Out of School Time (OST) Family & Youth Handbook which can be found in the PDF below. Please note that HOPE Center for the Arts is an extension of Hope for Youth & Families.

Download the Out of School Time Family & Youth Handbook.

Select all:

I have reviewed and agree to all policies outlined in this registration and in the OST Family & Youth Handbook.

SEZP Universal Consent

Download the 2026 Universal Consent Form here.

Select all that apply:

I have read this form and agree to let my student participate in this citywide project and in video/photography.

I have read this form and agree to let my student participate in this citywide project, but NOT in video/photography.

I have read this form and do not agree to let my student participate in this citywide project or in video/photography.

Program Release Expectations

Please review student release options and choose all that apply to your student.

Please choose your students dismissal option:

I will ensure that the student will be picked up promptly at dismissal time by myself or one of the contacts indicated above.

I GIVE Hope for Youth & Families, Inc./HOPE Center for the Arts PERMISSION for my student to BE DISMISSED WITHOUT SUPERVISION to walk or bike home.

I understand that it is my responsibility to communicate any changes in transportation arrangements to HYF.

Media Release and Photo/Video Consent

I grant permission for my student to participate in photography/videography activities and for HYFF to use images/videos as described above.

My student can participate in photo/video activities, but cannot be publicly identified for safety or privacy reasons.

Photos and videos of my student are not allowed for safety or privacy reasons. I understand that this may limit participation in certain activities.

Student Health Form

I agree to the following:

Release of Liability

I understand

This is the last part! You are almost there. Thank you for all of this.

By signing below, I affirm the information provided in this form is true and accurate to the best of my ability.

Your Signature

Sign Here

Please type your first name:

Please type your last name:

Relationship to participant:

Hope Help

Student Information

Schedule Preferences

Parent/Guardian Information

Emergency Contact #1

Emergency Contact #2

Ok! We are almost at the end. This section is about our policies at the Hope Center and your student's health forms:

Out of School Time Family & Youth Handbook

SEZP Universal Consent

Program Release Expectations

Media Release and Photo/Video Consent

Student Health Form

Release of Liability

Student Information

Schedule Preferences

Parent/Guardian Information

Emergency Contact #1

Emergency Contact #2

Thank you for all of this! We have just a bit more information for you.

The first is Transportation:

Ok! We are almost at the end. This section is about our policies at the Hope Center and your student's health forms:

Out of School Time Family & Youth Handbook

SEZP Universal Consent

Program Release Expectations

Media Release and Photo/Video Consent

Student Health Form

Release of Liability

Let's get in touch!

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