Project Club Permission Form

Form for signing up your student to the grades 3-5 After School Program.

Dear Parent/Guardian of Student(s) in Grades 3-5,

Project Club is an afterschool activity club for 3rd-5th graders. It meets on Mondays from
3:00-5:00 at the JMMY Center (1486 Stonebridge Road) and follows the school calendar. If
there is a snow day or early dismissal, we don’t meet. The school bus driver very kindly brings
the children to the center after school and one of us greets them to make sure they are safely off
the bus. Parents must pick up their children at 5:00. There is no cost. We have 5 adult
volunteers - all retired. They are David Little, Alexis Bell, Marilyn Prevuznak, Ginny Gutkopf and
Cindy Little.
Our basic premise is that children need the opportunity to be outside playing as well as inside
doing arts and crafts, community service projects, woodworking, baking and various other
activities. We work on team building, being respectful to each other and enjoying each other’s
company!
If you think your child might want to join us, please fill out the registration form below: https://jmmyvt.org/pc-permission. We accept 12 children and as of right
now, we have 7 children on our roster so we have 5 openings.
If you have any questions, please email me. Cindy.little1955@gmail.com.

JMMY Center After-School Permission Form

This form is a summary of the JMMY Center conduct policy. A copy of the full conduct policy and bylaws are available upon request.

1. Our main concern is the safety of all participants

Each participant has the right to have fun and be protected from any harassment. The environment is completely smoke, drug and alcohol free. Everyone has the right to participate in the after-school activities in the JMMY Center and to abide by the rules of the center. The JMMY Center has an open policy, all children are encouraged to participate in events, but it is entirely voluntary. Children in the after-school program must have a signed permission form, bus drop-off permission (turned into the GEMS office) and have a designated person who will pick them up. Children will not be released into the custody of anyone without the expressed permission of the parent/guardian.

2. We will handle misconduct appropriately

Any misconduct committed as outlined in the disciplinary policy will be handled with the smallest audience possible. We reserve the right to withhold access for any individuals who consistently refuse to abide by the conduct policy or commit serious infractions.

3. All volunteers are there to help your child

All volunteers have been fingerprinted and federally background checked. They are here to assist your child with any needs they may have. Each volunteer is a mandated reporter and is required to report any form of possible abuse.

4. We are not sponsored by the school

We are an independent organization that works closely with Georgia Plain Baptist Church. Our goal is not to solicit church involvement, but to provide a safe, nurturing space for the children and youth of Georgia. All our funding comes from donations, fundraisers, and grants.

By filling out and submitting this form, you are indicating that you agree with the stated afore mentioned. Furthermore, all the following information will remain strictly confidential and will not be shared with any other party.

Child's name *

Name of the child who will be attending this activity. If more than one child will be attending, please fill out a separate form for each child

Grade *

Parent's name *

Name of the parent or guardian authorizing the child the participate in this activity

Street address *

Town *

Home phone # *

Parent's cell phone # *

Parent's email address *

Allergies or medical conditions *

Students will have a snack once they arrive at the JMMY Center. Please let us know about any allergies or medical concerns that we should consider in regards to your child

Emergency Contact (if unable to reach parent)

Contact name *

Contact phone # *

Agreement *

I agree to the above-listed guidelines and certify that all the information I entered above is true and accurate

Today's date

reCAPTCHA Invisible *

Project Club 2026-2027 Permission Forms and news

JMMY Center After-School Permission Form

1. Our main concern is the safety of all participants

2. We will handle misconduct appropriately

3. All volunteers are there to help your child

4. We are not sponsored by the school