2020 TCG Memorial Academy Summer Experience

FREE!

TUESDAYS, WEDNESDAYS, THURSDAYS, JULY 7-30
8-10:30 & 11-1:30
REICMUTH PARK
6135 GLORIA DRIVE
SACRAMENTO, CA 95831

REGISTER BELOW!

In today’s world, with all of the ongoing challenges we face daily, we are honored to have the opportunity to provide a safe space and platform for our youth to fellowship, have fun, learn, and grow. We thank you for your patience, as we have been working extremely hard to ensure the Summer Experience was a reality this year.

In this, our 12th year of providing the Summer Experience, we, too, have had to navigate new obstacles in our commitment to continuing our programming, and honoring the legacy of Terrell Christopher Gladney. While we will maintain the same safe, engaging, and loving environment, there will be some unavoidable changes, that we will work diligently to minimize the impact of.

We are constantly monitoring the ever-changing status of the COVID-19 pandemic and the restrictions and requirements created as a result.

• We have aligned our programs and practices within the recommendations of health and government guidelines to help keep our scholars and mentors safe and healthy.
• Due to the unavailability of school campuses via civic permits, we are utilizing public park space.
• We are delivering programming to scholars in cohort groups, limiting interaction between large groups.
• We have created two, two hour blocks, a change from our historical format of four continuous hours.
• Due to limit physical space, and high demand, we may need to implement a waitlist system.

Despite the necessary changes, we are excited to create an outlet in which our young people can reconnect and create new memories. As always, thank you for your love and support of our youth.

Terrence Gladney, Sr.
Founder, Director
Terrell Christopher Gladney Memorial Academy

2020 TCG Memorial Academy Summer Experience Registration

Scholar (Student) Name*

First

Last

Date of Birth*

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Parent/Guardian Name #1*

First

Last

Parent/Guardian Name #2

First

Last

Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country

Phone*

Email*

Any Allergies or Health Concerns? If yes, please specify, as well as any medication or special care required.*

2019-2020 School of Attendance*

2019-2020 Grade Level*

TK/Pre-School

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

College/Career/Post-Secondary

2020-2021 Grade Level*

TK/Pre-School

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

College/Career/Post-Secondary

2020-2021 School of Attendance*

Preferred Time Block

8AM-10:30AM

11AM-1:30PM

COVID-19 PANDEMIC PARTICIPATION CONSENT FORMAssumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World HealthOrganization. COVID-19 is extremely contagious and is believed to spread mainly from person-toperson contact. As a result, federal, state, and local governments and federal and state healthagencies recommend social distancing and have, in many locations, prohibited the congregation ofgroups of people.Terrell Christopher Gladney Memorial Academy (hereby referred to as TCG Memorial Academy) has put in place preventative measures to reduce the spread of COVID-19;however, TCG Memorial Academy cannot guarantee that you or your child(ren) will not becomeinfected with COVID-19. Further, attending TCG Memorial Academy events could increase your riskand your child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending this event and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the event (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless TCG Memorial Academy, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club program.*

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Parent Name (Electronic Signature) This will serve as your electronic signature confirming your child's participation in our program:*

Today's Date (For Confirmation of Signature)*

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