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EDGE@Work Community Service Registration Form ’25-26

Please complete this registration and consent form. Only one form is needed per school year per student. This form does not reserve a spot in the EDGE@Work van to go out and serve within the community. Therefore, make sure to also select and sign up via the appropriate Sign Up Genius links for each volunteer outing for desired participation. This form is the permission slip and registration to allow participation in the program.

Name
Address
Parent/Guardian Information (Note: We need completed information for at LEAST ONE parent/guardian)
Parent/Guardian #2
Allergies/Conditions/Medications
Parent/Guardian Signature
Photo Release
I give my permission for EDGE Teen Services to use photos and/or videos that include my student on its social media sites and website, and in publications, printed materials and local media.
Gender Demographics (This information is necessary for the funding of our program. All information will be kept confidential)
Race/Ethnicity Demographics (This information is necessary for the funding of our program. All information will be kept confidential) Select all that apply
Student lives with: Select all that apply (This information is necessary for the funding of our program. All information will be kept confidential)
Participant’s Name

Contact Us

EDGE@East Teen Center
7568 Wyandot Lane
Liberty Township, OH 45044
located across from LEHS Main Campus melissa@edgeteencenter.com
Questions? Call 513-755-2400
Hours: 2:30pm-6:00pm *Summer hours may vary