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Neighborhood Academic & Athletic Association DONATIONS

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Teen Fun Nights

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Parents/Guardians Only

Participation, Travel and Hold Harmless Agreement

By signing and dating this form below, I, the undersigned, give my child/children permission to participate in Revelation Evangelistic Ministry's, Faith & Hard Works Ministry's Inc. Prosperity Academy & Community Center Programs and to travel with the Faith & Hard Works Ministry Inc, YMCA, Salvation Army, Washburn University, Kansas State University, Heartland Works, Topeka Workforce Center, Stardusters Crime Prevention Inc., Topeka Community Foundation, state of Kansas, City of Topeka, Shawnee County Government, Kansas Black Expo, Moses Project, and Neighborhood Academic & Athletic Association, the Christian & Agricultural College Preparatory High School.


I also Hold Harmless the organizations listed above, their staffs and Volunteers in cases of accidental injury, or loss of Property as a result of my child/children's Participation in the various Neighborhood Academic & Athletic Association's Pro-gram.

I also realize that the above listed agencies will not cover any medical cost associated to injuries to my child/children as a result of their participation in these programs and I also realize it is my insurance that will cover all medical cost associated to my child/children's participation in this program.

I also give the Staff & Volunteers permission to seek medical attention for my child/children in my absence, My child/children have had a Medical Physical within the last year and have been cleared for participation.

Use your mouse, trackpad or finger (if on touch device) to sign above.
17 - 15 =

Teen Fun Nights Code of Conduct:

  1. All participants are expected to show respect to others and staff at all times; swearing, fighting and/or rowdy behavior is not permitted. 
  2. Possession or use of drugs, alcohol and/or tobacco products are strictly forbidden at all times and is cause for immediate dismissal from any Teen Night programs. 
  3. Teen Nights participants are required to register and remain inside the building - in the designated program areas - during the scheduled programs. 
  4. Teen Nights participants must be picked up by 10:30PM 5. Teen Nights participants are free to move from each available area at will.
  5. If Teen Nights participants are not following rules, they will be sent home and not permitted to return to future events. 
  6. Teen Nights PARENT: Must agree to be available by phone during the hours (6:00 - 10:30 pm) if your child is participating at the Teen Nights at Hillcrest Community Center 
  7. Teen Nights PARENTS must also understand that they are responsible for picking their child up promptly from Teen Nights or arranging for another responsible adult to do so. 
  8. PARENT VOLUNTEERS: Parents are strongly encouraged to volunteer at any Teen Nights event. They must also be background checked. 9. Participants that are accompanied by a parent volunteer must be background checked and searched also. 
  9. Teen Nights, Revelations Evangelistic Ministry Inc, Faith & Hard Works Ministry, Shawnee County Government, City of Topeka, Kansas State University, State of Kansas, the members and their organizations of the One Topeka Family Coalition’s or it’s Volunteers is not financially responsible for injuries to your child/children or responsible for property loss or damage to personal property as result of your child/children’s participation in the Teen Nights programs:

All participants and their bags will be searched! For more information, contact Curtis Pitts at 785-304-8547.