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Equity Now, Inc X Landmark Christian

Afterschool Financial Education Program

Registration Form

5th & 6th Grade Scholars

Club Day: Tuesdays

Instructor: Dr. Briscoe

Start Date: Wednesday, March 18, 2026

Time: 4:00 p.m.- 5:00 p.m.

Payment: $175 total for the 8 weeks (payment plans available)

Contact: Ruth Simmons ruth@equitynowinc.org or Dr. Briscoe at natosha.briscoe@landmark-cs.org


Student Information

Grade
4th
5th

Parent/Guardian Information

Multi-line address

Emergency Contact (If different from above)

Parental Consent & Media Release: By submitting this form, I give permission for my child to participate in the Ethos Afterschool Program and all related supervised activities. I also grant Ethos Afterschool Program, Equity Now, Inc., and their partners permission to photograph, record, or film my child and to use my child’s likeness, image, video, voice, and/or work for educational, promotional, reporting, fundraising, and informational purposes in print and digital formats (including websites and social media), without compensation. I understand reasonable safety precautions will be taken, that my child is expected to follow program rules, and that no personally identifying information will be publicly shared without additional consent. I release and hold harmless Ethos Afterschool Program and Equity Now, Inc. from liability except in cases of gross negligence.

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Registration fee
$175
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