Triunfadores CPP Family Interest Form

The College Prep Program (part of Children Within Our Borders) hosts tutoring/mentoring sessions to help encourage students to achieve success. Normally, these sessions would be held in-person, but due to the current pandemic, they will be conducted virtually, through Zoom.

The program takes place every Monday 6:00pm to 7:30pm and Friday 5:00pm to 6:30pm, barring holidays. Students will recieve one-on-one services, including homework help, test prep, mini-lessons to encourage learning, and mentoring.

Please fill out the form below if you/your child is interested in participating in our program. We hope to hear from you soon!

If you have any question or concerns please send a text or whatsapp message to Emily Santiana, the Education Director, at (862)220-6320.

Your Name (Parent/Guardian): *

Your Email (Parent/Guardian): *

Phone Number

Area Code Phone Number

Number of Children Attending: *

Child's/Children's Name(s): *

Child's/Children's Grade Level(s): *

(Ex: Kindergarten, 2nd grade, etc.)

Does your student speak, read, and write fluently in English? *

Yes No

Do you have access to a secure internet connection and a device that is camera-enabled? *

Yes No

How many devices does your family have access to? *

#: 1, 2, etc.

What type of devices are these? *

Computer/Desktop/Laptop WITH a Front Camera Computer/Desktop/Laptop WITHOUT a Front Camera Tablet Phone

How did you hear about us/which organization are you affiliated with?

Iglesia hispana de Alachua Migrant Education Rural Women's Health Project Madres sin fronteras

I hereby grant permission to Children Beyond Our Borders Inc., the rights of my (and my child's/children's) image, in video or still, and of the likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.

By signing this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting on behalf of the College Prep Program and Children Within Our Borders.

I understand that the zoom sessions will be recorded to ensure accountability, and that my image and voice will be held in videos on the CPP drive. I understand that my personal information such as name, age, email address and phone number may be stored there as well to track students’ academic progress and aid in the program’s organizational goals.

By signing this release, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational and promotional purposes.

Parent/Guardian Signature *

Family Interest Form

Personal Information