Information to be shared is:
I understand that the purpose of this information is to aid in provision of academic assistance and to provide statistical information required by the Teen REACH grant. I am aware that I have the right to inspect and copy any infomation disclosed.
Current Grade Level: blanks Teacher: blank
My child has permission to participate in the Teen REACH program. I understand that Teen REACH is an activity-based, out-of-school program for youth. The goals of the program are:
This consent is valid for the length of my child's participation in Teen REACH or until revoked by me in writing.
In the event that I, or the emergency contact listed, cannot be reached in an emergency, I give permission to the Teen REACH staff to seek medical treatment for my child. This consent is valid for the length of time my child participates in Teen REACH or until revoked by me in writing.
I also understand that by signing this consent for my child, I knowingly release the Illinois Department of Human Services, Quincy Public School, and their employees, volunteers, and all other agencies in connection with Teen REACH from any and all claims of injury or illness sustained by my child while attending the program.