High School Registration - CLICK HERE
Middle School Registration - CLICK HERE
THANK YOU FOR YOUR INTEREST IN OUR UNITY 4TEENS PROGRAM
GRACIAS POR SU INTERÉS EN NUESTRO PROGRAMA UNITY 4TEENS
MÈSI POU ENTERÈ OU NAN INITE NOU 4TEENS PWOGRAM
We believe that children learn from us. We are their role models. Children are forming habits, attitudes and patterns that will affect them throughout life. We expect all employees to treat Unity 4Teens participants in a respectful manner and for participants to respond in the same way. We also expect participants to show this same respect to each other and to use all equipment and facilities in an appropriate manner. Unity 4Teens participants demonstrating inappropriate behavior will be redirected as a rst intervention.
For more serious infractions - such as biting, ghting, improper language - or for repeated infractions, the participant will be sent to the Site Director for further discussions. If this intervention does not resolve the problem behavior, the participant's parent(s)/guardian(s) will be contacted. Chronic misbehavior will result in dismissal from the program. Parents demonstrating inappropriate behavior towards staff, participants, or other parents/guardians will result in their child(ren) being dismissed from the program.
All clients shall enjoy all of their legally entitled rights, and in addition can expect the following rights to be honored while receiving any service at Hispanic Unity of Florida, Inc. (HUF):
I understand and agree that Hispanic Unity of Florida, Inc. recognizes any information obtained is of a confidential nature. Hispanic Unity of Florida and its employees agree to fully comply with preserving confidentiality and agree not to divulge or discuss confidential information for any purpose or in any matter not in conformity with the State of Florida or Federal law, except for the purpose of administrating this program.
I hereby authorize Hispanic Unity of Florida to obtain/release information about my child from/to the following organizations:
I understand and agree that the data collected and analyzed can be shared with other program funders & stakeholders.
I understand and agree that in case of an emergency, Unity 4Teens staff will attempt to reach the parent(s)/guardian(s) listed on this registration form with the emergency numbers provided. If for any reason we are unable to reach the emergency contact person, I authorize the President/CEO of Hispanic Unity of Florida or its staff to obtain necessary medical services to ensure my child’s health.
I authorize Unity 4Teens to use emergency services and have them transport my child to the nearest medical facility. I understand and agree that if any medical procedure is necessary due to an emergency, all reasonable attempts will be made to contact the parent(s)/guardian(s) listed on this registration form.
I do hereby release Hispanic Unity of Florida, its officers, agents and employees from and against any and all claims or demands of any kind or nature that may accrue in my favor on account of my child’s/my participation in the program. This includes any activity or event sponsored by Hispanic Unity of Florida during the program.
The provisions of this release and hold harmless shall apply whether or not the claim or demand results in whole or in part from any negligent or contributory negligent act or omission on the part of Hispanic Unity of Florida, its officers, agents or employees, or any combination thereof. Nothing in this agreement shall be construed to affect the rights, privileges and immunities of Hispanic Unity of Florida under the doctrine of “Sovereign Immunity” and as set forth in Section 768.28 statues.
If you feel that services to you or your child have been incorrectly denied or have not been provided fairly or reasonably, you may present your concerns, verbally and in writing, within three (3) business days following such action, to supervisory staff who will review the circumstances and render a decision within three (3) business days of receiving your complaint.
If the matter is not resolved to your satisfaction, you may send a written request to the agency’s grievance committee chairperson, who will investigate and assign a hearing date for you to present your case before the grievance committee within three (3) business days from the date they receive your request. You will have a final decision within four (4) business days following your hearing.
Forms and a copy of the complete appeals/grievance policy is available from Hispanic Unity of Florida, upon request. You have a right to seek legal recourse, through your own independent counsel if you believe that civil rights or confidentiality laws were violated in your case; however, you may request to resolve the issue through the agency’s appeal/grievance process.
Consent to Participate in Surveys & Data Collection
Your child has been chosen to participate in the Teen Outreach Program® - replicated at Apollo Middle School, Attucks Middle School, McNicol Middle School & Olsen Middle School - and owned by Wyman Center, Inc. (Wyman). During the time your child will spend in the Teen Outreach group, young people will explore their own growth and development, their goals for the future, and their goals for close and productive relationships with others. This program has been evaluated nationally and has shown very positive results for young people. This unique program will involve your child in volunteer work in the community. This work may occur off school grounds. The program promotes progress in school and avoidance of behaviors which may hinder your child's most successful growth and achievement.
I give my consent for my child to participate in Wyman surveys. In compliance with Children’s Online Privacy Protection Act (COPPA), Wyman provides the following information to survey participants. Wyman Center, Inc. operates a secure environment to collect and store information from student participants in its Teen Outreach Program®.
Wyman collects the following types of information directly from TOP® participants through online surveys:
I understand Wyman uses the participants’ responses to improve the Teen Outreach Program®. I understand that survey and data collection is voluntary and that my child may choose to participate or discontinue participation at any point in the process without risk of losing Wyman’s services. I am also aware Wyman will not require my child to disclose more information than is reasonably necessary to participate in Teen Outreach Program® as a condition of participation. I am aware Wyman will use and may share responses with third parties to market Teen Outreach Program® to increase awareness and funding and that Wyman will not disclose my child’ s identifying information to third parties or program staff. I also understand that the associated risks for my child to participate in this survey are minimal and will not exceed any discomfort that may be found in any daily life situations when answering routine survey questions.
For a sample report on how Wyman compiles/reports this data, go to www.wymantop.org. Contact information for Wyman Representative: Mindy Sharp, Sr. V.P., Finance and Administration; 600 Kiwanis Dr., Eureka, MO 63025; (636) 938-5245.
Please click on the following link to fill out and sign the consent form: https://cscbroward.co1.qualtrics.com/jfe/form/SV_571cnDtFiOsGvCl
You will be asked to select "provider name" - select Hispanic Unity of FloridaYou will be asked to select "program" - select Youth Force
We will need for this to be filled out as part of this registration process. Once you complete the consent form by clicking on the link above, please come back and finish the registration.
By signing, I hereby consent to all that is listed on this registration form. I have read and give consent for my child to participate in the Unity 4Teens after school and/or summer program. I also agree to be an involved participant in the program.
Once you submit, you will see a page confirming that we have received your application.