School Records Release
I grant Attack Poverty and it’s program staff permission to access my child’s school records for the purpose of assistance in tutorial programs.
I understand that in the event medical intervention is needed, every attempt will be made to contact the persons that I have listed on this registration. If my contacts cannot be reached, I hereby give permission to the physician or dentist, selected by the leaders at the “Friends of" location at which I/my child participate, to secure treatment as deemed medically necessary.
I authorize and grant Attack Poverty and the “Friends of" location, at which I/my child participate, the right to use, publish, and copyright my/their image (including audio, moving image, or photograph) for educational programs, web sites, and for the purpose of marketing and promotions. This release is effective from the date of signature. If I do not wish to be photographed or interviewed for news or promotional coverage, I will remove myself from situations where my wishes may be violated. I agree to waive my rights to hold Attack Poverty, their officers, agents and employees responsible for any liability, loss, or damage that occurs from my participation in any promotional activities.
I certify that this application was completed by me and that all of the information on this application is true and correct to the best of my knowledge. I understand that this application is not valid without my signature.