MEDICAL RELEASE AND AUTHORIZATION FORM
In case of emergency, I hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any.
Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs.
This authorization and permission form is valid for all The Common Good activities for the 2020-2021 school year & Summer 2021.
Release Form for Media Recording
I, the undersigned, do hereby consent and agree that The Common Good, its employees, Board members, volunteers, and agents have the right to take photographs, videotape, or digital recordings of me and use these in any and all media, now or hereafter known, and exclusively for the purpose of advertising or promoting The Common Good or any entities with which we partner. I further consent that my name and identity may be revealed therein or by descriptive text or commentary.
I do hereby release to The Common Good, its Board, employees, volunteers, and agents all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used.
I understand that there will be no financial or other remuneration for recording me, either now or in the future.
I also understand that The Common Good is not responsible for any expense or liability incurred as a result of my participation in this recording.
I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.
If not 18 years of age, Parent/Guardian Name signature is required at the bottom.
THE COMMON GOOD
RELEASE OF LIABILITY FORM
In consideration of my child participating in The Common Good’s Summer Basketball Camp. We/I, do for ourselves (myself) and for and on behalf of my/our child-participant do hereby release, forever discharge and agree to hold harmless The Common Good and its employees, Board members, volunteers, and agents thereof from any and all liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and child-participant that occur while said child is participating in the activity sponsored by The Common Good.
Furthermore, We/I and for and on behalf of our/my minor child-participant if under the age of 21 years hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participating in recreation and work activities involved therein.
The undersigned further hereby agree to hold harmless and indemnify The Common Good, its employees, board members, volunteers, and agents, for any liability sustained by The Common Good as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereof.
i HAVE READ THE FOREGOING AND UNDERSTAND THE BEHAVIORAL COVENANT FOR PARTICIPANTS AND WILL ABIDE BY THEM AS WELL AS THE DIRECTIONS OF THE LEADERSHIP OF THE COMMON GOOD’S LEARNING CENTER ACTIVITIES.
This Year we will check each student for symptoms of COVID-19 and do a temperature check during check-in to ensure a safe and healthy experience for students and staff.
We will not allow a child to attend programming if they are showing the signs of COVID-19:
We ask that parents/ legal guardians check their child for the signs of COVID-19 each morning before sending your child to the HUB. If your child shows signs of COVID-19, or if they have been around friends or family who show signs for or have tested positive for Covid-19, please do not send them to the HUB until they have been seen by a physician and have tested negative for COVID-19.
THE COMMON GOOD’S COMMITMENT TO SAFETY
By signing this form, I agree to check my child each morning for the signs of COVID-19 before sending them to HUB programming. I agree to not send them to HUB programming if they are showing signs of COVID-19 or if anyone they have been in contact with has been exposed to COVID-19.
Basketball Camp Parent Information Sheet/Policies
To teach, develop, organize, and offer youth players the opportunity to learn fundamental skills of basketball while instilling life-lessons and values such as character, teamwork, discipline, respect and sportsmanship.
The Basketball Camp for 4th and 5th graders will run from July 12th to July 15th, from 4:00-6:00pm. The Basketball camp for 6th to 8th graders will run from July 19th to 22nd, from 4:00-6:00pm. As a group, children will eat a snack, be active in our gym, and participate in different group activities each day.
Check-in/Check-out Procedures, Transportation, Authorization for Pick-up
Parents/legal guardians will identify on their child’s registration form who can and cannot pick up their child. The HUB is dedicated to the safety of the children in our program and will be requiring adults to show their ID upon pickup.
If a parent or legal guardian wishes to add more people to the “Can pick up” or “Cannot pick up” list, they will need to provide the notice in writing, by delivery or email to email@example.com. This policy is in place to maintain the safety of the children in our Basketball Camp.
The Learning Center uses a checkout system to ensure that every child is picked up by a safe and approved individual. Children will not be allowed to leave the HUB without an approved individual. Upon pick-up, a staff member or volunteer will require that each individual show proper identification to ensure they are on the “List of people who can pick up my child(ren).” We take very seriously the safety of the children in our programming and will not release a child to any individual we do not recognize without a proper identification card.
Late Pick-up Policy
The Basketball Camp ends at 6:00pm, therefore we ask authorized adults to arrive by 6:00pm. If a 6:00pm arrival is unlikely on an occasion, parents will need to call the HUB at (539) 867-3692 so a staff member can speak to the child about the delay. Two late pickups without notifying the Hub will result in your child’s enrollment in the basketball camp being discontinued.
If a child misses two days in a row without explanation, the program manager will remove them from the basketball camp roster.
Children will be well supervised, and trained staff and volunteers will remain with children at all times.
Care of Children Who Are Ill
Children who become ill while in our care may be sent home if:
• The child’s illness is keeping him or her from comfortably taking part in the basketball activities.
• The sick child needs more care than the staff can provide without affecting the health and safety of other children.
• Other children could get sick from being near the sick child.
• See our COVID-19 Response form to learn about our policies and procedures around COVID-19.
The HUB has developed and practices emergency plans for:
• Serious injuries or illnesses
• Lost or abducted child
• Poison exposure, including exposure to toxic substances
• Potentially violent situations in the program, including individuals with threatening behaviors
• Natural disasters, including tornado, blizzard, flood, or earthquake - The Learning Center will not be in session if Tulsa Public Schools cancels school for bad weather.
• Disruption of utilities, including loss of electricity, gas, water
Entrances are protected from unauthorized visitors by remaining locked from the outside. During enrollment parents can write the names of adults who are not allowed to pick up their child(ren).
Methods of Communication
· Feel free to share any concerns or questions that may arise.
· You may call the Learning Center at any time at (539) 867-3692.
· You can request a meeting with the Simon Falokun, the program manager at any time.
There are no weapons permitted at the facility. The HUB/Learning Center has a “No Weapons on Site” policy.
Every child’s information will be kept confidential. The Common Good will not share a child or a family’s personal information unless child abuse or neglect is reported or suspected.
Review and Revision of Policies, Plans, and Procedures
The policies and procedures are revised and updated as we learn new information and as we receive input from families, so feel free to provide input or ask questions at any time.
I have gone over these policies and by signing this I agree to follow the policies set forth.