This health history is correct and accurately reflects the health status of the participant to whom it pertains. The person described has permission to participate in all program activities except as set forth by me and/or an examining physician. If you fail to advise Life Enrichment Group of a medical condition, risks to your child may increase. I understand the information on this form will be shared on a “need to know” basis with L.E.G staff and volunteers. I give permission to photocopy this form. In addition, the health care provider has permission to obtain a copy of my child’s health record from providers who treat my child and these providers may talk with the program’s staff about my child’s health status.
I voluntarily sign this authorization in consideration for permission for my child(ren) to participate in the Life Enrichment Group and Know to Grow College Tours. I have read it, and I understand its content and significance. Signature* Date* Signature of Parent/Guardian (For participant less than 18 years of age)Signature* Date* Signature of Participant (For participant 18 years of age or older)
Parent/Guardians: Keep a copy for your records.
Code of Conduct
Confidentiality and virtual etiquette:1. No screen shotting other participants.
2. No disclosing instructor and other participant's personal contact information includes(email, phone, zoom and business information.)
3. Provide LEG with email address for student to take notes and access google doc (online journal)
4. No sharing information on other participant's business unless given full disclosure by individual
Technology:1. Do not share Zoom meeting ID with anyone outside of this program
2. Participants are to not engage in private chat with other participates during academic time
3. Have your video on unless you are experiencing connection issues and have expressed the issue to an L.E.G. staff member.
4. Find a quiet space without interruptions / background noise
5. Have a plain background – avoid backlight from bright windows
6. Have good lighting on your face so you can be seen clearly
7. Adjust your camera to be at around eye level if possible – especially take note of the angle of your laptop screen if using the built-in camera
8. Mute your microphone when not talking
9. Acknowlege that there will be times when the session will be recorded
CODE OF CONDUCT (Please keep this page for your records; you do not need to turn in this page)
The Life Enrichment Group Code of Conduct is to ensure the safety of all participants and to encourage conduct and behavior that will result in each participant receiving the full benefit of enjoyment and educational experience from this event. Participants are asked to consider both their underlying attitudes and effects of their behavior in representing themselves, their communities, and the Life Enrichment Group program.
Program participants and chaperones are expected to abide by the stated rules for this event:
• Fully participate in all scheduled activities. Inform your chaperone if you are ill. • Conduct yourself in a courteous manner, being respectful to all speakers, adults, roommates, and other participants. Use appropriate language, exhibit good sportsmanship, and act as a positive role model. Turn cell phones off or on silent during scheduled activities (no texting), workshops and speakers.• Be in your own rooms, observing the ‘lights out’ time noted on the schedule, and remain in your room/dorm all night.• Display of overly affectionate attention between participants is prohibited. • Do not tamper with or damage room furnishing, furniture, equipment, etc. Room occupants are responsible for any damage or misconduct. Falsely pulling a fire alarm is a crime. • Participants may not drive a car after their arrival at the event. • Abide by the dress code; it was developed to prevent participants from becoming offended or uncomfortable during their stay. If you choose to dress inappropriately, you will be asked to change. By planning ahead and packing appropriately, you will save yourself the inconvenience of changing your attire to ensure that you are contributing to a pleasant conference atmosphere.
The following dress code will be enforced for all individuals attending the conference, including chaperones:
1. Clothing: all clothing shall be neat, clean, acceptable in repair and appearance, and shall be worn within the bounds of decency and good taste as appropriate for L.E.G events. 2. Professional attire is strongly encouraged at this event at all the meetings. 3. Articles of clothing which display profanity, products, or slogans which promote tobacco, alcohol, drugs, sex, or advertise gang symbols or affiliation are prohibited. 4. Items of clothing which expose bare midriffs, bare chests, undergarments, or that are see-through are prohibited. Halter tops, tube tops, and spaghetti straps are not appropriate.
The following behaviors will not be tolerated:
• The possession or use of alcohol or illegal drugs, tobacco products, stolen goods, weapons, and fireworks.• Females in male rooms, males in female rooms.• Sexual, physical, or verbal abuse. Pornography materials of any kind.• Disrespect or negative attitudes of any kind will NOT BE TOLERATED.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
I have read the Code of Conduct and agree to abide by it.
I understand that I am responsible for my child’s behavior. I give permission to the staff in charge to administer the code. I understand that if my child is sent home, it will be my responsibility and at my own expense, and that the activity fee will not be returned.
I, Name of Parent/Guardian* have read the Code of Conduct. Parent/Guardian Signature* Date
I understand that I am responsible for my child’s behavior and will be responsible for all costs and expenses should my student not adhere to the code of conduct. I give permission to the staff in charge to administer the code. I understand what is being asked and expected of my student. I, * have read the Code of Conduct.
By signing below, you are agreeing to pay the $200 nonrefundable deposit to secure your spot for one of the Know to Grow College Tour Experiences. The total cost of the HBCU College Tour is $2,000 and the total cost of the Cali tour is $1,350. Participation in L.E.G.'s annual fundraiser is required in order to attend a Know to Grow College Tour Experience. Monthly payments will be scheduled and set with the L.E.G. team through PayPal. After you submit this application, you will receive an invoice to pay your nonrefundable deposit via the email we have on file. Please ensure the email you add on this form is accurate. Thank you and we look forward to you joining us for the Know to Grow progam!