Tutoring and Afterschool Program Enrollment Form

TUTORING PROGRAM REGISTRATION & APPLICATION FORM August 2024- - August 2025

Please complete the following information:

Child's Name

First NameLast Name

Gender:

MaleFemale

Nationality(Optional)

Fall School Grade

Student's Date of Birth

Student's Age

Student's School

Name of Parent(s)/Guardian(s)

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Work Number;

Note: If any of the above information changes, please notify the RARA office immediately.

EMERGENCY CONTACT INFORMATION List two emergency contacts other than those listed above:

Name and Relationship

Phone

Name and Relationship

Phone Number

Please enter a valid phone number.

Medical Problems/Allergies

If emergency medical care is necessary and I cannot be reached, I authorize the RaRa Foundation Inc. to act in my behalf in granting permission for my child to receive emergency medical treatment. Parents are responsible for all expenses incurred as the result of medical treatment.

Parent/Legal Guardian Signature

Date

The Tutoring Registration will begin on August 15, 2024. Students are dropped off and picked up by parents or designated guardian when tutoring takes place at location Tutoring is also online at this time. Hours of operation will be 9:00 A.M until 1:00 P.M. during the summer and from 4:00 P.M.-8:00 P.M during the Fall/Winter and Spring Sessions. RARA is closed on all Klein, Spring Aldine, Cy-fair and some HISD school professional developments, holidays, and breaks. Disrespect of the RARA staff, refusal to follow instructions, bullying of any type, are grounds for RaRa to no longer provide services.

(Sections Highlighted in Yellow are Needed Only when we are onsite)

I hereby waive, release, absolve, indemnify, and agree to hold harmless the RaRa Foundation Inc., its directors, officers, organizers, sponsors, supervisory staff, participants, and any other affiliates; for, from, and against all liability because of any bodily injury, or property damage, known or unknown,

which may occur or result from the participation of the above named child in any and all activities.I

individually, and as a parent/guardian for my child, have read this release and understood all the terms. I execute it voluntarily and with full knowledge of its significance.

Day

Month

Parent's Signature

Positive attitudes keep the Tutoring Registration fun. Below are some guidelines participants are expected to follow: Respect yourself and the RARA staff Play fairly and be honest Applaud the efforts of others, Avoid inappropriate language(Also when onsite) Eat and drink in designated areas Say only good things about others, Follow the instructions of the RARA staff, Resolve disagreements in a positive way (Also when onsite) Running allowed in outside areas, Listen during appropriate times and assemblies, Be respectful of other members and their property.Tobacco, drugs, alcohol, and weapons are prohibited . (Also when onsite) Take care of the facility, grounds, and equipment, If you make a mess, make sure you clean it up.

Child's Signature

Date

AUTHORIZATION TO PRODUCE AND USE AUDIOVISUAL MATERIALS

I hereby voluntary and without compensation authorize the RaRa Foundation Inc. to produce photographs, movies, videotapes, audiotapes, and Power Point Presentations of the below named student. This authorization is given on the condition that the materials taken or produced will be used for the purpose of community education or program promotion. I understand RaRa Foundation Inc Association, Inc. and its employees will not use these materials for compensation.

I understand that this grant of permission shall only be revoked by a written instrument delivered to the Executive Director of the RaRa Foundation Inc. This consent shall remain in effect, unless revoked.

Name of Student

Name of Parent/Legal Guardian

Date

Signature of Parent/Legal Guardian

BULLYING/HARASSMENT/FIGHTING POLICY (Includes Cyber Bullying)

Bullying/harassment/fighting has no place at the RaRa Foundation Inc Tutoring. Bullying/harassment/ fighting means more than beating up or pushing people around.

Violation of this policy includes: Physical assaults (touching in angry ways) Threats ("Better watch your back", "I'm gonna hurt you", "We're gonna get you", etc Harassment (always bothering someone)Racial slurs, Intimidation, Sexual harassment - physical or verbal Name-calling Spreading rumors, Extortion, Foul language, Taunting, Making insulting remarks about another student's family member(s),Using the internet to harass, threaten, verbally abuse, intimidate, or spread rumors.

Violation of the intent of this policy by a participant of the RaRa Foundation Inc will not be tolerated. Review of the policy serves as your WARNING.

If you are found to be in violation of this policy you will be suspended from this program. The enforcement of this policy and any judgment on the punishment of a student for violation of this policy will be the decision of the RARA Program Coordinator or Assistant Coordinator or both and is not subject to a hearing or appeal.

Student's Signature

Date

Parent/Guardian Signature

Date

The following individuals are authorized to check-out the above-named student from all RARA activities.

1. Name

Relationship

2. Name

Relationship

3. Name

Relationship

4. Name

Relationship

5. Name

Note: Add additional names if needed.

Relationship

Please note, if anyone is PROHIBITED from contacting or checking-out the student. Specify the individual(s) below:

Name

Relationship

Name

Relationship

Parent/Guardian Signature

Date

CHECK-OUT AUTHORIZATION FORM