Summer Journey School Consent Form for Catapult Learning

FREE Summer Learning!

Summer Journey School Consent Form for Catapult Learning

Dear Parents and Guardians:

Your child is eligible and invited to enjoy our Summer Journey School Program in-person on school campus. This program will include reading and math instruction, STEM, and SEL.

Catapult Learning’s Summer Journey program offers a comprehensive suite of programs that addresses the academic, social, and emotional needs by incorporating instruction, enrichment activities, and social-emotional support elements. This program offers robust educational opportunities and engaging activities, in-person and is designed to prepare students for the fall. . . all while having fun!

Parent/Guardian Consent - Please complete the information to accept or decline services for your child to attend Catapult Learning's Summer Journey Program.

You are required to fill out and submit the form below in order for your child to participate in Catapult's program. If you have more than one eligible child, please complete a separate form for each child.
Contact Info
Parent/Guardian
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Phone *
Please enter a valid phone number.
Preferred email address *

Confirmation Email Please confirm preferred email address
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Student
Registration
Student First Name *
Student Last Name *
Student Grade *
Student's Gender *

Male Female Prefer not to say
Select the name of the school you would like your child to attend during our Summer Program *
Do you consent to your student receiving the instructional services indicated above? *

Yes No

Last Step!
Please sign below and our team will take care of the rest! We can't wait to learn together!
Full Name *

First Name Last Name
Signature *

Clear
In registering your student, you as parent or guardian of student agree to the following:

Intervention I consent for my student to participate and receive summer program services designed to deliver instruction for students with the goal to increase their academic success in the classroom. Based upon the programs my student is registered in to participate in, I understand the services provided may include one or more Catapult intervention programs, including but not limited to Math Intervention, Reading Literacy, STEM/Robotics and Social and Emotional Learning.

I understand Catapult will receive personally identifiable information (“PII”) related to my student which is protected under the Family Educational Rights and Privacy Act (“FERPA”) and other state and local privacy laws. I consent to Catapult’s use of PII for the purpose of teaching my student. Catapult programs are intended to be administered in-person in traditional classrooms; however, if any services are delivered virtually, Catapult will share such PII with its Digital Platform Providers (“DPP”) (Google Classroom, Zoom, Microsoft Teams) and I consent to such sharing if my student uses these platforms, including the use of live audio, video or recordings.
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