Why Try Resilience Permission Form

Wings for L.I.F.E.

WhyTry-Resilience Program

Dear Parents and/or Guardians,

Wings for L.I.F.E. (Life-skills Imparted to Families through Education) would like to offer your son/daughter a special opportunity to participate in the WhyTry Resilience Program. Why Try helps build resilience, emotional & social intelligence & provides a supportive environment in which young adults gain knowledge and skills that will help them develop healthy and stable relationships in their lives to counteract negative factors and make better, more informed choices. If you are interested in having your pre-teen and/or teen participate, please read the directions below for completing and turning in the attached permission forms. Please note that space in the program is limited! Priority will be given to students whom we have forms that are COMPLETE and turned in on time. If we run of out space and are unable to enroll your student: 1) We will contact you to let you know that we were unable to enroll your student 2) We will put your student's name on our waiting list in case a space becomes available 3) If/ (when a space becomes available, we will contact you and let you know (for example, if a student moves or ends up not participating, that would result in a space opening up)

If you wish to sign up MORE THAN ONE Student, FILLOUT a sperate permission form for each child.

Please Check School*

MesaMt. ViewSierraBerrendo

Student's First & Last Name:*

Date of Birth:*

Date

Age:*

Grade:*

Gender, Please Check One:*

FemaleMale

Food Allergies:*

Other medical conditions/information Wings for L.I.F.E. staff should be aware of:*

Student school email:*

example@example.com

The program will be separated into three separate parts this year, with one week breaks in between sections (no class Please check the section(s) you would like your child to attend

WhyTry (1st Section) Dates to be determined at the beginning of the school year

WhyTry

WhyTry (2nd Section) Teachers will reach out with date/time

Substance Abuse Prevention (2nd Section)

Why Try (3rd Section)

Resilience for Youth (3rd Section)

We need the below information in case of emergency. Please be sure to include a phone number where you or another parent/guardian may be reached during the program. Information on Parents/Guardians

Relationship to Student*

Home #*

Cell #

Other #

Address*

Address

Street Address Line 2

Zip code

Mailing Address (if different than above)

Full Name

Relationship to Student

Home #

Cell #

Other #

Address

Street Address Line 2

Zip code

Mailing Address (if different than above)

CHILD PICKUP (Mesa students only, held during after school)3-4:30

the parent and/or guardian of the student/student listed in this

form give permission for my student(s) to attend the Why Try Program held each week.

After the program, my child(ren) will (CHECK ONE)*

WALK HOMEPICKED UP

*Iunderstand that I am responsible for arranging for my student to be picked up ON TIME.*

Only parents and guardians & the adults listed in the section below will be allowed to pick up your student from the program.

Name*

Relationship to student*

Phone #*

Other Phone #

Name

Relationship to student

Phone #

Other Phone #

Name

Relationship to student

Phone #

Other Phone #

Wings for L.I.F.E. - WhyTry Resilience Program 2021-2022

Permission and Acknowledgements 1 have read, and I understand the Why Try Attendance Policy. 1 also understand that 1 may be asked to complete confidential surveys and I agree to do so. I will also contact my student's Why Try Instructor if there is important information that needs to be updated on my student's permission form.

Students who disrupt class will be given 1 verbal warning. After the first verbal warning the student will be sent back to their classroom. If the student has to be sent back to their classroom 3-times, then the student will be dropped from the program. I understand there will be shared data between Wings and RISD

PHOTO RELEASE: I understand that photos of my student/student may be taken during various class activities. I hereby give my consent to allow Wings for L.I.F.E. to use photos taken of my student, listed on this form, in promotional publications (newsletters, newspapers, grants for funding, etc for Wings for L.I.F.E. and the Why Try Resilience Program. I understand that my student's names WILL NOT be used in any of these publications. If you do not want pictures to be taken of your student. please contact Lorraine Segovia (310-922-0717), director of Wings for L.I.F.E.

Signature of Parent/Guardian*

Date*

Date

Wings for L.I.F.E. - WhyTry Resilience Program 2021-2022

Retain this page for your Personal Records!!!

The Why Try program (provided by Wings for L.I.F.E) provides a supportive environment in which students gain knowledge and skills that will help them to "do their very best in life." The program uses a series of visual metaphors to teach social, emotional, and leadership principles. The program's unique multisensory approach caters to every learning type and has been used in over 16,000 schools and organizations with 2 million students and counting. The Why Try Program has been proven to increase GPA and graduation rates, reduce failure and expulsion, decrease rule-breaking behaviors, improve self-concept and emotional health, increase resilience, and improve academic progress in all areas. Why Try program will meet weekly at each school. Times and Days vary at each school. Contact Chelsea Vasquez, 575-936-9050, or Reana Gonzales, 575-317-9778, if you have any questions about the program.

Parent/Guardian Surveys: In order to continue to operate a successful program, we will need your cooperation in completing confidential surveys that will help us to measure the effectiveness of our program and improve the quality of our program.

Attendance Policy: It is very important for student to attend class EVERY WEEK for the section they are participation in to get the most out of the program. Please try to schedule your appointments on other days. The Why Try Teacher should be notified if your student must be absent. Three unexplained absences in a row may result in student being dropped from the program so that individuals on our waiting list may be able to participate in the program.

Why Try Teacher Contact Information: Reana Gonzales and Chelsea Vasquez are the Why Try Staff at your student's school. Please contact them at: 575-317-9778. or - 575. 936-9050, in case you need to advise them of an absence, an emergency, or information to be updated on your student's form.

Substance Abuse Prevention (2nd Section)

Resilience for Youth (3rd Section)

Wings for L.I.F.E. - WhyTry Resilience Program 2021-2022

FOR L.I.F.E. EMPOWERING YOUTH # FAMILIES