Tracey Wyatt Parent/Guardian Consent Form

Parent/Guardian Consent Form- Adventure Club Reading Program

August 2024 - May 2025

Program Location: Tracey Watts Rec Center

Participant Name

Gender

Parent/Guardian Name

Cell Phone

Allergies (Food/Drug) and/or Health Concerns*

Please list at least ONE person (in addition to the guardian(s) who may be contacted in case of

1. Name

Phone

Relationship

If allergies or concerns are listed above, please complete the Special Instructions section below, In addition to outlining special instructions herein, parents of children who have food allergies of any type are required to complete the "Special Instructions" section below:

What symptoms might your child exhibit?

Requested actions to be taken by staff Please Specify

This document is a consent/waiver agreement between Frontline Housing, Inc and the participant's parents/guardians. This form must be signed and returned before the participant attends the program. No child will be released to anyone who is not listed on our sign-out sheet. A parent must give written permission for any change to the pick-up allowances.

Adventure Club will be held by a staff member or volunteer. All staff members and volunteers are background checked and complete an orientation before attending their first session.

I agree that any photographs or video taken of me and/or my child or testimonial given may be used for promotional, educational and/or publicity without any compensation or prior approval.

By signing this agreement, I waive any right to present or future claims against Frontline Housing Inc., volunteers, board members, and employees, in the event of accident, injury, or loss of personal items.

I have read the above agreement and understand fully the terms and conditions that have been explained. By signing this parental consent form, I am giving my permission for my child to attend Frontline Housing's Adventure Club Reading Program 2024-2025.

Participant Name

Date

Signature of Parent/Guardian

Printed Name of Parent/Guardian

I, First Name Last Name do hereby consent and authorizeblank (name of school) to release any information pertaining to the academic progress of my child First Name Last Name including grades, homework, classwork, upcoming assignments, projects, special areas of focus, etc to the Book Buddies program in order to ensure the academic progress of my above listed child.

Parent Name

Student Name

Student Grade

Teacher's Name

Parent Signature

Date