Middle Grades Partnership Registration 2023-24
Student's Name
*
First Name
Last Name
Student's ID Number
Student's Gender
*
Male
Female
Non-binary
Student's Birth Date
*
-
Month
-
Day
Year
Date
Student's Grade in Fall of 2023 (school year after this summer)
*
5
6
7
8
9
How would you best describe your student's ethnic/racial background?
*
African American/Black
American Indian/Alaskan Native
Asian
Latino
White
Other
Parent/Guardian 1 Name
*
First Name
Last Name
Student's School
*
Belair-Edison
Park
City Springs
Boys' Latin
Cross Country
Bryn Mawr
Hamilton
Calvert
Hampstead Hill
Friends
Lillie May Carroll Jackson
Roland Park Country
Mt. Royal
McDonogh
Francis Scott Key
St. Paul's
Montessori Charter
Gilman
Relationship to Student?
*
Mother
Father
Grandmother
Grandfather
Stepmother
Stepfather
Aunt
Uncle
Sibling
Guardian
Other
Is this the primary contact?
Yes
No
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
-
Area Code
Phone Number
Home Phone Number
-
Area Code
Phone Number
Work Phone Number
-
Area Code
Phone Number
Email
example@example.com
Parent/Guardian 2 Name
First Name
Last Name
Is this the primary contact?
Yes
No
Relationship to Student?
Mother
Father
Grandmother
Grandfather
Stepmother
Stepfather
Aunt
Uncle
Sibling
Guardian
Other
Same address as Parent/Guardian 1?
Yes (you may skip the address fields below)
No (please fill in address information below)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
-
Area Code
Phone Number
Home Phone Number
-
Area Code
Phone Number
Work Phone Number
-
Area Code
Phone Number
Primary Email
example@example.com
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
-
Area Code
Phone Number
Emergency Contact Relationship to Student
What do you hope your student will gain from participation in MGP?
PARENT/GUARDIAN PERMISSIONS 2023-24
PERMISSION TO USE STUDENT DATA (for public school students) Middle Grades Partnership Directors and staff from my child’s school have my permission to obtain copies of my child’s English and Math grades, standardized tests scores, attendance records, and high school choice from Baltimore City Public Schools until my child completes grade twelve. I understand that this data is only used for Middle Grades Partnership program evaluation purposes and my child’s information will be safe and secure, according to best practice outlined by Baltimore City Public Schools. IRB#2018-095
*
Yes
No
PERMISSION TO USE STUDENT PHOTOGRAPHS/VIDEO Middle Grades Partnership and its partner schools have my permission to photograph and create videos and use any photographs and videos of my child/children in Middle Grades Partnership and partner school publications, website and/or other related uses. All photographs are the sole property of Middle Grades Partnership or the partner schools. Full names of students will not be used in marketing materials.
*
Yes
No
WAIVER AGREEMENT BY SIGNING BELOW, I HEREBY WAIVE, TO THE EXTENT PERMITTED BY LAW, ANY AND ALL CLAIMS, LAWSUITS, ACTIONS, OR DEMANDS AGAINST MIDDLE GRADES PARTNERSHIP THAT ARISE OR MAY ARISE IN CONNECTION WITH MY CHILD’S PARTICIPATION IN MIDDLE GRADESPARTNERSHIP ACTIVITIES FROM JUNE 1, 2023 TO JUNE 1, 2024. THIS WAIVER INCLUDES ANY CLAIMS OF NEGLIGENCE, OTHER TORT CLAIMS, OR OTHER ALLEGATIONS OF WRONGDOING BY MIDDLE GRADESPARTNERSHIP OR ITS DIRECTORS, TEACHERS OR INTERNS. HOWEVER, NOTHING IN THISWAIVER SHALL LIMIT MY RIGHTS AGAINST ANY PARTY OTHER THAN MIDDLE GRADESPARTNERSHIP, THEIR DIRECTORS, TEACHERS AND INTERNS ACTING UNDER THEORGANIZATION’S DIRECTION.
*
Yes
No-your student will not be able to participate in Middle Grades Partnership if this is checked.
PARENT/GUARDIAN SIGNATUREI give my child/student permission to participate in the Middle Grades Partnership program. I also hereby grant Middle Grades Partnership the permissions as indicated above, regarding my child.
*
Today's Date
*
-
Month
-
Day
Year
Date
Submit
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