CLC 20005 MARVEL*US INTEREST FORM

MARVEL*US LEARNING CENTER

Interest Form
Our MARVEL*US After School Program provides a safe and supportive environment for youth aged 5–13. Each afternoon is filled with academic enrichment, tutoring, creative expression, active play, and meaningful social-emotional learning. Designed to inspire confidence, encourage friendships, and support academic growth, our program keeps kids creating, moving, and exploring long after the school day ends!

NOW ENROLLING

5777 Chantry Drive

Columbus, Ohio 43232

Monday through Friday - 3 to 6 p.m.

Introduce your child to a world of superheroes and educational adventures!

Should you have any questions or concerns, you may contact MARVEL*US Staff at 614.321.2576 or camp@columbusliteracy.org.

The program is funded in part by the Franklin County Board of Commissioners and administered by FCDJFS.
Our MARVEL*US Summer Camp provides a safe and supportive environment for youth ages 5–13. Each day is filled with creative expression, structured activities, physical movement, and meaningful social-emotional learning. Designed to inspire confidence, encourage positive friendships, and support overall growth, our program keeps children engaged, active, and exploring throughout the summer.

NOW ENROLLING

June 15 - August 7, 2026

5777 Chantry Drive
Columbus, Ohio 43232

Monday through Friday - 9 a.m. to 3 p.m.

Introduce your child to a world of superheroes and educational adventures!

Should you have any questions or concerns, you may contact MARVEL*US Staff at 614.321.2576 or camp@columbusliteracy.org.

The program is funded in part by the Franklin County Board of Commissioners and administered by FCDJFS.
What program are you interested in?
OLD Participant Name
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What school does the participant attend?
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Street Address
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City
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Parent or Legal Guardian
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What is the participant's relationship to Parent/Legal Guardian?
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I am the parent or legal guardian of the above-listed minor child and the information provided on this form is complete and correct to the best of my knowledge.
Data Sharing Agreement

Groveport Madison Local School District
I authorize Groveport Madison Local School District to release my child's enrollment and educational records, which include but are not limited to documents that contain my name, social security number, student ID number, date of birth, grades, and test scores to Columbus Literacy Council.

Columbus Literacy Council's use of these records is limited to and in connection with enrollment in the After School/Summer Program entitled MARVEL*US and eligibility to qualify for the educational experience programs available through the FCDJFS OST program.

Student Information released to:

Columbus Literacy Council

5825 Chantry Drive

Columbus, Ohio 43232

I authorize Columbus Literacy Council to share my child's case updates and progress with Groveport Madison Local School District.
My signature is acknowledgement that I have read this Release of Information of the above-mentioned educational records as collected and utilized by MARVEL*US program at CLC and being shared between both programs in which my child is enrolled.
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MARVEL*US LEARNING CENTER

Parent or Legal Guardian

Data Sharing Agreement