TUB Application 2025-26

  • CHILD INFORMATION FORM

  • Child's Date of Birth (MM/DD/YYYY)*
     . .
  • Child's Gender*
  • Do you attend private or public school?*
  • Is your child proficient in English?*
  • Other language(s) spoken in your home
  • Child's ethnicity
  • Child's race*
  • Does child have health insurance? (ex., private insurance, KidCare, Medicaid)*

  • If not, we may be able to help you find affordable coverage - call 211 or visit www.thechildrenstrust.org/parents/health-connect/insurance
  • Format: (000) 000-0000.
  • Is this a cell/mobile phone?*

  • (Please note that The Children's Trust may contact you via postal mail, email and/or text to ask about your satisfaction with these services, and to make you aware of other Trust-funded programs, initiatives and events you may be interested in)

  • We want to get to know your child better so that we can provide the best possible experience in our programs. Please tell us more about your child. What are the main ways in which your child communicates? (Mark all that apply)
  • What, if any, help does your child receive at this time? (Mark all that apply)*
  • What conditions does your child have that are expected to last for a year or more? (Mark all that apply)*

  • If you marked "None of the above" on the previous question, please skip the next two questions and sign below. If you marked any other answer on the question above, please answer the remaining questions and sign below. 

  • Do any of the conditions marked above make it harder for your child to do things that other children of the same age can do?*
  • To support your child's successful participation in this program, in what areas might s/he need extra assistance?*

  • If you are interested in other services funded by The Children's Trust, please call 211 or visit www.thechildrenstrust.org. For special needs resources for your child, visit www.advocacynetwork.org or www.thechildrenstrust.org/cwd

  • I give my permission for this information to be submitted to The Children's Trust for program quality and evaluation purposes. The Children's Trust provides funding for the program.

  • DATE*
     / /

  • FOR STAFF USE ONLY (MUST BE COMPLETED)

  • Population Membership (check all that apply):

  • Internet and Promotion

    Student/Parent Agreement

  • As the parent or guardian for the aforementioned student, I do understand and agree to abide by the terms and conditions for use of the program based computers, all network and Internet systems, I further understand that violations of these terms of conditions may cause my students to forfeit further use of the technology provided by the program.

    I understand that these access is designed solely for educational purposes and the program has taken reasonable precautions to supervise usage. I also recognize it possible for the school/camp to restrict unsupervised access to all information or material and I will not hold them responsible for materials acquired on the network. I also accept full responsibility for supervision of my child who may access the resources of the program from outside the program setting.

    I also give permission to publish pictures and/or print work of or by my student that promote the best interest of the program and its accomplishments in or on: 

    • Dedicated web pages
    • Newsletters
    • Brochures
    • Newspaper
    • Cable television
    • Other Media sources

  • Field Trip Permission Form

  • At Teen Up-Ward Bound students will be going on numerous field trips throughout the year. Field trips are an important part of our academic curriculum. 

    Given the frequency of our field trips, this form is to serve as permission for your child to attend all field trips scheduled by Teen Up-Ward Bound, Inc. Parents will be notified of all field trips date and times upon scheduling.

    Please read the following and sign below indicating that you have read and accepted this policy. "I am the parent/guardian of the student below, and hereby give permission for him/her to participate in all field trips planned by the Teen Up-Ward Bound, Inc."

  • Date*
     - -
  • Do you give Teen Up-Ward Bound, Inc to transport your child to special events (i.e. field trips) by private transportation, buses, staff accompanied walks, public transportation, vans or other automobiles.*
  • In the case of injury or medical emergency, do you give Teen Up-Ward Bound, Inc permission to administer first aid, CPR, or call emergency medical services for your child? Do you authorize Teen Up-Ward Bound, Inc staff to provide any known medical history to medical staff and/or personnel.*

  • I, * attest that all information provided is accurate and true to the best of my knowledge. I agree to inform Teen Up-Ward Bound, Inc of any changes in the above information within 24 hours of the change.

  • Date*
     - -

  • Authorization for Photography/Video

  • I, * the parent or guardian of   *   hereby authorize and give consent to service providers and the staff of The Children's Trust of Miami-Dade County as follows:

  • I hereby:

  • the staff of The Children's Trust of Miami-Dade County to take/use still photographs, digital photographs, motion pictures, television transmission, and/or videotaped recordings (hereinafter "Recordings") of me, my children, or my wards for educational, research, documentary, and public relations purposes.

  • Date*
     - -
  • Date*
     - -

  • Any such Recordings may reveal your identity through the image itself without any compensation to you, your children or wards. 

    Any and all Recordings taken of you, your children or words shall be the sole property of The Children's Trust. 

    With regard to the use of any Recordings taken of you, your children or words, you hereby waive any and all present and future claims you may have against The Children's Trust of Miami-Dade County, their staff, service providers, employees, agents, affiliates and Board members, 

    PERMISSION TO VIDEO OR RELEASE PICTURES 

    Often we take pictures of special events for the photo album and for special projects or the children are video taped interacting with each other and get to watch themselves on television. Please fill out this form stating whether or not your child is allowed to be photographed or taped.

  • I hereby*

  • Teen Up-Ward Bound, Inc permission to take pictures/video tape my child for program purposes only. * , while at Teen Up-Ward Bound, Inc I understand that these pictures/videos are for fun and will be done in a reasonable manner.

  • Emergency Contact Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Have you/child previously attended Teen Up-Ward Bound?*
  • Did you receive your parent handbook?*
  • Does your child have any known allergies?*
  • Do you give your child permission to leave Teen Up-Ward Bound, Inc without being signed out by an authorized adult and/ or to walk home?*
  • Date
     - -
  • Should be Empty: