RodneyStreet Tutoring Sign-Up

Emergency Contacts
Please list all emergency contacts*
In the event that I cannot be reached in an emergency, I hereby give my permission to RodneyStreet staff to follow proper Emergency Medical Procedures.
Parent Initials*
Parental Consent
Please select consent given below and sign.*

I give permission to have my child, named above, participate in all RodneyStreet programs/activities – this includes transporting child to/from activities, if necessary.I grant RodneyStreet unrestricted permission to use photographs and/or video and/or voice recordings taken of my child for use in RodneyStreet publications, including web sites or other electronic forms of media. I authorize RodneyStreet, its assigns, and transferees to copyright, use, and publish the same in print and/or electronically. I agree that RodneyStreet may use such photographs of my child, with or without my child’s name, and for any lawful purpose, including, but not limited to, publicity and web content.I hereby release RodneyStreet, its staff, contractors, and volunteers from any responsibility as a result of any injury to the child named above due to participation in RodneyStreet activities.
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Communications Consent
I understand that as part of the registration process, either one or both parent/guardians listed in this application will be automatically enrolled to receive RodneyStreet communications. This includes the Remind App (a text based service) that will be used by staff for program communications and emails that will include the RodneyStreet monthly newsletter and general organization informational emails. I agree to be enrolled unless I Opt-out below.

I do not wish to be enrolled in the Remind AppI do not wish to receive the RodneyStreet monthly newsletter
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Tutoring lessons are now available.