RELEASE OF GRADES/BEHAVIOR REPORTS/ATTENDANCE REPORTS
I hereby give my permission for the HRC of 200+ Men, Inc. to have access to my child's grades and progress reports to assist with improvement in academics, attendance, behavior, and study habits while enrolled in this program. I further grant the release of behavior and attendance records. I understand that the HRC of 200+ Men, Inc. will maintain strict confidentiality of this information.
Signature Date
RELEASE FOR MEDICAL TREATMENT
In the event of an emergency and the inability of HRC of 200+ Men, Inc. to obtain consent, I hereby give permission for HRC of 200+ Men, Inc. to authorize treatment or surgery in which a qualified physician or surgeon shall deem necessary for my child.
Signature Date In case of emergency, to which hospital or urgent care do you prefer to have your child transported? Hospital/Urgent Care Facility Phone Number Primary Care Physician Phone Number Medical condition(s) we need to be aware of
PARENTAL ACKNOWLEDGMENT
I hereby give my permission for my child to participate in the HRC of 200+ Men, Inc. Scholars Academy, which may include travel to local, regional, and some instances out of state events. I understand that the HRC of 200+ Men, Inc. is not responsible for personal injury or loss of property. I understand that the success of my child's membership is contingent upon my participation in the program. I agree to immediately update this application when any of the information changes and also on an annual basis.