Community Violence Prevention Initiative

Community Violence Prevention Initiative
Dear Parents and Guardians,

We are excited to share some important news with you. Our school is partnering with the Center for Structural Equity (CFSE) to bring a new program called the Community Violence Prevention Initiative (CVPI) to help support our students during school time. This program is designed to help students who may be having trouble with attendance, schoolwork, or discipline issues.

The CVPI program will work with students to:

●        Help them get back on track with attending school regularly.

●        Provide extra support to complete assignments.

●        Encourage them to join after-school programs and activities that help build strong, positive relationships with others.

The Community Education Ambassadors (CEAs) from the CVPI will work closely with our school counselors and staff to identify students who could benefit most from this program. These trained ambassadors will mentor students, guide them, and connect them with helpful resources during the school day.

We need your help!

For the CEAs to provide the best support for your child, we are asking for your permission to allow them access to your child's school records, including grades and disciplinary history. This information will only be used to understand how to best assist your child in their academic success and personal growth.

Please complete the fields below to allow your child to participate in this valuable program.

If you have any questions or would like more information about the program, please feel free to contact your student's guidance counselor or contact CFSE for more information on their part in the program at (302)-476-8902 or info@structuralequity.org.

Thank you for allowing us to be a partner in your child’s education and success.

Sincerely,
Darryl Chambers
Executive Director, Center for Structural Equity
Student Information
Student Name

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Student Date of Birth

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Date
School
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Student Grade
Email
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Student Home Address
Student Cell Phone Number
Student Sexual Orientation
Student Race
Student Ethnicity
Parent/Guardian Information
Name

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Phone Number
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Signature

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I give the Center for Structural Equity permission to access my child's Student Educational Records through their school.

YesNo
I am interested in learning more about the Center for Structural Equity Afterschool Program.

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Center for Structural Equity Afterschool Program
As the new school year begins, we are excited to announce the continuation of our after-school program. Our program is designed to provide academic, emotional, and social support to students who need additional resources to succeed both inside and outside the classroom.

Through our after-school program, students will receive:

1. Academic Support: We offer help in core subjects such as Math, English, Science, and Social Studies. We aim to help students reinforce classroom learning and develop strong study habits that will serve them throughout their academic careers.

2. Enrichment Activities: In addition to academic support, we provide enrichment activities that promote creativity, critical thinking, and leadership. Students will have the opportunity to engage in workshops, community outreach, and educational activities.

3. Social and Emotional Development: Understanding the challenges many students face, we offer a supportive environment where they can openly discuss their emotions and experiences. Our staff has been trained in trauma-informed care to support our community better. We work closely with students to develop coping strategies, build resilience, and foster a sense of belonging.

4. Career Preparation: Older students will have access to job readiness programs, internships, and mentorship opportunities, helping them prepare for the workforce and higher education.

Our program is open to students of all grade levels and operates Monday through Friday from 3:30 PM to 6:30 PM. We are dedicated to unlocking the potential of every student by equipping them with the skills and resources needed for success. While we welcome all students, space is limited, and we may not be able to accept every child immediately. If our capacity is reached, we will place your child on a waiting list and notify you as soon as space becomes available. Though we do not like turning any child away, we will work to ensure they have an opportunity to join the program when a spot opens.

If you are interested in your child attending the Center for Structural Equity's afterschool program, please complete the information below.

If you have any questions or would like more information, please feel free to contact our office at 302-476-8902 or email us at info@structuralequity.org

Thank you for your continued support, and we look forward to a productive and engaging school year.

Sincerely,

Darryl Chambers

Executive Director

Center for Structural Equity
I want to register my student for the Center for Structural Equity Afterschool Program

YesNo

I give permission for my child to participate in youth programming provided by the Center for Structural Equity.
I give the Center for Structural Equity permission to use any photographic image or video of my child taken while participating in their program. These images or videos may be used in promotions or other related marketing materials.
Transportation Consent Form and Liability Waiver
I give permission to the Center for Structural Equity to transport my child in his/her/their private vehicle or company vehicle, and I understand and agree that all such transportation activity referenced in this paragraph shall be covered in full by the “Waiver and Release of Liability” set forth below. I understand that, if an employee of the Center for Structural Equity drives my child, the employee possesses a valid driver’s license and is currently insured to drive a motor vehicle.
I grant permission for my child to be transported by the Center for Structural Equity to/from the program site located at 813 n Tatnall St. Wilmington DE.
Waiver and Release of Liability
In consideration of the Center for Structural Equity accepting my child into their program, I hereby fully and irrevocably waive and release any and all claims, liabilities, rights, causes of action, damages, or losses that I and/or our child may have or may assert, either now or in the future, whether now known or unknown, against the Center for Structural Equity. By signing below, I further agree to hold harmless the Center for Structural Equity against any claims, liabilities, rights, causes of action, damages, or losses arising out of any injuries suffered by either myself or my child as a result of participating in their program.
Signature

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COVID-19 Testing Consent
I certify that I am the parent or legal guardian of the student named above and confirm that the student is at least 12 years of age. I hereby give my consent to the Center for Structural Equity for my child to participate in weekly testing for COVID-19 (also known as Coronavirus) and to the taking of a nasal swab for the purpose of performing the testing.

I understand that, as with any medical test, there is the potential for false positive or false negative results. It is recommended for both my child and myself to continue to take necessary precautions against COVID-19 including but not limited to wearing a mask, avoiding close contact with others (social distancing), and frequent washing of hands.

I understand that this is not creating a patient relationship between my child and the Center for Structural Equity by participating in weekly testing. I understand that testing facilities do not act as medical provider and that testing does not replace treatment by my child’s medical provider.

PRIVACY NOTICE: I understand that test results will be kept confidential except for disclosures required or permitted under law. In this regard, HIPAA specifically authorizes disclosure without my consent for certain purposes, including disclosures to a public health authority, government agencies, and persons at risk, as well as disclosures to prevent or lessen a serious and imminent threat to the health and safety of a person or the public. I authorize and consent to these disclosures.
Parent/Guardian Signature

Clear

Thank you for completing this form. We look forward to working with your child.
Should be Empty:

Community Violence Prevention Initiative

Student Information

Parent/Guardian Information

Center for Structural Equity Afterschool Program

Transportation Consent Form and Liability Waiver

COVID-19 Testing Consent