Whiz Kids Student Application 2025-26

Whiz Kids Student Application

We are excited that your student is interested in joining our Whiz Kids program! To start the application process, please complete the attached form. A Whiz Kids leader will reach out to you soon with the next steps. If you need any assistance while filling out the form, don’t hesitate to contact Marlene at marlene@whizkidsok.org. You can also call or text us at 405-215-9441 with any questions.
Student Name

First NameLast Name
What school does your child attend?
Which Whiz Kids site will the student be attending?
Student's grade level for school year '25-26:
Student's home room teacher:
Birth Date

MonthDayYear
Gender
Ethnicity
Address

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian #1 Name

First NameLast Name
Parent/Guardian #1 E-mail
example@example.com
Parent/Guardian #1 Phone Number
Format: (000) 000-0000.
Parent/Guardian #2 Name

First NameLast Name
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 Phone Number
Format: (000) 000-0000.
Does your child have any food allergies? If so, please describe here.
Are there any medical conditions we should be aware of?
Transportation and Drop-off Information

Please read and complete the following information regarding the transportation and drop-off of your student to and from Whiz Kids.
I am the lawful parent or guardian of the student listed above, that is enrolled at a participating Whiz Kids school, and will be attending the Whiz Kids Mentoring Program at the host site, which is offered by Whiz Kids of Oklahoma. In consideration for transportation to be provided to the student by volunteer drivers and Whiz Kids volunteer mentors (the “Volunteer Drivers”), in their personal vehicles in connection with events and activities organized, sponsored, or conducted by the Whiz Kids (the “transportation”), I, on behalf of myself, my spouse (if any), and the student and all of our personal representatives, executors, successors, assigns, and related parties, hereby agree and represent as follows: 1. I authorize the student to be provided with transportation by the Volunteer Drivers. Each Volunteer Driver shall be listed on a Volunteer Driver list maintained by Whiz Kids. I understand that each Volunteer Driver has certified to the Whiz Kids that he/she: (i) holds a valid and unrestricted Oklahoma driver’s license; (ii) has no medical or other condition that could impair his or her ability to operate his/her vehicle in a safe manner; (iii) maintains an automobile insurance policy that provides at least the minimum coverage required by Oklahoma law; (iv) when providing the transportation will only operate a vehicle that is properly registered, equipped with seat belts and in safe working condition; and (v) will notify Whiz Kids if any of the foregoing representations change. 2. I understand that Whiz Kids will not independently verify that the certifications made by each Volunteer Driver are correct. As a result, Whiz Kids cannot, and does not, guarantee that the Volunteer Driver certifications are accurate and/or will remain current. I further understand that Whiz Kids attempt to maintain the Volunteer Driver list shall not be construed as an affirmative undertaking by Whiz Kids to ensure student’s safety during the transportation, or as an obligation to maintain the Volunteer Driver list current. I understand that Volunteer Drivers are not employees or agents of Whiz Kids or of the School while providing transportation and Whiz Kids has neither control of nor responsibility for, their actions. 3. I, on behalf of myself, my spouse (if any), the student, and all of our personal representatives, executors, successors, assigns, and related parties, hereby release, waive, relinquish, discharge from liability, covenant not to sue, and agree to indemnify, defend and hold harmless, Whiz Kids, and its agents, employees, volunteers, including the Volunteer Drivers, insurers and others similarly situated (the “Releasees”) from any and all injuries (including death) to the student, and any loss or damage to property owned by me or by the student, in connection with the Transportation including, but not limited to, those arising from any negligent act or omission by any of the releasees. 4. I have the authority to enter into this release on behalf of the student without the approval of any other person or entity, and I HAVE CAREFULLY READ THIS RELEASE, AND FULLY UNDERSTAND ITS CONTENTS.
Please list the full names, phone numbers, and relationships to the student of at least two individuals permitted to receive your child at home or at another drop-off location (daycare/babysitters) or to pick your child up at the Whiz Kids site. They must be 18 years or older if they are not an immediate family member, or 16 years or older if they are a sibling, per Whiz Kids Safety Policy.

Whiz Kids reserves the right to ask for identification if necessary before releasing students.
Will you be picking your student up after each session, or will Whiz Kids need to provide transportation home or to another site (daycare, babysitter, etc.)? Please note that Whiz Kids students from Adam's Elementary, Hawthorne Elementary, Kaiser Elementary and Millwood Elementary must be picked up.
Primary Drop-off or Pickup Contact #1
(Include full name, relationship to student and phone number)
Primary Drop-off or Pickup Contact #2
(Include full name, relationship to student and phone number)
Primary Drop-off or Pickup Contact #3
(Include full name, relationship to student and phone number)
Physical Address of Primary Drop-off Location (Only include if student is to be transported by Whiz Kids.)

Street Address

Street Address Line 2

CityState

Zip Code
Permissions

Please read the following statements regarding the Whiz Kids program model and indicate whether you agree or not.
Whiz Kids is an independent after-school program designed to help your child succeed. To help our volunteers be most effective, we need permission to access your child’s test scores, attendance information and student ID number. Your child’s test scores will be used to help identify areas of needed improvement and will not be published or used to identify your child in any public manner. This is required to participate in Whiz Kids.
As part of the Whiz Kids program, students are invited to participate in an optional segment called Club Time, which includes age-appropriate activities such as games, singing, and a brief message focused on character development. These messages may include moral lessons from the Bible, presented in a visual and developmentally appropriate way.Please indicate your preference regarding your child’s participation in Club Time:
Whiz Kids has my permission for public use of photographs, digital images, or video of my child to promote the program. I understand that the images may be used in print and/or online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
I do hereby grant permission to Whiz Kids staff, coordinators, liaison, tutors, or another volunteer to take said participant to a physician or hospital, and hereby authorize medical treatment including, but not in limitation, to any x-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical services rendered under this authorization.
Medical Release Signature:
I give my child permission to participate in Whiz Kids activities which may include but are not limited to Spring Fling, any field trip planned by the site, etc.* I waive and release all claims for damages that I may have against Whiz Kids and its personnel for any/all injuries suffered by my child or myself while participating in this activity. I also agree that if my child or any other person should make any claim against Whiz Kids for damages resulting while participating in this activity, I will personally indemnify, defend, and hold harmless Whiz Kids and its personnel, against any losses, costs, fees, or damages. I have read and understand this agreement and willingly acknowledge indicating my agreement with these conditions. *You will be notified prior to the event with details of the event at which time you will have the option to allow your child not to attend.
I understand that if my child misses more than three sessions of Whiz Kids without an excused absence for medical or school event, they may be dismissed from the program and replaced with another student on the waiting list.
Please tell us about your child. What do they love? What are their interests and hobbies? Is there anything you want to share with their mentor?
Has anyone in your family ever participated in Whiz Kids before? If so, please share their name, age and where they participated in the past (elementary school name).
Student's T-Shirt size
I acknowledge that I submitted this Whiz Kids student application electronically.
Name of Parent or Guardian Completing This Form

First NameLast Name
Today's Date

MonthDayYear
Date
Signature
Should be Empty:

Whiz Kids Student Application

Transportation and Drop-off Information

Permissions

I acknowledge that I submitted this Whiz Kids student application electronically.