Ember & Root Required Forms and Agreements for Workshops and Events

Electronic Forms and Agreements

I understand that submission of this form serves as my signature, confirming that the information provided is accurate and that I agree to the stated terms and conditions.
Required Forms and Agreements

Please note: All forms are required for all events. TinkerKitchen and technology access vary by event.
What Program is your child enrolled in?*

Ember & Root Photo & Media Permission Form
Ember & Root may occasionally take photos or short videos of students during program activities to share the spirit of our community.

These may be used in:

Newsletters or family updates

Our website or social media

Printed materials like flyers or brochures

Internal staff use

We do not share last names or personal information
Yes, I give permission for Ember & Root to take and use photos or videos of my child.No, I do not give permission for Ember & Root to take and use photos or videos of my child.

Ember & Root Authorized Pick up Form
Child's Name

First NameLast Name
TODAY'S DATE

MonthDayYear
Date
The following people are authorized to pick my child up

Name at least 1
Name*

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name

Device Use Agreement Ember & Root

Not all events use technology, but this form is required for all E&R participant files.
Please review the following statements. By signing this form, you agree to each of the following:

Program Devices Only
I understand that personal devices (phones, tablets, smartwatches, etc.) are not allowed during program hours unless otherwise approved. They can have them for communication purposes only.

I understand that learners will use shared program devices for approved activities only.

Approved Applications and Websites
I agree that learners may only access pre-approved websites and applications for educational and creative purposes.

I understand that social media and messaging apps are not permitted.

I understand that occasional educational use of YouTube may be allowed with staff guidance.

Purposeful and Respectful Use
I agree that technology will be used as a tool for learning, creativity, and skill-building—not for passive entertainment.

I understand that learners are expected to use devices respectfully and responsibly.

Supervised Use
I understand that all tech use is supervised and monitored by staff.

Device Care
I agree that devices must be handled with care and used only for program purposes.

I will instruct my learner to report any technical issues or accidental damage to staff immediately.

Digital Camera Use
I understand that learners must ask for permission before using a camera.

I agree to respect privacy by only photographing individuals who have given consent.

I agree that photos and videos will be used appropriately and respectfully.

Acknowledgment
I have read and reviewed the Ember & Root Technology Use Agreement.

I agree to the guidelines listed above and will help support my learner in following them.

I will notify Ember & Root if my learner requires specific accommodations related to technology use.
Child's Name*

First NameLast Name
Parent's Name*

First NameLast Name

Ember & Root Tinker Kitchen, Food Exploration Waiver

**Not all events use the Tinker Kitchen, but this form is required for all E&R participant files.
By signing below, I acknowledge and agree to the following:
My child may opt in to food-related experiences at Ember & Root when that area is available.

All cooking and food prep activities will be supervised by staff.

I will provide full and accurate allergy and dietary information for my child before they begin attending the program.

Staff will take reasonable precautions to avoid cross-contact and to support each child’s dietary needs.

I understand that minor injuries (e.g., small cuts or spills) are possible and that risk is inherent in hands-on learning experiences.
Permission*
Child's Name*

First NameLast Name
Parent Name

Please share anything else you'd like us to know about your child!
Should be Empty:

Required Forms and Agreements

Ember & Root Participant Health form

Medical Information

If yes, please provide the medication and a signed action plan from your physician.

Consent & Acknowledgment

Ember & Root Photo & Media Permission Form

Ember & Root Authorized Pick up Form

The following people are authorized to pick my child up

Device Use Agreement Ember & Root

Ember & Root Tinker Kitchen, Food Exploration Waiver