Beasley Rising Leaders Waiver Forms  Logo
  • Beasley Rising Leaders Waiver Forms

  • Parental Consent and Release Form

  • I, the undersigned      , am the parent or legal guardian of the child/youth named   , who was born on Pick a Date       and resides in       . For any situation, I assure that I will be available for the phone call at       .

    As a parent or legal guardian, I affirm that I have been completely informed all the activities that the child/youth will participate. I understand the general structure of the activities/programs.

  • I hereby voluntarily release, forever discharge the Eric Beasley Foundation 501(c)(3), community, the corporation, its officers, directors, employees, volunteer and agents from any and all claims, demands, or causes of action, which are connected with my child's participation in the programs, or the use of the equipment and facilities, recreational activities and field trips. I agree to pay for any and all medical expenses incurred and give permission to the doctor or health care professional to provide medical care if necessary. The information I've given in this form is complete and accurate. By signing this form on      Pick a Date  , I confirm that I have fully informed myself of the contents of this Parental Consent and Release Form by reading it before I signed it.

    I warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect.

  • Media Release

  • Powered by Jotform SignClear
  • Beasley Rising Leaders Program Policies


  • Thank you for submitting your youth’s application in Beasley Rising Leaders. These policies help keep children safe, ensure a positive learning environment, and make logistics clear for families. Please read carefully and contact us with questions: [info@embfoundation.org]


    Attendance & punctuality

    • Regular attendance is important. Please notify us in advance if your child will be absent or late via [731.267.0683].
    • If your child misses more than [three] consecutive sessions without contact, staff will follow up to confirm continued enrollment.
    • Late arrivals may miss program activities and check-in procedures. Repeated tardiness may affect continued participation.

    Drop-off & pick-up procedures

    • Arrival window: [e.g., 8:30–9:00 AM]; pick-up time: [e.g., 2:45-3:00]. Please arrive within these windows.
    • Only authorized adults listed on the application may pick up a child. Photo ID is required at pick-up.
    • To add or change an authorized pick-up person, notify program staff in writing or by phone before pick-up.
    • Late pick-up: If you are more than [10/15] minutes late, staff will attempt to contact emergency contacts. 


    Health & Illness policy

    • Do not send your child if they have fever (100.4°F/38°C or higher), vomiting, diarrhea, contagious rash, or other contagious symptoms. Wait until 24 hours symptom-free (without fever-reducing medication) before returning, or follow public health guidance.
    • If a child becomes ill during program hours, staff will contact the parent/guardian and expect pick-up within [60] minutes.
      Communicable disease: If there is a confirmed exposure or case of a contagious disease in the program, families will be notified per public health guidance.
    • COVID-19: We follow current public health recommendations. If you or your child test positive for COVID-19, notify the program and follow isolation and return-to-program guidance. (We will update policies as guidance changes.)

     

    Medication & medical needs

    • Program staff can only administer prescription medication with a completed Medication Authorization form, the original labeled container, and written instructions from a parent/guardian; over-the-counter medications require prior written permission.
    • Staff are trained in basic first aid. If a child needs more extensive medical attention, parents will be called immediately; in emergencies, 911 will be called and the child will be transported to the nearest medical facility.

     

    Behavior expectations & support

    • Positive behavior supports: staff use praise, redirection, and brief time-outs when needed. We focus on teaching skills and supporting children to make better choices.
    • If a child’s behavior significantly disrupts learning or endangers others (physical harm, threats), staff will contact parents and may require a support meeting or immediate pick-up. Repeated or severe incidents may result in temporary suspension or dismissal.
    • For children with special behavioral needs, families should indicate supports on the application and may be asked to meet with staff to create an individualized support plan before the program begins.

     

  • Inclusion & accommodations

    • We welcome children of all abilities and backgrounds. Tell us on the application about any language, mobility, sensory, medical, or learning needs so we can plan reasonable accommodations.
    • If additional support (one-on-one aide) is required, families should request this during the application process. The program will make reasonable efforts to accommodate needs; in rare cases where safety or essential program delivery cannot be assured, staff will work with the family to find alternatives.

    Food & allergies

    • Light snacks and meals are provided. List all food allergies and dietary restrictions on the Health & Dietary Information form.
    • We follow allergy-safe practices (labeling, handwashing, separate storage) but cannot guarantee a completely allergen-free environment unless otherwise arranged.
    • If your child requires emergency medication for allergic reactions (EpiPen), bring it in the original container with instructions.


    Transportation & field trips

    • If you requested program transportation, pick-up/drop-off points and times will be provided before the program starts.
    • Children must follow bus/van safety rules while in transit.
    • For any off-site community project or field trip, families will receive advance notice and a separate permission slip if required.

    Media release & privacy

    • The Media Release form authorizes (or declines) use of your child’s photo or video for program promotion and reporting. You may opt out; we will honor that choice.
    • Personal information (health, behavioral notes) is kept confidential and shared only with staff who need it for safety and accommodations.
    • We will not sell or share personal data with third parties outside program partners without consent.

    Emergencies & incident reporting

    • In an emergency, staff will call 911, provide first aid, and contact parent/guardian immediately.
    • Families will be notified of any injury or incident involving their child using the incident.
    • Notification procedure: A written incident report will be available on request.


    Cancellation & program changes

    • In case of severe weather, public health guidance, or other emergencies, the program may be delayed, modified, or canceled.
    • Families will be notified by [text/email/phone] as soon as possible.
    • If the program must close temporarily, staff will aim to provide make-up sessions or alternative supports where feasible.

    Volunteers & visitors

    • Program volunteers and ambassadors are background-checked and receive orientation.
    • Families who volunteer must complete required forms and background checks as appropriate.
    • External visitors (sponsors, partner staff) must check in; children will not be photographed without a signed media release.

    Communication & updates

    • Weekly summaries will be emailed to families with highlights, reminders, and any changes.
    • Please ensure contact info is current.
    • For urgent matters during program hours call: [731.267.0683]. For non-urgent questions email: [info@embfoundation.org].

    Acknowledgment By enrolling, you acknowledge that you have read and understood these policies, agree to follow program rules, and consent to staff contacting emergency contacts when needed. If you have questions or need any accommodations, please contact us.



     

  • Powered by Jotform SignClear
  • Should be Empty: