Thank you for taking the time to complete this application and carefully read the updates within it.

Kinder-5th grade clubs will take place at CES, JES and MMES. With the exception of students from outlying schools, we will not mix students from different schools at any site. Therefore, students will remain at their school for all TLC afterschool clubs. Students from outlying schools are welcome to apply to clubs taking place at JES or CES.

Through our partnership with TCSD, we will once again be able to provide an Activity Bus to bring students from MMES to CES after TLC clubs this spring. Please note if you are interested in your student(s) riding the Activity Bus on your application. Activity Bus spaces will be limited and will be filled according to lottery status. If a space is available for your student(s), we will reach out to invite you to take the space(s) and provide the next steps needed to do so. If your child is granted a space on the Activity Bus, you must notify instructors by 2:00pm day-of with any pickup related changes.

Important Updates for the Spring 2026 Club Session & Summer SOAR Program:

1. The application will close on February 22rd. Any families who apply after February 22rd will be automatically waitlisted. 

2. We will notify families of enrollment or waitlist status on March 5th. All notifications will be sent via email. Families are required to respond to the email to accept their club space(s).

3. Club will run from Monday, April 6th until Thursday, May 28th. If your student is likely to miss two or more clubs due to scheduling conflicts, for example, other clubs, sports, etc., we ask that you do not apply for the spring session. This is in an effort to prioritize students who can attend the full duration of club. 

4. Completing this application does not guarantee a space in our clubs on one or more days. 

5. Please note that this application is for both our Spring Clubs and for our Summer SOAR Program. This year, we expect the SOAR program to run for six weeks of full-day programming from June 22 - July 30th. Please only apply to the summer SOAR program if you can commit to all six weeks of programming! 

• Notifications for acceptance into our Summer SOAR Program will be sent on March 12th. 

This authorizes Teton Literacy Center and Teton County School District #1 to share written or verbal information regarding my child’s academic performance, diagnosis, history, including medication, progress, psychological and educational testing, medical and legal information, social welfare and rehabilitation, reports and other materials that are relevant to my child's care. I give my permission for the staff of Teton Literacy Center, this 21st CCLC program with services located at Teton Literacy Center, Munger Elementary School, and Jackson Hole Middle School to review my child’s academic and behavior progress reports or their report card in order to document growth and progress in my child during his/her time in this before/after school or summer program. This includes attendance, academic performance, teacher surveys and information about whether my child has an identified exceptionality, an Individual Education Plan or Academic Improvement Plan, and suggestions from my child’s teacher(s) on how my child can best be helped in the program. TLC will send Wyoming Department of Education grade reports from your child’s teacher using WISERID numbers where data will be aggregated at the state level to protect your child’s identification. This data is collected to evaluate the effectiveness of TLC programs.

I understand that my records are protected under the laws regarding confidentiality, and cannot be disclosed without written consent, except in specific situations.  This consent is valid throughout my child receiving services at Teton Literacy Center.

Students must be respectful to the staff, volunteers and other students.  Students must respect other's physical space, physical safety and feelings. Staff and volunteers must also be respectful of students. 

Students and families understand that TLC Programs may include students from different schools and diverse cultures, religions, races, languages and ages. Students must be kind to all and accepting of each other. 

The use of culturally, racially or religiously insensitive remarks, mimicry, foul language or profanity is not acceptable at any time and will not be tolerated. 

All students and families are expected to know and follow the rules of both Teton Literacy Center and Teton County School District. All Teton County School District rules apply when students and families are in Teton Literacy Center Programs. These rules include playground protocol, wearing shoes at all times, sitting while eating snacks, using “inside voices” and walking in the hallways. These policies are put in place to keep all students safe. 

Parents or guardians are responsible for picking up their child on time at the end of the program.  Parents or guardians are also entirely responsible for arranging the student’s transportation to and from Programs.   

Students must remain at their assigned locations for program activities until a parent or guardian signs them out or gives written permission for them to leave. If there is a change in pick-up plans – such as a student needs to leave early, will be picked up by someone else, or needs to walk home – their parent or guardian must notify instructors prior to 2:00 pm.  

Students and families understand that there will be consequences for disruptive or dangerous behaviors, or for repeated violations of the rules set out here.  The consequences, which are entirely at TLC’s discretion, will depend on the severity and persistence of the student’s behavior.

If there is a discipline problem, the TLC teacher will fill out a “Refocus Form” or “Incident Report,” depending on the severity of the problem. Parents or guardians will be notified in writing of the problem. TLC may schedule a family meeting. If the student persists in misbehaving after the family meeting, TLC may enforce a break in services while the student and family work to build more appropriate behaviors. 

Acknowledgement of My Responsibilities as Parent or Guardian

I have read and understood the policies and procedures listed above and agree to comply with them. I have also reviewed these policies and procedures with my child.  I understand that if my child or I fail to comply with these policies and procedures my child may lose his or her funded space within this program. 

Scope of Acknowledgement and Release: Teton Literacy Center (TLC) provides out-of-school programs at its own facilities, at facilities that it rents from the Jackson Hole Community School, and at the facilities of organizations with which it collaborates, such as the Jackson Hole Children’s Museum and History Jackson Hole. TLC also provides afterschool programs at various Teton County Public Schools. I understand that all of these facilities, programs, and partner organizations are covered by this Acknowledgement and Release, and that TLC is defined in this Acknowledgement and Release to encompass all of these facilities, programs, and partner organizations.  

Acknowledgement and Assumption of Risk: I understand that my minor child’s participation in TLC’s out-of-school and afterschool programs is voluntary and that my child and I are free to choose not to participate. I understand that participation in voluntary out-of-school and afterschool activities includes risks, including risk of injury or illness that may range in severity from minor to disabling to catastrophic including even death. Although serious injuries are not common in out-of-school and afterschool programs, I understand that it is impossible to eliminate all risk. I acknowledge the existence of this range of risks, and knowingly and voluntarily assume them for myself and on behalf of my child. 

Acknowledgement that My Child’s Participation is at TLC’s Discretion:  I understand that my child is allowed to participate in TLC’s programs entirely at TLC’s discretion. My child has no right to participate. TLC may stop offering a program, change a program, remove my child from a program, change its rules and procedures applicable to a program, enforce its rules and procedures applicable to a program, impose conditions on my child’s participation in a program, change facilities, change partner organizations, and the like, entirely at its discretion.           

Release and Waiver of Liability:  I understand that TLC, as well as its employees, officers, contractors, directors, agents, and volunteers, including without limitation any employees, officers, contractors, directors, agents, and volunteers of partner organizations, will not be liable for personal injuries, accidents, illness, my reliance on TLC’s programs, emotional distress, or property damage, of any kind or degree, in connection with my child’s participation in such activities, including without limitation those arising from negligence.

Indemnity and Hold Harmless Agreement:  On behalf of myself and my child, I agree to release, hold harmless and indemnify TLC, as well as its employees, officers, contractors, directors, agents, and volunteers, including without limitation any employees, officers, contractors, directors, agents, and volunteers of partner organizations, from any loss, cost, damage, or expense, of any kind or degree, including without limitation all attorneys’ fees, costs, and dispute resolution expenses, which I or my child may have, directly or indirectly, in connection with my child’s participation in such activities. 

Knowing and Voluntary Agreement: I have read this Acknowledgement and Release, and understand its terms, and understand that my child and I are giving up substantial rights, including without limitation the right to sue.  I also understand that my child and I are giving up substantial rights against TLC’s partner organizations, including without limitation the right to sue.  I further understand my right to review this Acknowledgement and Release with advisers of my choice, and I have had the opportunity to do so.  I am signing this Acknowledgement and Release freely and voluntarily and intend by my signature to be a complete and unconditional release of liability to the greatest extent allowed by law.  

Severability.  If one or more part this Acknowledgement and Release is found to be unenforceable or illegal, the unenforceable or illegal part shall be severed from other parts of the Acknowledgement and Release without rendering the remaining parts unenforceable.   

Choice of Law and Venue.  This Acknowledgement and Release shall be interpreted according to the laws of the State of Wyoming and the venue shall be in Wyoming.

If YES, please describe below:

This student takes medications on a routine, daily, or frequent basis as follows: 

The student must bring enough medication to last the entirety of their time at TLC programming. The medication must be kept in the original packaging or bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration. The student must coordinate his or her use of medication with TLC staff.

Authorization of Medical Services

I have completed and reviewed this form and attest that the information it contains, including the student’s health history, is correct and complete as far as I know.  

I understand that TLC will attempt to reach the responsible parent or guardian at the cell phone number provided above in the event of a serious accident, injury, episode, or other medical emergency involving the student.  

I also understand that TLC and its staff may need to obtain or provide first aid or emergency medical or dental services for the student, and may need to do so before TLC is able to reach the responsible parent or guardian identified above.  

I hereby grant TLC and its staff full authority to take whatever action it considers appropriate under the circumstances regarding the health and safety of the student, including obtaining emergency medical or dental services for the student. I understand that I am financially responsible to providers of any such medical or dental services to the student, including providers of transportation to those facilities, and that I am also responsible for dealing with my insurance carrier (if any).

I further consent to the transportation of the student to a medical facility, including without limitation in a private vehicle or ambulance.   

I understand that Teton Literacy Center may, from time to time during its interactions with students and their families, take photographs, conduct interviews, make videos and other recordings, and display or use participants’ artwork and writings, for a variety of institutional, educational, and informational purposes, including marketing and fundraising.  On behalf of myself and my minor children, I broadly, voluntarily, and unreservedly (1) authorize Teton Literacy Center and its officers, agents, employees, successors, licensees, volunteers, and assigns (collectively, TLC), to do so, and (2) release TLC from all forms of actions or claims, and all types of redress, compensation, or relief, in any forum or venue, whether in the past, present, or future, arising from or associated with the subject matter of this Authorization and Release.    

Consistent with this broad authorization and release, I authorize TLC to take photos and make videos and other recordings of me and my minor children and to and use those images, likenesses, and appearances (collectively, photos) without compensation of any kind to me or my minor children, for any institutional, educational, and informational purpose, including marketing and fundraising.  I further authorize TLC to use my name, biography, personal information, data, and event, as well as those of my minor children, in connection with any such uses of the photos on the same terms.  I understand and agree to the broad authorization and release outlined here and waive any right or interest that I or my minor children may have, including any right to inspect or approve the photos.  My authorization and release, for myself and my minor children, is irrevocable and valid for TLC’s use of the photos in any place, manner, or media. The photos may be used in whole or in part, alone or with other photographs or recordings, and may be blurred or modified.  I understand that all right, title, and interest in the photos belongs solely to TLC.

Emergency Medical Care

In the case of an emergency, JHCM will not transport your child. They will call the parents or dial 911 for emergency transportation. JHCM staff will not administer medication during programs other than Benadryl and Epi-Pen in the case of an emergency. If your child requires medication during the program, the medication must be in the original container with doctor's orders for the medications. This includes Epi-Pens. If anything is administered, parents will be notified.

JHCM cannot guarantee a food allergen-free environment. Please provide sunscreen for your child(ren). If not provided, JHCM staff will apply program sunscreen if necessary for outdoor activity. 

Important to know:

• All MMES families interested in the activity bus must answer the questions below to apply.
• Activity Bus spaces will be limited and will be filled according to lottery status. If a space is available for your student(s), we will reach out to invite you to take the space(s) and provide the next steps needed to do so. 
• Families will be notified of their bus invitation/waitlist status on Thursday, March 5th. All invited families will be required to complete a form in order to accept their space on the bus.
• These students will be automatically placed on the bus at the end of club every single week. If you need to pick up at MMES, you must contact the club teacher prior to 2pm.
• If your student has received a space on the bus and is picked up from MMES more than three times, your space on the bus is subject to be removed. Thank you for understanding we have a lengthy waitlist for the bus! 

SOAR is a free, six-week intensive summer program for students exiting Kindergarten through 7th grade this school year.

If accepted, students must commit to attending all six weeks of the program.

This year, SOAR will run Monday–Thursday, June 22 – July 30, from 9:00 AM – 4:00 PM.

Please ONLY apply if your student can commit to all six weeks of SOAR!

Similar to previous years, all new students applying to be in the Jetsetter Cabin (including all rising 6th)  must complete a short essay answering the following question: 

*Why do you want to be a Jetsetter this summer? What are you hoping to gain by participating in this program?

This essay MUST be written by the student, and be at least two paragraphs long. Students can also turn a hand-written essay into Ms. Anna or Mr. Victor at TLC. Your student’s application will not be considered complete without this essay. 

Essays are due at the same time as all SOAR applications, February 22.

Potential Interview Invite 

Once you finish the application and your student has completed their essays. Students will then be invited to an interview with TLC staff between March 2 and March 12 as the next step in the application process (an invitation for your student to participate in this step will be emailed to you). Assuming completion of their interview, final notifications for rising 6th-8th grade applicants will be sent via email on March 18. 

Jetsetter Camping Trip

Students in the Jetsetter Cabin will have the special opportunity to attend an overnight camping trip in partnership with Teton Science Schools in Grand Teton National Park. The trip will take place from July 14th to July 16th, and is a required part of our summer curriculum. Students are expected to attend.

If you have any questions or concerns about this trip, please feel free to call the TLC office and ask to speak with Anna, Victor or Carisa. 

We require confirmation by May 1st. Late changes will not be accommodated. Last minute cancellations will jeopardize your student’s future programming opportunities, and a cancellation fee may apply. 

Parents will fill out the TSS forms at the parent meeting.

SOAR Field trips include, but are not limited to the following:

• Swimming at Teton County Rec Center 
• Hiking and swimming at R Park 
• Hiking, riding the chair lift/Tram, ropes course, and bungee trampoline at Jackson Hole Mountain Resort 

TLC will notify parents if students will leave the designated TLC site prior to the field trip. The activities listed above are subject to availability. Alternative field trips may be offered. Parents will be notified of scheduled field trips and any changes.

I certify that I am the parent or guardian of the above named student at SOAR summer program at Teton Literacy Center.  Teton Literacy Center has my full permission for my child to attend the program field trips traveling my START bus, rented van or school bus, or by foot.  I agree to hold harmless and release from liability the Teton Literacy Center SOAR Program, any employee, volunteer, board member or representative thereof, for any action, claim, or damage that may arise as a result of my child’s participation.  In the event that my child needs emergency or medical treatment, every attempt will be made to contact us, the parent/guardian.  In the event I/we cannot be contacted, my authorized signature below gives my/our permission to Teton Literacy Center to secure prompt treatment. 

Parents/guardians are responsible for providing student transportation to and from TLC programs. TLC SOAR summer program will take place in Teton Literacy Center Classrooms, Jackson Hole Community School Classrooms, and Colter Elementary school. Lunch and recreation will take place at Colter Elementary school. Only those persons designated on the TLC approved list will be allowed to pick up the student. If students are taking TCSD or public transportation parents/guardians must notify or students will not be allowed to leave the premises.

I have read, understand and agree to comply with the requirements of the policies and procedures listed in the application form and the parent handbook. I realize that failure to comply with these requirements may result in loss of my funded space within this program. I acknowledge any risk associated with SOAR and Teton Literacy Center program activities and field trips. I release the Teton Literacy Center, its staff, Board of Directors and volunteers from any liability.

This authorizes Teton Literacy Center and Teton County School District #1 to share written or verbal information regarding my child’s academic performance, diagnosis, history, including medication, progress, psychological and educational testing, medical and legal information, social welfare and rehabilitation, reports and other materials that are relevant to my child's care. I give my permission for the staff of Teton Literacy Center, this 21st CCLC program with services located at Teton Literacy Center, Munger Elementary School, and Jackson Hole Middle School to review my child’s academic and behavior progress reports or their report card in order to document growth and progress in my child during his/her time in this before/after school or summer program. This includes attendance, academic performance, teacher surveys and information about whether my child has an identified exceptionality, an Individual Education Plan or Academic Improvement Plan, and suggestions from my child’s teacher(s) on how my child can best be helped in the program. TLC will send Wyoming Department of Education grade reports from your child’s teacher using WISERID numbers where data will be aggregated at the state level to protect your child’s identification. This data is collected to evaluate the effectiveness of TLC programs.

I understand that my records are protected under the laws regarding confidentiality, and cannot be disclosed without written consent, except in specific situations. This consent is valid throughout my child receiving services at Teton Literacy Center.

Scope of Acknowledgement and Release: Teton Literacy Center (TLC) provides out-of-school programs at its own facilities, at facilities that it rents from the Jackson Hole Community School, and at the facilities of organizations with which it collaborates, such as the Jackson Hole Children’s Museum and History Jackson Hole. TLC also provides afterschool programs at various Teton County Public Schools. I understand that all of these facilities, programs, and partner organizations are covered by this Acknowledgement and Release, and that TLC is defined in this Acknowledgement and Release to encompass all of these facilities, programs, and partner organizations.  

Acknowledgement and Assumption of Risk: I understand that my minor child’s participation in TLC’s out-of-school and afterschool programs is voluntary and that my child and I are free to choose not to participate. I understand that participation in voluntary out-of-school and afterschool activities includes risks, including risk of injury or illness that may range in severity from minor to disabling to catastrophic including even death. Although serious injuries are not common in out-of-school and afterschool programs, I understand that it is impossible to eliminate all risk. I acknowledge the existence of this range of risks, and knowingly and voluntarily assume them for myself and on behalf of my child. 

Acknowledgement that My Child’s Participation is at TLC’s Discretion:  I understand that my child is allowed to participate in TLC’s programs entirely at TLC’s discretion. My child has no right to participate. TLC may stop offering a program, change a program, remove my child from a program, change its rules and procedures applicable to a program, enforce its rules and procedures applicable to a program, impose conditions on my child’s participation in a program, change facilities, change partner organizations, and the like, entirely at its discretion.           

Release and Waiver of Liability:  I understand that TLC, as well as its employees, officers, contractors, directors, agents, and volunteers, including without limitation any employees, officers, contractors, directors, agents, and volunteers of partner organizations, will not be liable for personal injuries, accidents, illness, my reliance on TLC’s programs, emotional distress, or property damage, of any kind or degree, in connection with my child’s participation in such activities, including without limitation those arising from negligence.

Indemnity and Hold Harmless Agreement:  On behalf of myself and my child, I agree to release, hold harmless and indemnify TLC, as well as its employees, officers, contractors, directors, agents, and volunteers, including without limitation any employees, officers, contractors, directors, agents, and volunteers of partner organizations, from any loss, cost, damage, or expense, of any kind or degree, including without limitation all attorneys’ fees, costs, and dispute resolution expenses, which I or my child may have, directly or indirectly, in connection with my child’s participation in such activities. 

Knowing and Voluntary Agreement: I have read this Acknowledgement and Release, and understand its terms, and understand that my child and I are giving up substantial rights, including without limitation the right to sue.  I also understand that my child and I are giving up substantial rights against TLC’s partner organizations, including without limitation the right to sue.  I further understand my right to review this Acknowledgement and Release with advisers of my choice, and I have had the opportunity to do so.  I am signing this Acknowledgement and Release freely and voluntarily and intend by my signature to be a complete and unconditional release of liability to the greatest extent allowed by law.  

Severability.  If one or more part this Acknowledgement and Release is found to be unenforceable or illegal, the unenforceable or illegal part shall be severed from other parts of the Acknowledgement and Release without rendering the remaining parts unenforceable.   

Choice of Law and Venue.  This Acknowledgement and Release shall be interpreted according to the laws of the State of Wyoming and the venue shall be in Wyoming.

If YES, please describe below:

This student takes medications on a routine, daily, or frequent basis as follows: 

The student must bring enough medication to last the entirety of their time at TLC programming. The medication must be kept in the original packaging or bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration. The student must coordinate his or her use of medication with TLC staff.

Authorization of Medical Services

I have completed and reviewed this form and attest that the information it contains, including the student’s health history, is correct and complete as far as I know.  

I understand that TLC will attempt to reach the responsible parent or guardian at the cell phone number provided above in the event of a serious accident, injury, episode, or other medical emergency involving the student.  

I also understand that TLC and its staff may need to obtain or provide first aid or emergency medical or dental services for the student, and may need to do so before TLC is able to reach the responsible parent or guardian identified above.  

I hereby grant TLC and its staff full authority to take whatever action it considers appropriate under the circumstances regarding the health and safety of the student, including obtaining emergency medical or dental services for the student. I understand that I am financially responsible to providers of any such medical or dental services to the student, including providers of transportation to those facilities, and that I am also responsible for dealing with my insurance carrier (if any).

I further consent to the transportation of the student to a medical facility, including without limitation in a private vehicle or ambulance. 

I understand that Teton Literacy Center may, from time to time during its interactions with students and their families, take photographs, conduct interviews, make videos and other recordings, and display or use participants’ artwork and writings, for a variety of institutional, educational, and informational purposes, including marketing and fundraising.  On behalf of myself and my minor children, I broadly, voluntarily, and unreservedly (1) authorize Teton Literacy Center and its officers, agents, employees, successors, licensees, volunteers, and assigns (collectively, TLC), to do so, and (2) release TLC from all forms of actions or claims, and all types of redress, compensation, or relief, in any forum or venue, whether in the past, present, or future, arising from or associated with the subject matter of this Authorization and Release.    

Consistent with this broad authorization and release, I authorize TLC to take photos and make videos and other recordings of me and my minor children and to and use those images, likenesses, and appearances (collectively, photos) without compensation of any kind to me or my minor children, for any institutional, educational, and informational purpose, including marketing and fundraising.  I further authorize TLC to use my name, biography, personal information, data, and event, as well as those of my minor children, in connection with any such uses of the photos on the same terms.  I understand and agree to the broad authorization and release outlined here and waive any right or interest that I or my minor children may have, including any right to inspect or approve the photos.  My authorization and release, for myself and my minor children, is irrevocable and valid for TLC’s use of the photos in any place, manner, or media. The photos may be used in whole or in part, alone or with other photographs or recordings, and may be blurred or modified.  I understand that all right, title, and interest in the photos belongs solely to TLC.

Important to know:

• All families interested in the MMES activity bus will answer the questions below to apply.
• Activity Bus spaces will be limited and will be filled according to lottery status. If a space is available for your student(s), we will reach out to invite you to take the space(s) and provide the next steps needed to do so.
• Families will be notified of their bus invitation/waitlist status on Thursday, March 6th. All invited families will be required to complete a form in order to accept their space on the bus.
• These students will be automatically placed on the bus at the end of club every single week. If you need to pick up at MMES, you must contact the club teacher prior to 2pm.
• If your student has received a space on the bus and is picked up from MMES more than three times, your space on the bus is subject to be removed. Thank you for understanding we have a lengthy waitlist for the bus! 

SOAR is a free, six-week intensive summer program for students exiting Kindergarten through 7th grade this school year.

If accepted, students must commit to attending all six weeks of the program.

This year, SOAR will run Monday–Thursday, June 22 – July 30, from 9:00 AM – 4:00 PM.

Please ONLY apply if your student can commit to all six weeks of SOAR!

Similar to previous years, all students applying to be in the Jetsetter Cabin (rising 6th, 7th and 8th graders) must complete a short essay answering the following question: 

*Why do you want to be a Jetsetter this summer? What are you hoping to gain from participating in this program?

This essay MUST be written by the student, and be at least two paragraphs long. Students can also turn a hand-written essay into Ms. Anna or Mr. Victor at TLC. Your student’s application will not be considered complete without this essay. 

Essays are due at the same time as all SOAR applications, February 22.

Potential Interview Invite 

Once you finish the application and your student has completed their essays. Students will then be invited to an interview with TLC staff between March 2 and March 12 as the next step in the application process (an invitation for your student to participate in this step will be emailed to you). Assuming completion of their interview, final notifications for rising 6th-8th grade applicants will be sent via email on March 18.

Jetsetter Camping Trip

Students in the Jetsetter Cabin will have the special opportunity to attend an overnight camping trip in partnership with Teton Science Schools in Grand Teton National Park. The trip will take place from July 14th to July 16th, and is a required part of our summer curriculum. Students are expected to attend.

If you have any questions or concerns about this trip, please feel free to call the TLC office and ask to speak with Anna, Victor or Carisa. 

We require confirmation by May 1st. Late changes will not be accommodated. Last minute cancellations will jeopardize your student’s future programming opportunities, and a cancellation fee may apply. 

Parents will fill out the TSS forms at the parent meeting.

SOAR Field trips include, but are not limited to the following:

• Swimming at Teton County Rec Center
• Hiking and swimming at R Park
• Hiking, riding the chair lift/Tram, ropes course, and bungee trampoline at Jackson Hole Mountain Resort 

TLC will notify parents if students will leave the designated TLC site prior to the field trip. The activities listed above are subject to availability.  Alternative field trips may be offered.  Parents will be notified of scheduled field trips and any changes.

I certify that I am the parent or guardian of the above named student at SOAR summer program at Teton Literacy Center. Teton Literacy Center has my full permission for my child to attend the program field trips traveling my START bus, rented van or school bus, or by foot. I agree to hold harmless and release from liability the Teton Literacy Center SOAR Program, any employee, volunteer, board member or representative thereof, for any action, claim, or damage that may arise as a result of my child’s participation. In the event that my child needs emergency or medical treatment, every attempt will be made to contact us, the parent/guardian. In the event I/we cannot be contacted, my authorized signature below gives my/our permission to Teton Literacy Center to secure prompt treatment.

Parents/guardians are responsible for providing student transportation to and from TLC programs. TLC SOAR summer program will take place in Teton Literacy Center Classrooms, Jackson Hole Community School Classrooms, and Colter Elementary school. Lunch and recreation will take place at Colter Elementary school. Only those persons designated on the TLC approved list will be allowed to pick up the student. If students are taking TCSD or public transportation parents/guardians must notify or students will not be allowed to leave the premises.

I have read, understand and agree to comply with the requirements of the policies and procedures listed in the application form and the parent handbook. I realize that failure to comply with these requirements may result in loss of my funded space within this program. I acknowledge any risk associated with SOAR and Teton Literacy Center program activities and field trips. I release the Teton Literacy Center, its staff, Board of Directors and volunteers from any liability.

This authorizes Teton Literacy Center and Teton County School District #1 to share written or verbal information regarding my child’s academic performance, diagnosis, history, including medication, progress, psychological and educational testing, medical and legal information, social welfare and rehabilitation, reports and other materials that are relevant to my child's care. I give my permission for the staff of Teton Literacy Center, this 21st CCLC program with services located at Teton Literacy Center, Munger Elementary School, and Jackson Hole Middle School to review my child’s academic and behavior progress reports or their report card in order to document growth and progress in my child during his/her time in this before/after school or summer program. This includes attendance, academic performance, teacher surveys and information about whether my child has an identified exceptionality, an Individual Education Plan or Academic Improvement Plan, and suggestions from my child’s teacher(s) on how my child can best be helped in the program. TLC will send Wyoming Department of Education grade reports from your child’s teacher using WISERID numbers where data will be aggregated at the state level to protect your child’s identification. This data is collected to evaluate the effectiveness of TLC programs.

I understand that my records are protected under the laws regarding confidentiality, and cannot be disclosed without written consent, except in specific situations.  This consent is valid throughout my child receiving services at Teton Literacy Center.

Scope of Acknowledgement and Release: Teton Literacy Center (TLC) provides out-of-school programs at its own facilities, at facilities that it rents from the Jackson Hole Community School, and at the facilities of organizations with which it collaborates, such as the Jackson Hole Children’s Museum and History Jackson Hole. TLC also provides afterschool programs at various Teton County Public Schools. I understand that all of these facilities, programs, and partner organizations are covered by this Acknowledgement and Release, and that TLC is defined in this Acknowledgement and Release to encompass all of these facilities, programs, and partner organizations.  

Acknowledgement and Assumption of Risk: I understand that my minor child’s participation in TLC’s out-of-school and afterschool programs is voluntary and that my child and I are free to choose not to participate. I understand that participation in voluntary out-of-school and afterschool activities includes risks, including risk of injury or illness that may range in severity from minor to disabling to catastrophic including even death. Although serious injuries are not common in out-of-school and afterschool programs, I understand that it is impossible to eliminate all risk. I acknowledge the existence of this range of risks, and knowingly and voluntarily assume them for myself and on behalf of my child. 

Acknowledgement that My Child’s Participation is at TLC’s Discretion:  I understand that my child is allowed to participate in TLC’s programs entirely at TLC’s discretion. My child has no right to participate. TLC may stop offering a program, change a program, remove my child from a program, change its rules and procedures applicable to a program, enforce its rules and procedures applicable to a program, impose conditions on my child’s participation in a program, change facilities, change partner organizations, and the like, entirely at its discretion.           

Release and Waiver of Liability:  I understand that TLC, as well as its employees, officers, contractors, directors, agents, and volunteers, including without limitation any employees, officers, contractors, directors, agents, and volunteers of partner organizations, will not be liable for personal injuries, accidents, illness, my reliance on TLC’s programs, emotional distress, or property damage, of any kind or degree, in connection with my child’s participation in such activities, including without limitation those arising from negligence.

Indemnity and Hold Harmless Agreement:  On behalf of myself and my child, I agree to release, hold harmless and indemnify TLC, as well as its employees, officers, contractors, directors, agents, and volunteers, including without limitation any employees, officers, contractors, directors, agents, and volunteers of partner organizations, from any loss, cost, damage, or expense, of any kind or degree, including without limitation all attorneys’ fees, costs, and dispute resolution expenses, which I or my child may have, directly or indirectly, in connection with my child’s participation in such activities. 

Knowing and Voluntary Agreement: I have read this Acknowledgement and Release, and understand its terms, and understand that my child and I are giving up substantial rights, including without limitation the right to sue.  I also understand that my child and I are giving up substantial rights against TLC’s partner organizations, including without limitation the right to sue.  I further understand my right to review this Acknowledgement and Release with advisers of my choice, and I have had the opportunity to do so.  I am signing this Acknowledgement and Release freely and voluntarily and intend by my signature to be a complete and unconditional release of liability to the greatest extent allowed by law.  

Severability.  If one or more part this Acknowledgement and Release is found to be unenforceable or illegal, the unenforceable or illegal part shall be severed from other parts of the Acknowledgement and Release without rendering the remaining parts unenforceable.   

Choice of Law and Venue.  This Acknowledgement and Release shall be interpreted according to the laws of the State of Wyoming and the venue shall be in Wyoming.

If YES, please describe below:

This student takes medications on a routine, daily, or frequent basis as follows:

The student must bring enough medication to last the entirety of their time at TLC programming. The medication must be kept in the original packaging or bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration. The student must coordinate his or her use of medication with TLC staff.

Authorization of Medical Services

I have completed and reviewed this form and attest that the information it contains, including the student’s health history, is correct and complete as far as I know.  

I understand that TLC will attempt to reach the responsible parent or guardian at the cell phone number provided above in the event of a serious accident, injury, episode, or other medical emergency involving the student.  

I also understand that TLC and its staff may need to obtain or provide first aid or emergency medical or dental services for the student, and may need to do so before TLC is able to reach the responsible parent or guardian identified above.  

I hereby grant TLC and its staff full authority to take whatever action it considers appropriate under the circumstances regarding the health and safety of the student, including obtaining emergency medical or dental services for the student. I understand that I am financially responsible to providers of any such medical or dental services to the student, including providers of transportation to those facilities, and that I am also responsible for dealing with my insurance carrier (if any).

I further consent to the transportation of the student to a medical facility, including without limitation in a private vehicle or ambulance. 

I understand that Teton Literacy Center may, from time to time during its interactions with students and their families, take photographs, conduct interviews, make videos and other recordings, and display or use participants’ artwork and writings, for a variety of institutional, educational, and informational purposes, including marketing and fundraising.  On behalf of myself and my minor children, I broadly, voluntarily, and unreservedly (1) authorize Teton Literacy Center and its officers, agents, employees, successors, licensees, volunteers, and assigns (collectively, TLC), to do so, and (2) release TLC from all forms of actions or claims, and all types of redress, compensation, or relief, in any forum or venue, whether in the past, present, or future, arising from or associated with the subject matter of this Authorization and Release.    

Consistent with this broad authorization and release, I authorize TLC to take photos and make videos and other recordings of me and my minor children and to and use those images, likenesses, and appearances (collectively, photos) without compensation of any kind to me or my minor children, for any institutional, educational, and informational purpose, including marketing and fundraising.  I further authorize TLC to use my name, biography, personal information, data, and event, as well as those of my minor children, in connection with any such uses of the photos on the same terms.  I understand and agree to the broad authorization and release outlined here and waive any right or interest that I or my minor children may have, including any right to inspect or approve the photos.  My authorization and release, for myself and my minor children, is irrevocable and valid for TLC’s use of the photos in any place, manner, or media. The photos may be used in whole or in part, alone or with other photographs or recordings, and may be blurred or modified.  I understand that all right, title, and interest in the photos belongs solely to TLC.

Important to know:

• All MMES families interested in the activity bus must answer the questions below to apply.
• Activity Bus spaces will be limited and will be filled according to lottery status. If a space is available for your student(s), we will reach out to invite you to take the space(s) and provide the next steps needed to do so.
• Families will be notified of their bus invitation/waitlist status on Thursday, March 6th. All invited families will be required to complete a form in order to accept their space on the bus.
• These students will be automatically placed on the bus at the end of club every single week. If you need to pick up at MMES, you must contact the club teacher prior to 2pm.
• If your student has received a space on the bus and is picked up from MMES more than three times, your space on the bus is subject to be removed. Thank you for understanding we have a lengthy waitlist for the bus! 

SOAR is a free, six-week intensive summer program for students exiting Kindergarten through 7th grade this school year.

If accepted, students must commit to attending all six weeks of the program.

This year, SOAR will run Monday–Thursday, June 22 – July 30, from 9:00 AM – 4:00 PM.

Please ONLY apply if your student can commit to all six weeks of SOAR!

SOAR Field trips include, but are not limited to the following:

• Swimming at Teton County Rec Center 
• Hiking and swimming at R Park 
• Hiking, riding the chair lift/Tram, ropes course, and bungee trampoline at Jackson Hole Mountain Resort 

TLC will notify parents if students will leave the designated TLC site prior to the field trip. The activities listed above are subject to availability.  Alternative field trips may be offered.  Parents will be notified of scheduled field trips and any changes.

I certify that I am the parent or guardian of the above named student at SOAR summer program at Teton Literacy Center. Teton Literacy Center has my full permission for my child to attend the program field trips traveling my START bus, rented van or school bus, or by foot. I agree to hold harmless and release from liability the Teton Literacy Center SOAR Program, any employee, volunteer, board member or representative thereof, for any action, claim, or damage that may arise as a result of my child’s participation. In the event that my child needs emergency or medical treatment, every attempt will be made to contact us, the parent/guardian. In the event I/we cannot be contacted, my authorized signature below gives my/our permission to Teton Literacy Center to secure prompt treatment.