If we are unable to reach the parent/guardian listed at the above phone numbers, whom should we call?
EMERGENCY CONTACT/RELEASE INFORMATION:

Policies: I/We authorize College Bound for Kids (CB4K) to release my child to any of the above individuals listed as an Emergency Contact/Release Information. The above listed individuals must be 18 years or older. I hereby release and hold harmless Kids 4 College (K4C), College Bound for Kids (CB4K), its agents, employees, officers, directors, sponsoring groups and/or agencies from any and all liability which may result from my child's participation in the program. I agree that College Bound for Kids, its Board of Trustees, directors, officers, representatives, employees and agents shall be held harmless from any and all liability, claims, causes of action, and demands arising out of or in connection with my child's participation in the program. I hereby waive any and all claims. CB4K and K4C are not responsible for lost or stolen items.

Photography: I/We give permission for Kids 4 College (K4C) and College Bound for Kids (CB4K) to photograph and/or video record my child while participating in program activities. I understand that these images or recordings may be used for educational purposes including, program documentation, classroom displays, promotional materials, brochures, social media, and website content that highlight program activities. I understand that no identifying personal information will be shared. I understand that I may revoke this consent in writing to info@collegebound4kids.com at any time.

College Bound for Kids has permission to take whatever steps they deem appropriate to obtain medical care for our child in the event of illness, accident, or injury. In this connection, we understand that they will attempt to contact us and that, if they find it necessary, they will call the child's doctor, or another doctor, call an ambulance, or have our child taken to a hospital in the company of a staff member, as they deem appropriate. We, the parents/guardians agree to be responsible for any expenses incurred in obtaining such medical care, and we hereby release College Bound for Kids and Kids 4 College from all liability in connection with their actions pursuant to authorization.

I hereby acknowledge the existence of the assigned risk associated with all programs for children and the areas where such activities and programs take place. I am aware that the program works in large group settings and does not offer individualized assistance to students. I am aware that the Program may take field trips during the summer and school year. I consent for my child to ride on the bus and attend and participate in all activities and field trips.

Your signature below indicates that you have read and understand all the policies and information and adhere to the terms of the program and consent to the activities and field trips if your child attends the program.

THIS FORM MUST BE COMPLETED BEFORE YOUR CHILD STARTS THE PROGRAM.

Summer School Site:

1. I will Respect others and myself (no bad language or behaviors)
2. I will keep my hands, feet, and all objects to myself
3. I will raise my hand to speak/leave my seat
4. I will not play in the restroom during restroom breaks
5. I will not be afraid to ASK QUESTIONS!
6. I will not eat in class or share food with others
7. I will always let a counselor know if I have a problem or concern
8. I will be a good listener and friend to others
9. I will stay focused and TRY MY BEST!

• 3 late pickups will lead to automatic termination (if a late pick up is in excess of 30 min the Site Coordinator can cause for immediate termination)
• CB4K is not responsible for lost, stolen or damaged items
• Fighting and student misconduct may cause for immediate termination
• After 3 infractions a student will be dropped from the program
• Parent/Guardian Conduct: Parents and guardians are expected to communicate respectfully and follow all program policies and procedures. Failure to comply with program expectations, including late pickups, failure to follow sign-out procedures, or inappropriate behavior or language toward staff or students, may result in immediate termination of the student's enrollment.

I/We hereby release and hold harmless Kids 4 College (K4C), College Bound 4 Kids (CB4K), its agents, employees, officers, directors, sponsoring groups and/or agencies from any and all liability resulting from my child's participation in the program. If my child or I cannot conform to the structure of the program, I will be asked to remove him/her from the program. I understand K4C and CB4K are not responsible for lost or stolen items. I authorize Kids 4 College and College Bound 4 Kids to speak with my child's teacher and to access grades, report cards or test information to further help my child in the after school program.

I/We give permission for Kids 4 College (K4C) and College Bound for Kids (CB4K) to photograph and/or video record my child while participating in program activities. I understand that these images or recordings may be used for educational purposes including, program documentation, classroom displays, promotional materials, brochures, social media, and website content that highlight program activities. I understand that no identifying personal information will be shared. I understand that I may revoke this consent in writing to info@kids4college.com at any time.

Kids 4 College and College Bound 4 Kids staff have permission to take whatever steps they deem appropriate to obtain medical care for our child in the event of illness, accident, or injury. In this connection, we understand that they will attempt to contact us and that, if they find it necessary, they will call the child's doctor, or another doctor, call an ambulance, or have our child taken to a hospital in the company of a staff member, as they deem appropriate. We, the parents/guardians agree to be responsible for any expenses incurred in obtaining such medical care, and we hereby release K4C/CB4K and its agents from all liability in connection with their actions pursuant to authorization. I hereby acknowledge the existence of the assigned risk associated with all programs for children and the areas where such activities and programs take place.

I understand that by signing this form, I confirm that I will review and discuss the program rules with my child, follow all the policies and guidelines listed in order to support a collaborative partnership between home, school, and the programs: Kids 4 College and/or College Bound 4 Kids

Revised 06/2025