Jax Understood Academic Services Waiver and Parent Agreement

Jax Understood Academic Services Waiver and Parent Agreement

Jax Understood Tutoring Services LLC. Please complete this form before your child’s first session. We’re excited to have your child participate in a Jax Understood program! This form applies to all programs, tutoring sessions, classes, enrichment activities, and educational experiences offered by Jax Understood Tutoring Services LLC (“Jax Understood”). Our goal is to provide a safe, supportive, and engaging environment where every student can learn, explore, build confidence, and grow at their own pace. By completing this form, you acknowledge that you have reviewed and agree to the policies and expectations outlined below and give permission for your child to participate in Jax Understood programs and activities.
Student’s Full Name

First NameLast Name
Student’s Age
Student’s Grade Level
Program enrolling for
Parent/Guardian’s Full Name
Parent/Guardian’s Phone Number
Parent/Guardian’s Email
Emergency Contact’s Name
Emergency Contact’s Phone Number
Relationship to Student
Does your child have any known allergies or sensitivities?
If “Yes,” please describe allergies, sensitivities, or reactions we should be aware of.
Is there anything else we should know to help your child safely and successfully participate in Jax Understood Programs?
Attendance Agreeement
Authorized Pick-up Persons. Please list the full names of anyone authorized to pick-up your child
Jax Understood offers drop-off programs. Parents/Guardians are responsible for bringing their child to the program location and ensuring they are checked in before leaving. Parents/guardians are expected to pick up their child promptly at the scheduled end of the session. A 5-minute grace period is provided for pick-up. A $10 late pick-up fee will apply when a parent/guardian or authorized adult is more than 5 minutes late. If an unexpected delay occurs, please contact Jax Understood as soon as possible.
Payment may be completed via Zelle or cash. Zelle: Jax Understood Tutoring Services LLC. Tag: jaxunderstood
Sessions may involve

-Movement and interactive games

-Hands-on learning activities

-Educational materials and manipulatives

-Technology/tablets/computers when applicable

-Group activities and collaboration

Materials may include, but are not limited to:

-Baking soda
-Vinegar
-Borax
-Food coloring
-Shaving cream
-Alka-Seltzer
-Hydrogen peroxide
-Batteries
-LED lights
-Copper tape
-Small buzzers
-Small motors
-Tablets
-Craft and household materials
-Other age-appropriate STEAM materials

Certain materials will only be used with appropriate adult supervision and safety procedures.

Safety goggles and gloves will be provided and required when appropriate for a particular activity.
Materials and Activities Permission
SAFTEY EXPECTATIONS

Students are expected to:

-Follow instructor directions and safety instructions.
-Use materials and equipment only as instructed.
-Wear safety goggles and/or gloves when directed.
-Treat instructors and other students respectfully.
-Ask for help when they are unsure how to use a material.
-Report spills, injuries, or unsafe situations to an adult.
-Never intentionally misuse materials or equipment.
-Never intentionally harm themselves or another student.
Safety Agreement
Behavior & Community Expectations

Jax Understood services are designed to be welcoming and a collaborative learning environment.

Students are expected to respect other students, instructors, materials, and the program space.

Unsafe or inappropriate behavior may include:

-Repeatedly refusing to follow safety instructions
-Intentionally misusing materials or equipment
-Physical aggression
-Bullying or harassment
-Threatening behavior
-Intentionally damaging property
-Behavior that creates a significant safety concern

If a student repeatedly engages in unsafe behavior or behavior that creates a significant risk to the community, the student may be asked not to return to the program.

Parents/guardians will be contacted regarding significant safety or behavioral concerns.
Behavior Agreements
Emergency Medical Authorization

In the event of an emergency, Jax Understood will make reasonable efforts to contact the parent/guardian or emergency contact.

If emergency medical attention is necessary, I authorize Jax Understood and/or program staff to seek appropriate emergency assistance for my child.
Emergency Medical Authorization.
Academic Services
Photo & Video Permission

Jax Understood may occasionally photograph or record students participating in activities for program documentation and promotional purposes.
Choosing “No” will not affect your chid’s ability to participate.
Parent/Guardian Acknowledgement

Please review each statement carefully.
Parent/Guardian Legal Name
Electronic Signature

By signing, I acknowledge tha I have read and understand the SPARK Waiver and permission form and agree to the policies, permissions, and acknowledgments contained within this form
Date

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2 digit month, 2 digit day, 4 digit yearDate
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