SUMMER FREEDOM SCHOOL REGISTRATION

*Required Information

Student Name *

Date Of Birth *

Please leave this field empty.

School *

Grade Completed * 1st2nd3rd4th5th6th7th8th

Gender MaleFemale

Parent/Guardian Name *

Parent/Guardian Email *

Cell Phone *

Work Phone

Address *

City *

State *

Zip *

Emergency Contact Name *

Cell Phone *

VOICE has permission to take and use photos/videos of my child. *
YesNo

VOICE has permission to transport my child on field trips. *
YesNo

VOICE has permission to seek emergency medical care for my child. *
YesNo

My child has special medical needs or food allergies. *
YesNo

If yes, please explain:

My child has permission to walk home from the program site. *
YesNo

My child has permission to be picked up from the program site by:

I understand that for my child to attend Summer Freedom School a parent/guardian or family member must:

1. Volunteer a minimum of three hours each week at Summer Freedom School (tasks include greeting students, serving meals, and assisting in classrooms). Opportunities are available outside of program hours.

2. Attend mandatory monthly Parent Empowerment meetings (each meeting counts as one volunteer hour). Parents must attend an orientation meeting before their children can participate in Summer Freedom School.

I give permission for my child to attend Summer Freedom School and agree to release and hold harmless VOICE and all VOICE representatives from any and all liability and claims as a result of my child’s participation in Summer Freedom School activities. *
YesNo

A copy of the most recent report card and STAAR scores must be attached or presented on the first day of the program.

Copies of student’s most recent report card and STAAR scores are attached.
YesNo