Middle School & High school Programs Application

Weekday HS Programs
(4:00-6:00pm, October-May)
Weekday Middle School Programs
(4:00-6:00pm, October-May)
Saturday Programs
(10:00am-3:00pm, October-May)
College Saturdays
(10:00am-12:00pm)
Name *
Name
Address *
Address
Cell Phone *
Cell Phone
Date of Birth *
Date of Birth
(He, Her, Them, etc)
LIABILITY I, the undersigned parent/guardian, hereby release DreamYard Project, Inc. and any organization with which it might contract for service, from any and all liability for any injury that might befall my child during their participation in any program. I understand the details of the program my child is registering for and know that the program is not only education, but can also have physical activity associated with it and the use of professional tools/equipment. I grant DreamYard Project, Inc. permission to provide immediate medical care to my child whether by DreamYard staff or a medical professional at their discretion and to the best of their ability. I acknowledge and agree that my son/daughter shall act in a responsible manner and follow all rules pertaining to these activities and understand that a violation of the rules may result in the participant being sent home at the parent/guardian's expense. PHOTO/VIDEO CONSENT I also grant DreamYard Project, Inc. the right to use photographs and/or video and other records of my child's likeness, biography, voice and sounds during her/his participation with DreamYard Project, Inc. for publicity purposes without compensation to me or my child; this includes but is not limited to: art work, programs, projects, or products my child has worked on/created. I further grant DreamYard Project to assist my child in any academic counseling, services, or educational advice. DATA COLLECTION I give DreamYard Project, Inc. and SportUp, a DreamYard partner organization with a mission to improve youth development outcomes, permission to collect my child's identifiable student level data from his/her school, school district and NYC Department of Education. This data includes grades, attendance, ELA and Math test information, student perception survey, enrollment, biographic, course and credit, fitness and graduation outcomes for the years of 2009-2010 through 2024-25. This data and study should benefit the students and schools involved, in particular, evaluating the impact of after-school programs on student' school participation, grades and behavior. I understand that this information will be used solely for evaluation purposes and will only be included in reports in aggregate form. MEDICAL RELEASE If emergency medical care is necessary and I cannot be reached, I authorize the DreamYard Project to act in my behalf in grant permission for my child to receive emergency medical treatment. Parents are responsible for all expenses incurred as the result of medical treatment. TYPING YOUR NAME BELOW ACKNOWLEDGES THAT YOU HAVE READ AND AGREE TO THE TERMS ABOVE IN THIS RELEASE.
Guardian Signature *
Guardian Signature
Typing your name acknowledges the terms above.
Cell Phone
Cell Phone
Work Phone
Work Phone
Parent/Guardian Address *
Parent/Guardian Address
(Allergies, Physical limitations, etc). Please provide extensive details.