Middle school Weekday Programs Application

Weekday Programs *
Name *
Address *
Phone *
As the legal guardian of a participant, I hereby
release DreamYard Project 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 educational, but can also have physical activity associated with it and the use of professional tools/equipment. I grant DreamYard Project 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 also grant DreamYard Project 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 for publicity purposes without compensation to me; this includes but does not limit: 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. Lastly, 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 the violation of the rules may result in the participant being sent home at the parent/guardian’s expense. Typing your name below acknowledges this release.
Guardian Signature *
Guardian Signature
Typing your name acknowledges the terms above.

Questions ?

Contact:  Chelsea John, Outreach & Community Relations Coordinator

718-588-8007 x211