Permission Slip Complete this form to learn more about volunteering with the Dyslexia Tutoring Program. We’re happy to answer any questions you may have about this incredibly rewarding opportunity. WRITTEN PERMISSION OF PARENT OR GUARDIAN FOR MINOR CHILD’S PARTICIPATION IN DYSLEXIA TUTORING PROGRAM, INC.Child's Name First Last I am the _____ of the above named child.(Required) Father Mother Legal Guardian I hereby give my permission to Dyslexia Tutoring Program, Inc. to conduct such tests and educational screening as it deems necessary to determine my child’s eligibility for its volunteer tutoring services. I hereby give my child permission to participate in the "Tutorial Program," which is operated by Dyslexia Tutoring Program, Inc. I understand that it is my responsibility to provide transportation to and from tutoring sessions. I further understand that transportation provided by tutors, or transportation to/from attendance at outside events, are not the responsibility of Dyslexia Tutoring Program, Inc. The Dyslexia Tutoring Program, Inc. does not encourage individual meetings between individual volunteers and my child outside those scheduled as a part of the "Tutorial Program.” I understand that any meeting between my child and a volunteer that is not a part of the "Tutorial Program" is not to be deemed to be sponsored by or affiliated with Dyslexia Tutoring Program, Inc. I understand that my child or I may be contacted in the future as part of Dyslexia Tutoring Program’s need to document program outcomes. The purpose of such contact is to gain information regarding the student’s progress after he/she/they completed participation in the tutoring program. I agree to keep Dyslexia Tutoring Program informed of my child’s progress when the program contacts me after his/her/their tutoring has ended. I hereby waive and release any and all claims against Dyslexia Tutoring Program, Inc., its board members, employees, independent contractors, affiliates, volunteers and tutors for any injury suffered by my child in connection with his or her participation in the "Tutorial Program" or related events. Please read and check the following:If Accepted into the Dyslexia Tutoring Program: I understand there may be media coverage of my child while in the Tutoring Program, and that photos may be used in brochures, reports, websites, or other similar media. I give DTP permission to release any photos, films, or videos that include my child. Yes No Signature Consent Agreement(Required) By typing my name below, I acknowledge that it serves as my electronic legal signature. Signature of Parent or Guardian(Required) First Last Email(Required) Date(Required) MM slash DD slash YYYY Address of Parent or Guardian(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide at least one phone number below:(Required) Mobile Phone Home Phone Work Phone Mobile Phone(Required)Home Phone(Required)Work Phone(Required)CAPTCHA
