I Support Community’sInside Out Club at your School
Developing kids with character, inside and out
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WHAT:K - 2ndgraders will learn empathy, collaboration and other character-building skills through a fun mix of learning activities and mini volunteer service projects that benefit local nonprofits. This spring’s projects will support Special Olympics, Trees That Feed, Meals on Wheels and more! Lessons and activities are different than those in the fall.
Please note if your son or daughter is in the YMCA Safe N Sound program, they will have Inside Out Club through that program. Please do not sign them upvia this form.
WHEN/WHERE: From 2:30 to 3:30in the MPRon the following Wednesdays: February 1st, March 1st, April 5th, and May 3rd.
HOW:Return this permission slip/signed waiver (on the back) to your teacher by Monday, August .. There are 25 spots for this session. You will be notified by email if your child makes it in on Thursday, September .
My son/daughter has permission to participate in the Inside Out Clubon the dates and time specified above.
Student’s name:______Grade:____ Teacher:______Gender: __
Siblings:If you are signing up siblings, please include all siblings on one permission slip.
My son/daughter will ______(Fill in how going home)
Parent(s) Information:Name(s):______
Address: ______
Email(s):______Cell Phone (s): ______
Volunteer:This club is not possible without parent volunteers. Please mark below if you’re available to help:(Circle all you can help at)
January 30 February 27 March 14April 18
READ & SIGN THE BACK. PLEASE RETURN ENTIRE FORM.
Photographic & Video Release:
I hereby expressly grant to I Support Community (“ISC”) and its employees, agents and assigns, the right to photograph my child(ren) and use those picture(s)/videography in connection with the promotion of I Support Community, ISC’s programs, and the Inside Out Club. Means of promotion may include, but not limited to, the ISC website, ISC flyers or brochures, Facebook, Twitter, ISC Blog, Linked-In and any other social media deemed necessary by ISC.
______YES, I give permission______NO, I do not give permission
Release from Liability:
I do hereby release and forever discharge I Support Community, their agents (including volunteers), employees, and assigns, and their respective personal representatives, affiliates, and assigns, and any and all persons who might be claimed to be liable, whether or not herein named, none of whom admit any liability to the participant, but all expressly denying liability, from any and all claims, demands, damages, actions, causes of action or suits of any kind or nature whatsoever, which I now have or may hereafter have, arising out of or in any way relating to any and all injuries and damages of any and every kind, to both person and property, and also any and all injuries and damages that may develop in the future, as a result of or in any way relating to participating in the Inside Out Club.
Furthermore, this Release shall be binding upon the participant, and his respective administrators, personal representatives, and assigns. This Release shall be subject to and governed by the laws of the State of Illinois.
I hereby certify and represent that I have read the foregoing and fully understand the meaning and effect thereof and, intending to be legally bound, I have hereunto set my hand this ______day of ______, 20_____.
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Student(s) Name(s)Parent/Guardian SignatureDate:
Evaluation Release:I Support Community is continually working to improve the Inside Out Club.To do this they collect general, nondescript information of the child(ren)’s experience. No children will be identified by name.
During the fourth lesson your son/daughter will be asked to complete a brief activity, which will ask them to share something from their experience, identify items they learned and/or draw a picture. This activity is short and will not include your child’s name or identifying information. Your student will be asked for his/her agreement to send the activity document back to I Support Community.
Your signature below indicates your consent for your child to be included in the evaluation.
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Student(s) Name(s)Parent/Guardian SignatureDate:
TEAR OFF REMINDER: Inside Out Club at Mill Street School, Wednesdays from 2:30pm to 3:30pm / Pick up by Door #5 (near flag pole) / February 1st, March 1st, April 5th, and May 3rd