Turning Point Seattle Tutoring 2020-2021
2nd - 5th grade students, September 20th - May 26th

MONDAYS, TUESDAYS, and THURSDAYS, after school - 5:00pm

$25 to register
Child's first and last name: *
Boy or Girl *
School name and teacher's name: *
Grade for the 2021-2022 school year: *
Mailing address (please include apartment number, city and zip code): *
Parent's names / or caregiver's names: *
Cell phone number: *
Email: *
Free and Reduced Lunch *
Required
Ethnicity: *
Languages in addition to English that are spoken at home: *
Please list any food restrictions:
Does child have a special need/disability/medical condition? *
If yes, please describe:
Emergency contact, in case we can't reach you. Please give name and cell phone: *
Health Insurance Company and Policy #: *
Emergency Treatment Release
In the event that I cannot be contacted, I give my consent for Turning Point Seattle staff to administer first aid and call for emergency medical help. I consent for medical procedures to be performed for my child by a licensed physician or hospital if deemed necessary to protect my child’s health. Any expenses will be accepted by me.
Liability
I hereby hold Turning Point Seattle, its agents, officers and employees harmless from, and waive, release and discharge any claim or cause of action I have, or in the future may have, for injury, accident, illness, or death occurring during or by reason of this program, including being not limited to the administration of or the non-administration of said medical treatment, first and/or medication in accordance with the consent and/or information provided above. This release is limited to discharge in advance Turning Point Seattle, its agents, officers and employees from any and all liability even though that liability may arise out of negligence or carelessness on the part of the persons Turning Point mentions above.
I have carefully read this authorization/release and fully understand its contents and voluntarily consent to its terms and conditions.
Signature: *
My child needs shuttle transportation from Parkwood or Meridian Park:
Clear selection
Transportation Permission and Release of liability, waiver to claims, assumption of risks and indemnity agreement. By signing this legal document, you will waive certain legal rights, including the right to sue.
Liability: I hereby release and forever hold harmless Turning Point Seattle, their directors, officers, employees, representatives, and drivers from responsibility for the lost or stolen property or bodily injury resulting from or attributed to the bus transportation.
I have carefully read this authorization/release and fully understand its contents and voluntarily consent to its terms and conditions.
Signature: *
Do we have permission to photograph or videotape your child:
For use in art projects or bulletin boards? *
For use in Turning Point Seattle brochures, on website or in newsletters? *
I prefer that: *
Required
Please submit this form, then bring or mail the $25 registration fee to our office: Turning Point Seattle, 1315 North 160th Street, Shoreline, WA 98133.
Please email or call with any questions: lynn@turningpointseattle.org, (206)819-3407
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