Turning Point 2020-2021 Tutoring Registration
2nd - 6th Grade
September 28th - May 27th
MONDAYS, TUESDAYS, and THURSDAYS, after school - 5:00pm
$25 to Register
CHILD'S First and Last Name: *
Boy or Girl *
School and teacher's name: *
Grade for the 2020-2021 school year: *
Address, Apartment #, City and Zip code: *
Parent/Caregiver name(s): *
Cell Phone #: *
Email: *
*
Required
Ethnicity: *
Language(s) spoken at home: *
Medical and Emergency
Food Restrictions:
Does child have a special need/disability/medical condition? *
If yes, please describe:
Emergency contact, in case we can't reach you. 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 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, 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, 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 *
Bus Transportation Permission and Waiver Release
My child needs shuttle transportation from Parkwood or Meridian Park:
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, 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 *
Photo Permission
Do we have permission to photograph or videotape your child:
• For use in art projects or bulletin boards? *
• For use in Turning Point brochures, on website or in newsletters? *
• I prefer that: *
Please return this form along with your $25 Registration Fee to Turning Point:
1315 N 160th Street, Shoreline, WA 98133 | lynn@turningpointseattle.org | 206.402.6960
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