Parent/Guardian Permission Form for BLP Tutoring Program
Explanation of Program Requirements
Your child is applying to serve as a tutor for the Brookline Literacy Partnership (BLP) Tutoring Program. A complete application includes parent/guardian permission. We expect that parents/guardians who sign this form have spoken with their child and reviewed the dates for tutoring (see below). We expect that your child has also explained that tutors will travel by chartered bus every Monday from Brookline High School, departing at approximately 3:15, to the Mather Elementary School, and will return to BHS by 6 pm. Tutors may not miss tutoring more than once and are subject to dismissal if they do. Please click here to learn more about the BLP: http://www.brooklineliteracypartnership.org/
Student's first name *
Please be sure that your child has used the same name in their application.
Student's last name *
Please be sure that your child has used the same name in their application.
Parent/Guardian's name *
Parent/Guardian's Email *
Parent/Guardian's phone number *
Do you give permission for your child to participate in the Tutoring Program during the season she/he/they have applied for? *
Please be sure you have reviewed the dates for the sessions (above). I do hereby forever release, acquit, discharge and covenant to hold harmless the Town of Brookline, its School Committee and School Department, their employees, as well as any chaperones who will accompany the students on this trip, from any and all actions, causes of action, claims, demands, damages expenses and compensation on account of, or in any way growing out of any and all personal injuries and property damage which may result at any time from his/her participation in the above described trip, as well as all claims or rights of action for damages which he/she may hereafter have either before or after he/she has reached his/her majority.
My child has a medical issue that the staff person in charge should be aware of. I will contact Bridget Knightly to inform her if my child has been accepted to the Tutoring Program
Thank you!
Bridget Knightly (bridget_knightly@psbma.org), BHS Librarian and Primary Advisor for the BLP
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