EMERGENCY MEDICAL AUTHORIZATION: I authorize any representative of A1 Learning Connections/The S.M.A.R.T. Institute staff to seek attention for my child when immediate medical care is warranted by the circumstances and that I cannot be reached, or if under the circumstances there is no time to attempt to reach me because of the nature of the injury or illness. I further authorize the health care professionals selected by the organization to provide the necessary care and treatment for my child.

In the event of an emergency, I hereby give permission to The S.M.A.R.T. Institute/A 1 Learning Connections and anyone associated with its after school programs to secure proper medical treatment for my child.

STUDENT RECORD AUTHORIZATION: I give the authorized staff of A1 Learning Connections/The S.M.A.R.T. Institute permission to access my child’s records. These may include but not limited to achievement scores, progress reports and report cards. I understand that these records are necessary to create individual plans and services for the student.

PHOTOGRAPH/VIDEO AUTHORIZATION: I hereby give A1 Learning Connections/The S.M.A.R.T. Institute or their designated agent, permission to use photographs/videos of my child for publicity or professional services, and to use such photograph/videos at the discretion A 1 Learning Connections/The S.M.A.R.T. Institute.

INTERNET RELEASE: I hereby give my child permission to participate in program related internet activities.

REFERRAL AUTHORIZATION: I hereby give authorized staff of A 1 Learning Connections/The S.M.A.R.T. Institute permission to refer my child to other agencies (e.g. Health, Counseling and Psychological testing). As a parent/guardian, I may request to be fully informed and/or give signed consent for any testing or treatment involving my child.

CLASS/CLUB SELECTION: I herby understand that my student may not be placed in all requested classes/clubs. I herby understand that all consideration will be given toward each request.

LIABILITY: In consideration of my child’s participation in the activities of A 1 Learning Connections/The S.M.A.R.T. Institute, I do hereby agree to hold free from any and all liability A 1 Learning Connections/The S.M.A.R.T. Institute, its contracted persons or organizations, and its respective officers, employees and volunteers and do hereby for myself, my heirs, executors and administrators, waive, release and forever discharge any and all rights and claims for damages which I may have or which hereinafter accrue to me arising out of or connected with my child’s participation in any of the activities of the program.

HANDBOOK: I have received The S.M.A.R.T. Institute/A 1 Learning Connections Handbook.