I give my permission to enroll in the Urban Enrichment Institute, hereafter referred to as UEI. The services, activities, and programs of UEI are available to my child free of charge.

1. I understand that he will participate in UEI for the summer program, receiving counseling, supervised recreational activities, and enrichment experiences. I understand he is free to join or leave the program at will and I will not hold UEI responsible for his attendance.

2. I understand that the information I provide will be confidential and will not be released to any other agency without my written consent.

3. Recognizing that parental involvement is important in child activities. I agree to participate in the Family Support Group.

4. I authorize the Houston Independent School District (HISD) and the school’s psychological counselor to release confidential information such as financial, medical, H-status reports, test scores, grades, interviews, and other such material to UEI as necessary to improve my child’s school work and/ or behavior.

5. I authorize UEI to provide my child with professional counseling services and/or therapy.

6. I authorize UEI to transport my child on field trips, supervised recreational activities, appointments, meetings, and other schedules for UEI activities.

7. I authorize UEI to obtain licensed medical, dental, and/or surgical treatment for my child if I am unable to be reached in the event of an illness, accident or emergency.

8. I further state that I will NOT hold UEI, HISD, or any other authorized work site organization, or agency liable for such medical, dental, and/or surgical treatment in such cases of illness, accident, or any other emergency situation. I recognize that UEI is not regulated by Child Care Licensing and the Department of Family and Protective Services.

9. I grant permission for my child to be photographed, interviewed, and filmed as a participant in UEI activities. I understand that this will be used for public viewing and I release photographs/interviewers/film crews from any claims and liabilities.

10. I recognize that UEI is not a day care facility and is not structured to provide after-school child day care.

Letter of Agreement