New York City Urban Debate League Middle and Elementary School Pre-Season Registration Form

This permission form covers your child’s participation in all 2016-2017 NYCUDL programming including but not limiting to all Tournaments, Workshops, Travel Team, Summer Debate Institutes. To participate please fill out and submit our student application form below. If you have any questions regarding this application, please contact Program Director Aubrey Semple at aubrey@debate.nyc. Thank you and we welcome you to the new debate season!

Registration forms gather information about debaters essential to the operation of of the New York City Urban Debate League (NYCUDL). NYCUDL may share information with the National Association for Urban Debate Leagues (NAUDL). NYCUDL and NAUDL use information to improve and grow urban debate programs. NYCUDL and NAUDL may use data to measure your academic progress. NYCUDL and NAUDL do not share, sell, rent or trade personally identifiable information with third parties for their promotional purposes. If you have additional questions please consult our posted privacy policy.

Did you mean to fill out the high school form? Find it here .

Student Code of Conduct

Debater Information

First Name

Middle Name

Last Name

School or Debate Organization

Date of Birth (mm/dd/yyyy)

Student Email Address

Expected High School Graduation Year

Current Grade (2016-17 season)

K12345678

Gender

MaleFemaleOther

Ethnicity (select all that apply)

American Indian/Native AlaskanAsianBlackHispanic/LatinoNative Hawaiian/Pacific IslanderWhite Two or more racesOtherTwo select more than one choice press and hold Ctrl

Home Zip Code

All school and District policies are in effect during NYCUDL debate season. Students must:

(1) Show courtesy and respect toward others and property at all times.

(2) Dress appropriately at all times.

(3) Use appropriate language.

Statement of Disciplinary Action

The following are examples of disciplinary action which may be taken in the event that the Code of Conduct, school policies, or district policies are not followed:

(1) Sent home immediately at his/her own expense.

(2) Referred to school administration.

Student Signature: Please type your signature below indicating you have read and understood the code of conduct.

Parent/Guardian Information

First Name

Last Name

Parent/Guardian Email

Home Address

Street Address

City

State

Zip Code

Neighborhood/Borough

HarlemBronxBrooklynManhattanQueensStaten IslandOther

Parent/Guardian Phone Number

Company/Employer

Parent/Guardian Consent

Permission to participate in the NYCUDL. I do hereby consent that my child may participate in the stated activity, and in consideration for the New York City Urban Debate League (NYCUDL) giving its time and supervision of such activity, do hereby personally on behalf of my child, absolve and release the NYCUDL, its agents and volunteers from any claim of personal injuries which might be sustained by my child while participating in such activities, or while returning to his/her home.

Student Code of Conduct. I understand that my child will be expected to sign and follow a code of conduct to participate in the stated activity, and that, in the event of inappropriate behavior by my child, I may be contacted and asked to pick up him/her.

Media Consent. I give permission for the NYCUDL, its licensees, and/or its affiliates to use photographs, portraits, films, videos, quotations and media of my child in legitimate accounts and promotion of the NYCUDL.

Yes,I consent to media.No, I do not consent to media.

Survey Opt In

In order to assure that The NYC Urban Debate League is of high quality and has a positive impact on your child(ren), the NYCUDL engages in ongoing evaluation and quality improvement efforts. Therefore, your child will be asked to fill out surveys at the beginning and end of each program cycle.

All data obtained from your child will be kept confidential and will be used by staff to increase the quality of the program. Data are gathered and analyzed through a web-based software – Algorhythm’s Youth Development Impact Learning System (YD iLearning System). Your child will be assigned a unique numeric identifier and his/ her name will not be associated with data. Data within this system are kept confidential in a secure database. Algorhythm’s YD iLearning System will never use your child’s name for any reason and all data analyzed through this system will highlight combined or group results. Staff within the NYCUDL will have access to the data so that they can continue to improve the program and support your child’s individual needs.

Participation is completely voluntary. You have the right to terminate your child’s participation at anytime or refuse to participate entirely without jeopardy to your status in the program.

I consent for my child(ren) to participate in NYCUDL surveys.

YesNo

Identifiable Student Information

Your child is participating in The NYC Urban Debate League – a West Harlem Development Corporation funded program. As part of the evaluation process, West Harlem Development Corporation is requesting your consent to access identifiable student level data from the New York City Department of Education. This data may include one or the more of the following: Demographic, Course Grades, Graduation (NYC); Graduation (NYS); NYSESLAT; NYS Science; NYS Social Studies; Regents; Advance Placement; PSAT; SAT; ELA & Math for the 2016/2017 school year(s).

Consent is completely voluntary. If you do not provide consent for your student to participate, there will be no effect on your student’s grades or eligibility to participate in the program.

I consent to sharing identifiable student data with NYCUDL and the West Harlem Development Corporation.

YesNo

Parent/Guardian Signature Please type your signature below indicating that you have read and understood the permission to participate, media consent and code of conduct.