826DC Student Application

STUDENT



















PRIMARY PARENT OR GUARDIAN #1

Note: Please advise us of any changes regarding custody of the student.














PRIMARY PARENT OR GUARDIAN #2

Note: Please advise us of any changes regarding custody of the student.
















EMERGENCY CONTACT #1













EMERGENCY CONTACT #2













LANGUAGE(S)






RACE/ETHNICITY


GENDER PRONOUNS


MEDICAL INFORMATION








If you answered yes to any of the above, please fill out the Food Allergy and Anaphylaxis form and return to 826DC. 








Should your student change medications and/or doses, please notify us so we can make the appropriate changes to this information.
RELEASE, INFORMED CONSENT AND LICENSE AGREEMENT, AND PHOTO, VIDEO & RADIO FOOTAGE PERMISSION

PLEASE NOTE:
826DC is a nonprofit organization and a chapter of the 826 National network, both of which are dedicated to supporting under-resourced students ages 6 to 18 with their creative and expository writing skills and to helping teachers inspire their students to write. For all permission and release information below, “
826DC,” “we” and “us” collectively refers to 826DC and/or 826 National. The "Author" refers to the student participating in 826DC's program. This form is an agreement between the participating student if over 18 or the parent(s)/guardian(s) of the participating student if under 18 and 826DC.


A NOTE ON IN-CENTER PROGRAMS: 

826DC is a writing center, where students are invited to come work on and receive assistance with homework, individual work, and writing projects when the center is open to students. Although students are encouraged to feel at home while in the center, they are also expected to have homework or writing work to do. In the center, we are collectively respectful of each other and our surroundings. 826DC staff reserve the right to ask students to leave if we feel they are being too disruptive. 826DC should not be considered an alternative to daycare services. All students must sign up for in-center programs in advance, unless the program is specifically labeled as “drop-in.” Families are responsible for making any necessary arrangements to get their student home. 






CONSENT TO EMERGENCY MEDICAL OR DENTAL TREATMENT

IN-PERSON PROGRAMMING LIABILITY RELEASE FOR ACCIDENTAL INJURY OR EXPOSURE

PUBLISHING PERMISSION

This form grants 826DC the right (but not the obligation) to edit and publish the Author’s Work (“Work” includes the student’s own writings, audio and visual) in any manner in any type of publication, media or materials affiliated with 826DC, now existing or which may be created in the future. Each student whose work is published will receive a free copy of the book in which their work is included.

The Author understands and agrees that 826DC has the right, but not the obligation, to consent to the publishing of excerpts of the Author’s work in newspapers, magazines, online media, or other publications in order to promote not only your student’s work but also to support or publicize the nonprofit work of 826DC and its partners and promotions.   

This is a non-exclusive agreement. The author retains rights to their work, and they can also publish all work outside of projects with 826DC. Publication elsewhere has no effect on 826DC’s rights under this agreement. The Author promises that the work she or he submits is “original,” which means that she or he created the work and wrote the story and did not copy someone else’s story or writing. The Author also promises us that if the story is based on real people and actual events, that the description of such people and events is true and does not disclose private or personal facts about anyone else without first obtaining that person’s permission in writing. We also ask students not to use any inappropriate language in their stories or other writing and not to write about incidents that may hurt, degrade, or endanger others.


FILM, PHOTOGRAPHY, AUDIO, AND MEDIA PERMISSION
During 826DC programming, 826DC may document the work of the student authors through photography, film, video, audio, or other recording techniques. Students agree that these images and recordings may thereafter appear in 826DC publications, reports, film productions, websites, or social or online media platforms. This documentation shares the hard work of the students and more information about 826DC’s programs and impact. No material will be used for commercial purposes. 826DC may also wish to use this material in promotional materials (which may include 826DC fact books, websites, or social or online media platforms) on the radio, television, in press articles, or other media about 826DC, including partnerships and promotions benefiting 826DC. These materials provide the public with helpful information about programs at 826DC and amplify students’ work to a broader audience. 

SCHOOL CONTACT PERMISSION

PERMISSION FOR FEEDBACK

PERMISSION FOR EMAIL AND MOBILE PHONE NUMBER COLLECTION AND COMMUNICATION
For purposes of communicating with students about current and upcoming program opportunities and events, 826DC and 826 National may collect email addresses and email students ages 13 and above. This information will be used solely for program, event, and alumni engagement purposes by 826 and will not be used for any commercial purpose or given to any third party. Students may opt out of these communications at any time.