Enroll for Springboard:

Yes, I want to enroll. Si, quiero inscribirseYes, I want to enroll. 是的，我想報名。

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Deactivated enrollment form?

YesNoClosed

Available Grades

Instruction Type

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Enrollment is currently closed for your school.

La inscripción está cerrada para su escuela.

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Parent / Guardian Information

First Name:

Last Name:

Phone:

Email:

Additional Guardian's Phone:

Street Address:

City:

State:

Zip Code:

At home, our family mostly speaks:

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Agreement to have Springboard Use Your Child's Image, Audio and First Name

I give permission for any photograph, image, voice, video or other recording, in all forms, and the first name of my child to be published and distributed in any media for promotional or informational purposes in connection with Springboard Collaborative and I understand that no royalty, fee, or other compensation shall become payable to me by reason of such use

YesNoSometimes we request photos of teachers and students in action to show our program at work! In a virtual world, photos might include a screenshot of a zoom class or of a celebration at the end of the program. In person photos might include students reading independently, with their parents or with their teachers. These photos are usually used for data reporting, future funders and/or for promotional materials about Springboard. The only identifying information would be the child's first name but nothing else (i.e. not their last name, address, etc.).

Agreement for Springboard to Text You

I agree to receive text messages from Springboard Collaborative, including workshop reminders, reading reminders and tips from Springboard Connect, and surveys. I can stop receiving these messages anytime by texting STOP. I accept the Connect Terms and Conditions and Privacy Policy

YesNo

Agreement for Data Use

I give Springboard permission to use the information from this form and from my family's participation in this program to (1) ensure that I can engage in the program (i.e. collect my family's attendance and student's assessment data) and (2) report on the results of this program. I understand that Springboard will remove all information that identifies my family when doing that reporting, such as our names or contact information.

Similar to the media release, school partners and funders typically ask for reports from previous partnerships to see how it went. The data we share is never identifying individual students; rather it includes demographic information about them, such as grade, ethnicity, gender and assessment data/reading level if available. This information would never identify a child like "John Brown at School ABC has an IEP and is reading on a level G." Rather, it could sound like "John, a 3rd grade boy, grew from a Level G to a Level P in F&P after completing Springboard this spring." It could be even more broad like "x% of Hispanic students attended Springboard programming at School ABC."

Parent Agreement

I understand the nature of Springboard Collaborative program and participation is voluntary. I understand that Springboard Collaborative is not responsible for loss, damage, illness, or injury to person or property as a result of participation in the program. I hereby release and discharge Springboard Collaborative and its officers, employees, agents, and volunteers from any and all claims for injury, illness, death, loss, or damage as a result of program activities.

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Información de padre/tutor

Nombre:

Apellido:

Correo Electrónico :

Celular:

Otro Número de Teléfono:

Domicilio

Ciudad

Estado

Código postal:

En casa, mi familia y yo principalmente hablamos:

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Lanzamiento de prensa

Concedo el permiso para que cualquier fotografía, imagen, voz, video, o alguna otra grabación, en toda forma, y también que el primer nombre de mi hijo/a sea publicado o distribuido en cualquier medio con fines promocionales o informativos en conexión con Springboard Collaborative.

SíNo

Comunicación de Springboard

Acepto recibir mensajes de texto de Springboard Collaborative, incluyendo recordatorios de talleres, recordatorios de lectura y consejos de Springboard Connect, y encuestas. Puedo dejar de recibir estos mensajes en cualquier momento enviando mensajes de texto STOP. Acepto Connect Terms and Conditions and Privacy Policy.

SíNo

Lanzamiento de datos

Autorizo a Springboard a utilizar la información de este formulario y de la participación de mi familia en este programa para (1) garantizar que pueda participar en el programa (es decir, recopilar la asistencia de mi familia y los datos de evaluación del alumno) y (2) informar sobre los resultados de este programa. Entiendo que Springboard eliminará toda la información que identifique a mi familia al hacer ese informe, como nuestros nombres o información de contacto.

Permiso del padre

Entiendo la naturaleza del Programa de Springboard Collaborative y también entiendo que la participación en el programa es voluntaria. Entiendo que Springboard Collaborative no es responsable por la pérdida, daño, enfermedad o lesiones a personas o propiedades como consecuencia de la participación en el programa. Yo libero y descargo Springboard Collaborative y sus funcionarios, empleados, agentes y voluntarios de cualquier y todas las reclamaciones por lesión, enfermedad, muerte, pérdida o daño como resultado de las actividades del programa.

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Parent / Guardian Information 家長/監護人信息

First Name 名:

Last Name 姓:

Phone 電話:

Email 電子郵件:

Additional Guardian's Phone 附加監護人電話:

Street Address 街道地址:

City 城市:

State 州:

Zip Code 郵政編碼:

At home, our family mostly speaks 在家裡，我們家大多會說的語言:

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Agreement to have Springboard Use Your Child's Image, Audio and First Name 同意讓 Springboard 使用您孩子的圖像、音頻和名字

I give permission for any photograph, image, voice, video or other recording, in all forms, and the first name of my child to be published and distributed in any media for promotional or informational purposes in connection with Springboard Collaborative and I understand that no royalty, fee, or other compensation shall become payable to me by reason of such use 我允許任何形式的照片、圖像、語音、視頻或其他錄音以及我孩子的名字在任何媒體上公開和發布，用於與 Springboard Collaborative 相關的宣傳或信息目的；並且我知曉不會因此類使用而支付給我任何的版費、使用費或其他補償

Yes 同意No 不同意Sometimes we request photos of teachers and students in action to show our program at work! In a virtual world, photos might include a screenshot of a zoom class or of a celebration at the end of the program. In person photos might include students reading independently, with their parents or with their teachers. These photos are usually used for data reporting, future funders and/or for promotional materials about Springboard. The only identifying information would be the child's first name but nothing else (i.e. not their last name, address, etc.).

Agreement for Springboard to Text You 向您發送短信的協議

I agree to receive text messages from Springboard Collaborative, including workshop reminders, reading reminders and tips from Springboard Connect, and surveys. I can stop receiving these messages anytime by texting STOP. I accept the Connect Terms and Conditions and Privacy Policy 我同意接收來自 Springboard Collaborative 的短信，包括來自 Springboard Connect 的研討會提醒、閱讀提醒和技巧以及調查。我可以隨時通過發短信 STOP 來停止接收這些消息。我接受 Connect 條款和條件以及隱私政策

Yes 同意No 不同意

Agreement for Data Use 數據使用協議

I give Springboard permission to use the information from this form and from my family's participation in this program to (1) ensure that I can engage in the program (i.e. collect my family's attendance and student's assessment data) and (2) report on the results of this program. I understand that Springboard will remove all information that identifies my family when doing that reporting, such as our names or contact information.

本人允许Springboard使用本表格中的信息以及我家人参与本项目的信息，以（1）确保我能够参与本项目（即收集我家人的参与率和学生的评估数据）及（2）报告本项目的结果。本人理解，在进行报告时，Springboard将删除所有识别我家人的信息，例如我们的姓名或联系方式。

Similar to the media release, school partners and funders typically ask for reports from previous partnerships to see how it went. The data we share is never identifying individual students; rather it includes demographic information about them, such as grade, ethnicity, gender and assessment data/reading level if available. This information would never identify a child like "John Brown at School ABC has an IEP and is reading on a level G." Rather, it could sound like "John, a 3rd grade boy, grew from a Level G to a Level P in F&P after completing Springboard this spring." It could be even more broad like "x% of Hispanic students attended Springboard programming at School ABC."

Parent Agreement 家長協議

I understand the nature of Springboard Collaborative program and participation is voluntary. I understand that Springboard Collaborative is not responsible for loss, damage, illness, or injury to person or property as a result of participation in the program. I hereby release and discharge Springboard Collaborative and its officers, employees, agents, and volunteers from any and all claims for injury, illness, death, loss, or damage as a result of program activities. 我了解 Springboard 協作計劃的性質，並且知道參與是自願的。我了解 Springboard Collaborative 不對因參與該計劃而造成的人員或財產損失、損壞、疾病或傷害負責。我特此免除 Springboard Collaborative 及其管理人員、員工、代理人和志願者因該計劃活動而導致的任何和所有傷害、疾病、死亡、損失或損害的索賠。

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Please Review & Sign Below

I have a device with internet that my child can use during programming , or my school will provide the necessary technology to participate
I understand my child will participate in an online reading program
I understand that my child and sometimes myself will participate in online learning activities that include video meetings with teachers and other families and students
I understand that I may meet with the teacher over the phone or online video to discuss the program and my child’s progress

Type your First, Last Name, and Relationship to scholar(s) to sign electronically

Your Full Name:

Relationship to scholar(s):

Por favor revise y firme a continuación

Tengo un dispositivo con Internet que mi hijo puede usar durante la programación, o mi escuela me ha proporcionado la tecnología necesaria para participar.
Entiendo que mi hijo participará en un programa de lectura en línea
Entiendo que mi hijo y, a veces, yo mismo participaremos en actividades de aprendizaje en línea que incluyen reuniones de video con maestros y otras familias y estudiantes.
Entiendo que puedo reunirme con el maestro por teléfono o por vídeo en una plataforma digital para discutir el programa y el progreso de mi hijo.

Escriba su nombre y apellido para firmar electrónicamente

Nombre:

Relación con el estudiante:

Please Review & Sign Below

I have a device with internet that my child can use during programming , or my school will provide the necessary technology to participate
I understand my child will participate in an online reading program
I understand that my child and sometimes myself will participate in online learning activities that include video meetings with teachers and other families and students
I understand that I may meet with the teacher over the phone or online video to discuss the program and my child’s progress

Type your First, Last Name, and Relationship to scholar(s) to sign electronically 輸入您的名字、姓氏及與學者的關係以進行電子簽名

Your Full Name 你的全名:

Relationship to scholar(s) 與學者的關係:

Asian	Black
Hispanic	Native American
White	Other
Prefer not to say

PreK/TK	Kindergarten
1st	2nd
3rd	4th
5th	6th
7th

Afroamericano	Caucásico
Hispano	Asiático
Nativo americano	Otro
Prefiero no hacerlo

PreK/TK	Kindergarten
1o	2do
3ro	4to
5to	6to
7to

Asian 亞裔	Black 非裔
Hispanic 西班牙裔	Native American 美洲原住民
White 白人	Other 其他
Prefer not to say 不想說

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