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*Please Note: If you have been or are currently in a Big Thought program, click 'Existing youth'. if you are not currently enrolled in a Big Thought program, click 'New'. 

Consent Packet

Dear Parent or Guardian,


Big Thought is excited to offer a series of Special Projects designed to engage young minds with hands-on, real-world experiences. Our goal is to connect youth with industry-standard skills, preparing them for future opportunities in various fields.

 

No matter the passion, our Special Projects aim to inspire, equip, and empower you for success.

 

Youth will receive:

  • Digital Badge(s)
  • Coaching
  • Mentorship
  • Skill Development

 

Our team will reach out to you within the next 2-3 days to provide additional information.

 

If you have any questions before then, please feel free to reach out to us at specialprojects@bigthought.org.


Thank you for your interest in Big Thought’s Special Projects. We are so excited to have you on board!

 

Denesha Ogunsegha

Senior Manager, Programs Projects 

In this packet you will find a Registration form to review and update as well as the Consent and Photo Release forms. You must complete all pages and e-sign this document for the consent to be considered complete and your child to be allowed to attend and participate in Big Thought Special Projects. 


To help ensure the success and safety of all participants, Big Thought Special Projects complies with Dallas ISD policies and procedures. Please visit the district’s website at www.dallasisd.org/domain/11 to review the Student Handbook and Student Code of Conduct.

 

We are excited to work with your student this year. 



Please complete all pages.  When you have finished you will submit your e-signature and then receive an email asking you to verify your email address.  Please click the link in the email to confirm it and then you have completed the application process.
Youth Information





(MM/DD/YYYY)












School Information




Attendance Commitment Pledge 
Attendance in the program is incredibly important. For your student to fully benefit from the exciting programming being offered, it is important for them to attend consistently.
Please list two contacts for your child.
CUSTODIAL PARENT OR GUARDIAN (Required)










SECOND PARENT OR GUARDIAN










AUTHORIZED ADULTS, Continued
Please list up to three (3) additional contacts who may pick up your student (at least one (1) is required).  Older siblings may pick up provided they are listed below. 

If there are no additional contacts to list for this student, please skip to Page 5.
Contact 1 (Required)




Contact 2




Contact 3




Emergency Information
The following information is required in case of emergency. The Health and Medical form will be transported with your student to the nearest clinic/hospital to assist the paramedics and hospital staff. This form is also required to be with students during all field trips, if scheduled as part of this Program.

If none of the emergency information is different for this student (e.g., primary care doctor or date of last physical exam), please skip to Emergency Contacts.








In case of a medical emergency, whom may we contact?

If there are no additional emergency contacts to list for this student, please skip to Health Information.















Health Information
* All medical documentation and information noted on and/or connected to this questionnaire will be handled and maintained as confidential. This information could be shared on an as needed basis.  Again, confidentiality will be maintained. 

(If Yes, details will be provided on Page 6.)


Student's Present / Past Medical History




I, the undersigned, hereby authorize Big Thought staff to contact the person(s) and healthcare provider(s) named on this form and to authorize the named physicians, clinics, hospitals, and others to provide emergency transport and healthcare to said student. In the event that the physicians, parents/guardians, or any persons named on this form cannot be contacted, Big Thought staff and school personnel are hereby authorized to take whatever action is deemed necessary to provide emergency care to said student. (paraphrase of Section 35.01, Texas Family Code). I HEREBY AGREE TO WAIVE, RELEASE, INDEMNIFY, AND HOLD HARMLESS BIG THOUGHT, its respective officers, affiliates, owners, directors, contractors, agents, and employees from any claims, liabilities, and causes of action asserted against BIG THOUGHT by reason of the acts, omissions, or neglect of BIG THOUGHT, its employees, or agents. I certify I am a parent with the legal control of the student, the student’s legal guardian, or have other court ordered control of the student. I understand that I must notify the Program in writing to change any information on this form or to revoke any consent given herein. I understand it is a penal code offense to falsify information for enrollment. I testify all information on this document to be true and correct.
Food Allergies
Please indicate the foods that cause an allergic reaction in your child. 
Mild = reaction is barely noticeable or causes minor irritation;
Moderate = reaction may require medication or other non-emergency intervention;
Severe = reaction is potentially life threatening if not treated immediately (e.g., ambulance or immediate ER visit) 
Mild Moderate Severe




(Please describe)

(Please describe)

Media Consent and Publicity Release
Right to Use.  I, the undersigned, give to Big Thought, its agents, employees and partners, including iThrive Games, (“Big Thought”) my full permission and irrevocable right to use my child’s photograph, video image, likeness, voice recording, art work, story, or performance, in any form of media now known or later developed (including print, digital, electronic, visual, broadcast, Internet, social media, or otherwise) (“Content”).  This permission applies to all purposes for which the Content can be used in connection with programing presented or managed by Big Thought in which my child is participating, has participated or will participate (“Programs”).

Ownership.  Big Thought will own all of the Content, and any physical material in which the Content is contained, and may use, publish, reproduce, edit, adapt, modify, distribute and display the Content.  On behalf of myself and my child, I irrevocably transfer and assign all rights to the Content, and waive any right to compensation.

Waiver and Release.  I hereby release Big Thought and its legal representatives from all claims and liability relating to the Content and the ownership and use of the Content. I agree that no claim of any kind will be made by me for myself or on behalf of my child regarding the Content, its ownership or use.  

[Use of Name.  I understand that Big Thought will not use my child’s name in connection with the Content.] 

FOR MINOR CHILD OR WARD: I am the parent or legal guardian of the child, and have read and understand this Media Consent and Publicity Release, and give my consent and permission as set forth above.
permission for Big Thought to use my student's photo, likeness, and other materials as described above.
Program Assessment & Dallas City of Learning Consent 
I understand that Big Thought conducts an annual evaluation of the Program, and, as part of that evaluation, Big Thought may administer surveys to my student, administer academic and/or social and emotional learning assessments to my student, and may access student records in compliance with FERPA regulations. I understand that Big Thought will:

  • Keep all individual information confidential to the extent allowed by law.
  • Never report information on a student by name or identifying information and will only share information in the aggregate (meaning overall results), to ensure that no personally identifying information is released about a student in the Program.
  • I also understand that my consent is voluntary. My decision whether or not to allow my student to participate in the Program assessment will not prejudice my present or future relations with Big Thought or my student's School teacher or other School official(s). If I permit my student to participate in the Program assessment, I am free to discontinue participation at any time without prejudice. I understand that if I withdraw my student from the Program, my student’s information will be removed from the project results.  I understand that I can request copies of the evaluation tools by contacting Big Thought at Tyra.cole@bigthought.org
As part my student's experience in the Program, my student may have the opportunity to participate in Dallas City of Learning (DCoL), an education initiative and online platform designed to help students discover new interests, develop skills and earn recognition for their learning achievements. DCoL is a partnership with the Dallas Mayor’s Office and Dallas ISD, and is managed by Big Thought. For more information, please visit dallascityoflearning.org. A portion of data that have been provided above, including the student's name, birth date, and Parent/Guardian email or phone, will be shared with DCoL to enable the student's participation.

permission for my student to participate in Program Assessment.

Page 9

Final Acknowledgement
This program is not licensed by the State of Texas.

Big Thought operates in accordance with the US Department of Agriculture and Texas Health and Human Services Commission policy, which prohibits discrimination on the basis of race, color, national origin, sex, sexual orientation, age or disability.

I, the undersigned, do hereby authorize Big Thought permission, for the purpose of program evaluation, to administer surveys to my child, administer academic and/or social and emotional learning assessments to my child and access student records in compliance with FERPA regulations.

I agree to waive, release, discharge, and hold harmless Big Thought and its directors, officers, Trustees, employees, agents, and assigns, from any and all liability, claims, demands, suits, judgments, losses, or expenses which might arise from or out of, or relate directly or indirectly to, my child's participation in the Generation Liberation program. This includes, but is not limited to, any medical care, whether emergency or otherwise, required which arises out of an accident or injury incurred by my child or contraction of COVID-19 while participating in the Program.
E-Signature
This form uses e-Signature to accept your approval of, and agreement to, the forms described above and in detail on the preceding pages, in relation to the student named below. 

Please click "e-Signature" to go to the final page and sign the document.

PLEASE NOTE: After you sign the document, you will be sent a VERIFICATION email.  You MUST click the link in that email to complete the e-Signature process!
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