Applied to Goodnow Summer Program

Yes

Looks like you have applied already!

Our records show that you have already applied for Goodnow Summer Program for this child. If you do not believe this to be true, email goodnow@artsforlearningmd.org

Hidden Fields

Student ID from Input Student ID form

This number can be located on your report card. If you can't locate your student's ID Number, it is highly recommended that you call their home school to request it, and then complete this registration form. Registration/enrollment is on a first come, first served basis and there are a limited number of slots.

Account ID

Contact ID

Student Information

Other need for reasonable accommodations

16. Does this student receive ESOL services as an English Language Learner?

YesNoI don't know

17. Is this student involved in Gifted and/or Advanced programs?

YesNoI don’t know

18. If your student attends a Baltimore City Public School, what school does this student currently attend? If your student does not attend a Baltimore City Public School please click the "I do not see my school listed" option.

This is a list of all Baltimore City Public Schools. Attendance at a school on this list does not guarantee eligibility for the program.

If you do not see this student's school on the list. Please type the school name.

19. Why should this student be accepted to the Goodnow Summer program? How do you hope they will benefit from the program?

20. What would you like us to know about your child both academically and in general? Please share how we can best support them.

Student Transportation Plan

2. My student will ARRIVE to the program each day by (choose one):

3. My student will DEPART from the program each day by (Choose One):

Child's Medical Information

1. Is your child on any medication?

YesNo

If yes, please list the medications and any side effects below:

2. Are any medications to be taken during the program?

YesNo

If yes, please list the medications to be taken during the program as well as the time/s to be taken, the dosage and any other information staff needs to know.

3. Please list below any special limitations or concerns your child may have, such as dietary restrictions, allergies (including the reaction and treatment required should your child become exposed to the allergen), or chronic health conditions.

Parent/Guardian Information

You will have an opportunity to register more than one student in the same family at the end of the application as long as the parent/guardian information on this page applies to all students being registered.

Parent/Guardian #1 Contact Information

Parent/Guardian First Name

Parent/Guardian Last Name

Relationship to Student(s):

Home Phone (If N/A Please Leave Blank):

Cell Phone (Note: this number can be used to notify you of important program information):

Work Phone (If N/A Please Leave Blank):

Email Address:

Address

City/Town

State/Province

ZIP/Postal Code

What is the primary language spoken by this parent/guardian?

EnglishSpanishOther (please specify)

Other Parent Primary Language

Parent/Guardian #2 Contact Information

Parent/Guardian First Name

Parent/Guardian Last Name

Relationship to Student(s):

Home Phone (If N/A Please Leave Blank):

Cell Phone:

Work Phone (If N/A Please Leave Blank):

Email Address (If N/A Please Leave Blank):

Check here if the home address for this parent/guardian is the same as Parent/Guardian #1

Home Address Line 1

City/Town

State/Province

ZIP/Postal Code

Emergency Contact #1

At least one emergency contact is required. This person must be different from the parent/guardian listed on the previous page.

First name

Last Name

Relationship to Student(s):

Home Phone (If N/A Please Leave Blank):

Cell Phone:

Email (If N/A Please Leave Blank):

Emergency Contact #2

First Name

Last Name

Relationship to Student(s):

Home Phone (If N/A Please Leave Blank):

Cell Phone:

Email (If N/A Please Leave Blank):

I am the Parent/Guardian of

a minor child (the “Student”). Arts for Learning Maryland. (“Arts for Learning”) is the operator of Goodnow Summer Program.

Goodnow Summer Program CONSENT, WAIVER AND RELEASE STATEMENT

By checking the CONSENT box below and signing this document, I agree and consent to all of the following terms and conditions:

1. I certify my understanding that I will receive policies and procedures and related information about the Goodnow Summer Program. Upon enrollment of my child in the Goodnow Summer Program, I agree to follow the policies and procedures described.

2. I give Arts for Learning Maryland, Inc. (“Arts for Learning”) permission to access and keep copies of my child's/children's academic record(s), including report cards, IEPs, standardized test scores, and cumulative records. Arts for Learning will keep these data confidential and use them only for analysis and program planning. I understand that Arts for Learning may share data collected during the program, including attendance, demographics, and academic outcomes, with program funders and sponsoring organizations; however, any information shared will not specifically identify program participants.

3. I give Arts for Learning permission to contact me (using telephone, email, mail, SMS text message, or robocall via telephone) using the contact information I provided about the status of enrollment, my child's attendance, upcoming events and programs, schedule changes, and program updates.

4. I certify my understanding that I will be given a Field Trip Permission Form to authorize my child's participation in any field trip or other off-site activity planned by the program and that alternate care will not be provided should I choose not to grant such permission for the Student’s participation. Additionally, I acknowledge that the Student’s participation in Field Trips is at the sole discretion of the Arts for Learning Team.

5. I release Arts for Learning as an organization, as well as its employees, contractors, volunteers, and agents (collectively, the “Arts for Learning Team”) from any liability suit or claim for property damage or loss, or personal injury to the Student, except to the extent such claims arise directly from the gross negligence of Arts for Learning and/or the Arts for Learning Team.

6. Arts for Learning takes great care in capturing thoughtful, high-quality images of students’ incredible artwork, their pride, excitement, determination, friendship, and joy. I understand that the images, video, and materials collected over the course of the Goodnow Summer Program are vital for building awareness of the program in the community and for securing funding so that it can continue to grow and remain available at no cost to students. I give permission for the Student to be included in the documentation/promotion of Arts for Learning and its partners, including photographs, audio/visual/video recordings, interviews, reproductions of academic and artistic work, participation in surveys, and written quotations or descriptions of activities. I also understand that resulting materials may be exhibited before the community, fundraising, or other groups and individuals and/or included in media articles, partner publications, and Goodnow Summer Program funder promotional materials.

7. I certify that the Student will attend every day of the program except in the event of an emergency. I acknowledge that students who miss more than 3 days of the program may be removed so that their spot can be given to another student

8. I certify that the entered information is true and correct to the best of my knowledge.

PLEASE READ THIS ACKNOWLEDGMENT OF RISK, WAIVER, AND GENERAL RELEASE OF CLAIMS (THIS “RELEASE”) CAREFULLY. BY SIGNING THIS RELEASE, YOU WILL GIVE UP CERTAIN LEGAL RIGHTS. IF YOU DO NOT UNDERSTAND ANYTHING IN THIS RELEASE, YOU SHOULD SEEK THE ADVICE OF YOUR LEGAL COUNSEL BEFORE SIGNING BELOW.

In consideration of providing your child/children with transportation, recreational, sports, and physical activities and being permitted to attend Events/Field Trips with Arts For Learning Maryland’s Goodnow Community Center programs, the undersigned (“you”), on behalf of yourself and the other persons described below, hereby agree to the following:

Acknowledgment of Risk. You acknowledge there is an inherent risk in your child/children attending All Events/Field Trips Arts For Learning Maryland’s Goodnow Community Center programs. You further acknowledge that such risk includes, but is not limited to, physical injury, illness, death, or damage to personal property. You acknowledge the risks inherent in the time you are present in the program. You and your child/children assume all risk of any injury, damage, or loss. You acknowledge that Arts for Learning Maryland would not be willing to provide such activities to or permit your child/children to attend unless you enter into this Release and that your consent to provide such activities, including Events/Field Trips, and/or permit your child/children to attend is good, valuable and legally sufficient consideration for this Release.

Waiver and Release Claims. You irrevocably and unconditionally waive, relinquish, discharge, release, and covenant not to sue Arts for Learning Maryland and each of their respective affiliates, owners, directors, managers, members, officers, employees, representatives, board members, agents, assigns and insurers (collectively, the “Waived Parties”), from any and all rights, claims, demands, causes of action, damages, liabilities or losses, whether known or unknown, that your child/children have or incurs, or may have or incur, that arise during, result from or are related to your child/children’s participation in its programs WHETHER CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OR OTHER FAULT OF ANY OF THE WAIVED PARTIES. THIS IS AN ABSOLUTE WAIVER AND RELEASE.

Disclaimer of Liability. In no event shall any Waived Party be liable for any direct, indirect, incidental, special, exemplary, punitive, or consequential damages, however, caused and on any theory of liability, whether in contract, strict liability of tort) arising in any way out of your child/children’s participation in the Arts For Learning Maryland programs, even if such Waived Party has been advised of the possibility of such damage. This disclaimer of liability applies to any damages, injuries, or losses, including, without limitation, personal injury, death, or property damage, under any cause of action.

Additional Representations. You acknowledge you have had an opportunity to object to any or all the terms described herein and, after careful consideration, fully understand the extent of the waiver represented by such terms in their aggregate and waive your and your child/children’s right to bargain for different terms. You understand that if you later learn that any fact you believed to be true at the time you signed this Release is later found to be incorrect, you and your child/children nevertheless are bound by this Release.

YOU HAVE READ THIS RELEASE THOROUGHLY. YOU SIGN THIS RELEASE VOLUNTARILY ON BEHALF OF YOURSELF, YOUR MINOR CHILD/CHILDREN, YOUR AND THEIR HEIRS, NEXT OF KIN, ASSIGNS, PERSONAL REPRESENTATIVES, AND RELATED INDIVIDUALS. NO ONE HAS MADE ANY REPRESENTATIONS, STATEMENTS, OR INDUCEMENTS THAT CHANGE OR MODIFY ANYTHING WRITTEN IN THIS RELEASE

THIS IS A CONSENT, WAIVER, AND RELEASE OF LEGAL RIGHTS. READ IT CAREFULLY AND BE CERTAIN YOU UNDERSTAND IT BEFORE SIGNING. PLEASE CHECK ONE OF THE BOXES BELOW, THEN SIGN YOUR NAME.

CONSENT: I have read this Consent and Release and agree and consent to the terms and conditions set forth in it. I agree that I and the Student, and all of our heirs, legal representatives and assigns, are and shall be legally bound by the terms in this Consent and Release, and understand that Arts for Learning will rely on my consent and agreement. NON-CONSENT: I do not agree or give my/our authorization or consent to the terms in this Consent and Release on behalf of the Student, AND HEREBY WITHDRAW MY APPLICATION IN THE PROGRAM.

By signing below, I represent and certify that I am the parent or guardian of the Student, at least eighteen (18) years of age, and fully competent and authorized to sign this Consent and Release.

Please sign this form digitally by typing your first and last name:

11. Do you have another student in the same family that you would like to register for the Goodnow Summer program? If you chose yes, a new application will open up. If you choose no, you will be done with the registration process.

YesNo