Enroll for Springboard:

Yes, I want to enroll. Si, quiero inscribirse

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Parent / Guardian Information

First Name:

Last Name:

Phone:

Email:

IMPORTANT: Please provide an accurate email address so that you can receive digital programming rewards if your child is eligible

Additional Guardian's Phone:

Additional Guardian's Email:

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. I understand this permission is not a requirement for enrolling in this program and that refusing to grant this permission does not impact my eligibility to enroll in this program.

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 understand this permission is not a requirement for enrolling in this program and that refusing to grant this permission does not impact my eligibility to enroll in this program.

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.

I understand that my student cannot participate in this Springboard program if I do not accept this policy.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."

I accept Springboard's Data Privacy and Security Policy. I understand that my student cannot participate in the Springboard program if I do not accept this policy.

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."

I accept the Springboard Connect Terms and Conditions. I understand that my student cannot participate in this Springboard program if I do not accept this policy.

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 unless the damage, illness, or injury to person or property is a result of Springboard Collaborative's negligence, recklessness, or willful misconduct. 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 except claims that are a result of Springboard Collaborative's negligence, recklessness, or willful misconduct. I understand that my student cannot participate in this springboard program if I do not accept this policy.

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Información de padre/tutor

Nombre:

Apellido:

Correo Electrónico:

IMPORTANTE: Por favor, proporcione un email correcto para que pueda recibir recompensas digitales de programación si su hijo es elegible.

Celular:

Otro Número de Teléfono:

Otro Correo Electrónico:

Domicilio

Ciudad

Estado

Código postal:

En casa, mi familia y yo principalmente hablamos:

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Acuerdo a que Springboard Use la Imagen, el Audio y el Nombre de Pila de su Hijo

Yo doy permiso para que cualquier foto, imagen, voz, video o cualquier otra grabación en todos formatos y el nombre de pila de mi hijo se publique y se distribuya en cualquier forma de medios o propósitos promocionales o informacionales en conexión con Springboard Collaborative, y entiendo que ninguna regalía, tarifa ni otra recompensación me llegará a ser pagadera por razón de dicho uso. Entiendo que este permiso no es requisito para inscribirnos en este programa, y que no rechazar esta autorización no impacta mi elegibilidad de matricularme en el programa.

SíNo

Acuerdo para Recibir Mensajes de Texto de Springboard

Yo estoy de acuerdo con recibir mensajes e texto de Springboard Collaborative, incluyendo recordatorios para talleres, recordatorios a leer, consejos de Springboard Connect y encuestas. Puedo optar a no recibir estos mensajes en cualquier momento, mandando el mensaje STOP. Entiendo que este permiso no es requisito para inscribirnos en este programa, y que no rechazar esta autorización no impacta mi elegibilidad de matricularme en el programa.

SíNo

Acuerdo de Uso de Datos

Yo le doy permiso a Springboard para usar la información de este formulario y de la participación de mi familia en este programa para (1) asegurarme de que puedo participar en el programa (es decir, recopilar los datos de asistencia de mi familia y de evaluación del estudiante) y (2) hacer informes 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. Entiendo que mi estudiante no puede participar en este programa de Springboard si no acepto esta política.

Acepto la Política de Privacidad de Datos y de Seguridad de Springboard. Entiendo que mi estudiante no puede participar en el programa de Springboard si no acepto esta política.

Acepto los Términos y Condiciones de Springboard Connect. Entiendo que mi estudiante no puede participar en este programa de Sprinboard si no acepto esta política.

Acuerdo de Padre

Entiendo que la naturaleza del programa de Springboard Collaborative y que participar es voluntario. Entiendo que Springboard Collaborative no es responsable de pérdidas, daños, enfermedades ni lesiones a personas ni propiedades en el programa, a menos que el daño, la enfermedad o la lesión a persona o propiedad es resultado de negligencia, temeridad o mala conducta intencionada de Springboard Collaborative. Yo por el presente libero y dispenso a Springboard Collaborative y sus oficiantes, empleados, agentes y voluntarios de cualquier y todas reclamaciones por lesiones, enfermedades, muertes, pérdidas o daños resultando de las actividades del programa salvo las reclamaciones que resulten de negligencia, temeridad o mala conducta intencionada de Springboard Collaborative. Entiendo que mie estudiante no puede participar en este programa si no acepto esta política.

Asian	Black or African American
American Indian or Alaska Native	Native Hawaiian or Other Pacific Islander
White	Other
Prefer not to say

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

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

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

Afroamericano	Caucásico
Asiático	Nativo americano
Nativo hawaiano u otro isleño del Pacífico	Otro
Prefiero no hacerlo

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