2026-2027 Wise Readers to Leaders Tikkun Olam Teen Corps Teen Board Application

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Thank you for your interest in joining our Wise Readers to Leaders 2026–2027 Tikkun Olam Corps Teen Board!

The Tikkun Olam Corps Teen Board provides high school students with the opportunity to develop leadership skills while making a meaningful impact on the scholars and families served by Wise Readers to Leaders. Through year-round service, Teen Board members help plan events, lead initiatives, support fundraising efforts, and create opportunities that engage both scholars and fellow teen volunteers.

To participate in the 2026–2027 Teen Board, all interested applicants must complete and submit this application.

Teen Board Commitment

By submitting this application, you are committing to attend the following four required in-person Teen Board meetings:

August 30, 2026
October 25, 2026
January 24, 2027
April 25, 2027

Meetings are held at Stephen Wise Temple (15500 Stephen S. Wise Drive
Los Angeles, CA 90077)

In addition to the quarterly meetings, members will participate in virtual check-ins with their committee chairs and the Executive Committee. Depending on the committee you join, there may be additional responsibilities throughout the year.

If you have any questions, please email lead@wisereaderstoleaders.org.

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Teen Applicant Information

First Name

Last Name

Age

Grade level (Fall of 2026)

9101112

High School Attending

Cell Phone

Email

Street Address

City

State

ZIP Code

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Telephone

Parent/Guardian E-mail

Parent/Guardian Street Address

Parent/Guardian City

Parent/Guardian State

Parent/Guardian ZIP Code

Second Parent/Guardian First Name

Second Parent/Guardian Last Name

Second Parent/Guardian Telephone

Second Parent/Guardian E-mail

Second Parent/Guardian Street Address

Second Parent/Guardian City

Second Parent/Guardian State

Second Parent/Guardian ZIP Code

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Short Answer Question

What inspires you to be part of our mission to change the world one scholar at a time?

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Parent/Guardian Consent Needed

Before the application can be finalized, a parent or legal guardian must review and sign the required Consent and Release Forms.

By signing these forms, I acknowledge that I am the parent or legal guardian of the applicant and agree to support and ensure my child’s full participation in the Wise Readers to Leaders program, including adherence to the commitments and expectations set forth by the organization.

By typing my name below, I confirm that I have reviewed this application and agree to the above.

*Please select "Next Page" to be directed to the consent forms (p.5-8).

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Consent to Treat Minor

Emergency Medical Consent

I, the undersigned parent or legal guardian of relevant child/children consent to any of the staff, employees, agents and representatives of WRTL administering or consenting to the administration of such emergency medical care to the child/children as such person deems appropriate in the circumstances, and hereby authorizes medical treatment in case of emergency.

I further authorize release of medical records and/or information pertaining to the diagnoses or treatment of the above-named child/children when such disclosure is necessary for the purpose of evaluation, treatment or emergency care.

This form will remain in effect through the full calendar year of programming.

I consent to emergency medical care and the release of medical info for the child/children if needed during the program year.

YesNo

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Media Release Form

I hereby authorize and irrevocably grant to the Wise Readers to Leaders and its affiliates, licenses, agents and assigns:

The unrestricted right to use and publish any part of the information that I have given to Wise Readers to Leaders and the right to record both my child/children and me, including our name, voice, appearance, likeness and comments on film, audiotape, videotape, still photographs, print and any other media known or hereafter invented. I acknowledge that Wise Readers to Leaders shall own all right, title and interest in and to this media. I further agree that Wise Readers to Leaders may cause all or parts of this media to be used for any and all publications, exhibitions, public displays, editorials, advertising or other purposes.
The exclusive ownership of all artwork created by my child/children during his/her/their participation in the Wise Readers To Leaders Program.

I waive any inspection or approval of the media or any advertising or publicity in which my child's/children's or my name, voice, appearance, likeness, narrative, or comments might appear. I expressly release and agree to hold harmless Wise Readers To Leaders and its agents, employees, licenses and assigns from and against any and all claims including, but not limited to, invasion of privacy that I might ever have in any way relating to any of the aforementioned uses.

I understand and agree to the media release policies stated above.

YesNo

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Parent/Guardian Commitment Form

Parent/Guardian Roles, Responsibilities & Commitments

I, the parent or legal guardian, understand that Wise Readers to Leaders engages Junior Literacy Leaders in structured volunteer service supported by curriculum, training, and supervision. This program is designed to foster leadership development and a commitment to service while supporting younger scholars through literacy and enrichment activities.

I understand that a key goal of the Junior Literacy Leader program is to cultivate responsible, engaged teen volunteers and that parent/guardian support is an important component of a student’s successful participation

I acknowledge that all adults associated with the program—including parents and guardians—are expected to serve as positive role models, reinforce the importance of responsibility and academic achievement, and support a safe, respectful, and nurturing environment in which all participants are valued.

I agree that during the time my child/children is enrolled as a Junior Literacy Leader with Wise Readers to Leaders, I will:

Support my child's/children’s commitment to volunteer service and program responsibilities.
Encourage timely attendance and consistent participation in all required program activities.
Communicate with Wise Readers to Leaders staff as needed to support my child’s successful engagement.
Uphold the values and expectations of the Wise Readers to Leaders program.

I understand and agree to the parent commitment policy stated above:

YesNo

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Release Form

Wise Readers to Leaders – Participation & Liability Agreement

In consideration of the child/children named in this application (the “child/children”) being permitted to participate in Wise Readers to Leaders (“WRTL” or the “Program”), the undersigned, parent(s), or legal guardian(s) of the child/children, on behalf of our heirs, executors, administrators and assigns, and the child/children, hereby agree to the following terms and conditions set forth below:

Participation

I/We give permission for the child/children to participate in the Wise Readers to Leaders program through the full calendar of programming in whatever format said program shall be whether virtual, in-person or hybrid. If the program is fully or partially virtual, I/we give permission for the scholar to use Zoom or any other media platform approved by Program staff.

Expectations

I/We understand and acknowledge that the child/children is/are expected to abide by all WRTL/Stephen Wise Temple and any future site partner's (collectively referred to herein as “SITE PARTNERS”) regulations during the course of the Program. I/We agree that WRTL has the right to terminate the child/children's participation in the Program for any behavior deemed detrimental to the Program or the child/children.

Hold Harmless

I/We acknowledge that as a condition of the child/children participating in the WRTL Program, I/We hold harmless and waive any and all claims against Wise Readers to Leaders (“WRTL”), Stephen Wise Temple (“SWT”), and all future site partners, and its officers, employees, agents, and volunteers, including, but not limited to, claims arising out of any ordinary negligence of any officer, employee agent, or volunteer of the WRTL and SITE PARTNERS for any injury, accident, illness, or death, or any loss of damage to personal property occurring during or by reason of the Scholar participating in the Program, unless claim is based on gross negligence.

Voluntary Release of All Claims

I/We voluntarily release, discharge, waive and relinquish all claims that each may have against WRTL and SITE PARTNERS and, its staff, agents, employees, representatives, successors, and assigns (collectively the “Releases”), arising out of or in any way related to the child's/children's participation in the Program, including, but not limited to, claims for bodily injury, personal injury, emotional distress, property damage or wrongful death occurring to the child/children arising out of his/her/their involvement in the Program. This release, discharge, waiver and relinquishment also pertains to any instruction or supervision related to the Program on the part of WRTL, its officers, directors, trustees, employees and agents, unless claim is based on gross negligence.

Medical Care

I/We consent to any of the staff, employees, agents and representatives of SWT and WRTL administering or consenting to the administration of such emergency medical care to the child/children as such person deems appropriate in the circumstances, and hereby authorizes medical treatment in case of emergency.

Medical Insurance

I/We understand and acknowledge that WRTL does not carry or maintain health, medical, or disability insurance coverage for the child/children and therefore agrees to assume the responsibility for such insurance coverage on the child/children.

Severability

If any provision of this agreement is held invalid or unenforceable, the remainder of this agreement shall nevertheless remain in full force and effect. If any provision is held invalid or unenforceable with respect to particular circumstances, it shall nevertheless remain in full force and effect in all other circumstances.

Voluntary Agreement

The child/children and the parent(s)/guardian(s) acknowledge that they have read this Release and are aware of the legal consequences of signing this binding document. My signature below indicates that I have read and freely signed this agreement. I further certify that I am legally competent to sign this agreement.

Contact Information

Wise Readers to Leaders has my consent to release contact information, including phone number and email addresses to Wise Readers to Leaders Staff and Teen Volunteers.

Important – Read Entire Agreement Before Signing

I understand and agree to the release form stated above:

YesNo

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The Tikkun Olam Corps Teen Membership Contribution

Our Tikkun Olam Corps Teen Program and our broader year-round programs exist because of the generous financial support of individuals and families like yours. We suggest a one-time $200 membership contribution, which covers participation in both the Tikkun Olam Corps Teen Board and the Remote Tutoring Program as a teen tutor throughout the 2026–2027 program year.

Your membership contribution not only sustains the program, but truly shows a familial commitment to healing the world and making a difference. We encourage our JLLs and their families to view this membership contribution as an opportunity to live important values, such as generosity, commitment to community and authentic relationship building. With that being said, we do not want financial hardship to be a limiting factor for any teen or family. Please reach out to the WRTL Management at wrtl@wisereaderstoleaders.org so that we can make an arrangement that is suitable to your family.

Please note that our Remote Tutor Application will be released on August 7.

Please Select One

Yes, I understand and will make a tax deductible membership contribution.Yes, I understand and have already submitted the one-time $200 contribution, which covers participation in the Tikkun Olam Corps Teen Board and the Remote Tutoring Program.Yes, I understand and would like to speak with WRTL staff regarding our membership contribution.

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Membership Contribution

Donor First and Last Name (In order for us to send a tax acknowledgement letter.)

Donor Email

Donor Street Address

Donor City

Donor State

Donor Zip Code

Tikkun Olam Corps Teen Membership Contribution (Standard $200 per member)

Please enter amount (numbers only, no $ symbol)

How would you like to make payment?

Credit Card (Visa, Mastercard, AMEX)eCheck/ACHMail a Check If you are mailing a check, please make payable to Wise Readers to Leaders. Address: Wise Readers to Leaders, Attention Joyce Anderson, 15500 Stephen S. Wise Drive Los Angeles, CA 90077

The total membership contribution displayed includes all applicable fees, including a 3% processing fee for payments made by credit card.

To avoid the processing fee, you may choose to pay via check or eCheck/ACH.

Credit Card Processing Fee

Total Membership

Credit Card Information

Name on Card

Card Number

MM

YY

Code

Billing Information

Billing First Name

Billing Last Name

Billing Street

Billing City

Billing State

Billing Zip

Billing Email

eCheck/ACH Information

Name on Account

Bank Name

Bank Routing Number

Bank Account Number

Account Type

CheckingSavings

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