2022 Franklin HS "Power UP Summer Learning" Registration
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Student First Name *
Student Last Name *
What is your student's Seattle Public School ID#? (Optional if you don't know) *
What is your (student SPS) email? *
What is your (student) cell number or best contact number? *
What is the name of the school your student attended for 8th grade? *
What is your student's gender and preferred pro-noun? *
What is your student's t-shirt size?
Clear selection
What is your student's ethnicity? Please check one or more *
Required
I have access to a laptop or computer to use for this program *
I have reliable access to wifi to engage in this program
Clear selection
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Email *
What is the primary language spoken at home? Choose one or more *
Emergency Contact Info: Who can we call other than parents or guardian? Put their name and contact phone number *
Your child's doctor or provider phone number *
Your medical insurance and policy number
Please list any allergies, illness, chronic disorder, behavioral concerns, or developmental needs that we should know about and that may impact participation in any or all program activities. Type in "none" if they don't have any. *
Please list any food allergies or preferences (vegetarian, gluten free, vegan, etc.) Type in "nonee" if there are none. *
Does your child take medications that we need to be aware of? *
Participation: I give permission for my child to participate in all activities, including field trips and be transported as authorized by Seattle Public Schools (SPS). A schedule of field trips will be distributed to parent/guardian.  I give permission for Media Release to SPS and The Good Foot Arts Collective to use any pictures of my child related to program for further promotional purposes. *
Medical Treatment: I hereby give permission for my child to be given cardiopulmonary resuscitation (CPR) and first aid treatment by a qualified staff member of the SPS. I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. In the event I cannot be contacted, I further consent to the disclosure of health information and to the medical, surgical and hospital care treatment and procedures (including, but not limited to, administration of necessary anesthetics, tests, x-ray examinations, transfusions, injections, drugs) to be performed for my child by a licensed physician or hospital selected by SPS when deemed immediately necessary or advisable by the physician to safeguard my child’s health. *
Release from Liability: By signing below, I hereby agree to release Seattle Public Schools and all of its employees, volunteers, directors, officers and other representatives from any ordinary negligence and from all responsibility and liability of any nature, including claims for injury, death, loss or damage resulting from my child’s participation in this program. This includes the loss of the right to sue, win and recover damages if my child is injured by actions of SPS or any independent contractor for SPS. I acknowledge that I have signed this of my own free will and that my child’s participation in this program is purely voluntary. *
Parent/Guardian Consent: I have read and understand all of the information in this application and have completed this form to the best of my ability.  I give consent to participate in the Power UP program as described above and will enter my name below to validate my consent.  (Please enter your first and last name below) *
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