Consent and Release Statement

  • I give The Leaven permission to access and keep copies of my child’s academic record, including report cards, standardized test scores, STAR testing reports, IEP, ELL, Special Edcuation and other records. This permission will extend for a year. These scores will be kept confidential and only be used by The Leaven for the purpose of program planning and group analysis.
  • I give The Leaven permission to collect the student state ID number from my child’s school to be used for access to academic records.
  • IĀ give The Leaven permission to notify me using the contact information (telephone, e-mail, mail, or robocall via telephone) about the status of my enrollment, my child’s attendance, upcoming Leaven events, schedule changes and program updates.
  • I certify my understanding that The Leaven reserves the right to reject the application of any scholar whose needs The Leaven determines cannot be adequately met by the resources of the program.
  • I certify my understanding that I will be given a Field Trip Permission Form to authorize my child’s participation in any field trip planned by the program and that alternate care will not be provided should I choose not to grant such permission for my child’s participation.
  • I acknowledge that my child’s participation in Field Trips is at the discretion of the program staff.
  • I release The Leave as an organization, as well as its employees and volunteers, sponsors, from any liability suit or claim for property damage or loss, or personal injury to my child.
  • I give permission for my child to be included in the documentation of The Leaven, sponsors and partners including photographs, audio/visual recordings, reproductions of academic 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.
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