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East Palo Alto Tennis and Tutoring (EPATT) Program 

Consent Form

2023 - 2024






Updated: 8/9/2023

EAST PALO ALTO TENNIS & TUTORING (EPATT) PROGRAM 2023-2024

 

CONSENT FORM

I give permission for my child(ren) to participate in the East Palo Alto Tennis and Tutoring program. I hereby to authorize EPATT staff to arrange for transportation of my child(ren) to the closest hospital in case of accident or illness. I understand that an effort will be made to notify me before such action is taken and the expenses of these services and any subsequent medical expenses will be assumed by me. I give permission for the above-named minor(s) to participate in all EPATT activities and in so doing absolve EPATT, their employees, volunteers, and officers from such liability that may arise as the result of participation. I release and forever discharge EPATT and employees, volunteers, and officers from any and all claims and demands of every kind, nature, and character which may have been or may hereafter be acquired for any and all damages, losses, or injuries which may have been suffered or sustained by my child(ren) in connection with the program activities. I have read, understand, and agree with the statement above:

May 18, 2024

PARENTAL PERMISSION FOR SCHOOL VISITS BY EPATT STAFF AND ACCESS TO STUDENT RECORDS

Dear School Administrator and/or Faculty/Staff,

As part of their child’s participation in the East Palo Alto Tennis & Tutoring (EPATT) program, the parent/guardian of the Student has granted EPATT's staff permission to speak with you about their child’s academic performance, participation, and attendance. Additionally, they have granted permission to EPATT's staff to obtain a copy of their child’s progress reports, report cards, and attendance records. This information will remain confidential and will be used only to monitor their child’s classroom performance and to project performance milestones.

I grant permission to the administrators/faculty/staff at my child’s school to discuss information related to my child’s classroom participation, performance, and/or attendance with EPATT staff. I also give permission to release copies of my child’s, class schedule, progress reports, report cards, transcripts, and attendance records to EPATT's staff. Please contact me if you have any questions. Thank you. 


MEDIA RELEASE FORM

Photo, Video, and Audio Recording Release for Person(s) Under 18 Years of Age.

I hereby authorize EPATT to photograph my child(ren) and use their photographs or other reproductions of their likeness for print, digital or online publication purposes.

I hereby authorize EPATT to videotape or audio record my child(ren). These videos and recordings may be used for promotional or publicity purposes and published online or played on radio or television broadcasts. Additionally, I authorize the use of my child(ren's) name in these broadcasts and videos.

This release is effective until revoked in writing by the undersigned. Such revocation shall only be effective to prevent any expanded future use of the recordings. 


RINGCENTRAL SERVICE PARENTAL CONSENT

I hereby authorize EPATT to subscribe me as a member of RingCentral services. I hereby consent EPATT to send voice and SMS/MMS text messages through the RingCentral services. 


EZ-TEXT SERVICE PARENTAL CONSENT

I hereby authorize EPATT to subscribe me as a member of EZ Texting services. I hereby consent EPATT to send voice and SMS/MMS text messages through the EZ Texting services. 


COVID-19 PROTOCOLS AND RELEASE

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. EPATT has put in place preventative measures to reduce the spread of COVID-19; however, EPATT cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending or participating in EPATT events, programs, summer camps, and facilities could increase your risk and your child(ren)’s risk of contracting COVID-19.

EPATT and its staff have put in place preventive protocols to reduce the spread of the Coronavirus/COVID-19 such as:

  • Participants are expected to notify the EPATT staff if they are feeling unwell or have been in contact with someone with COVID- 19 over the past 5 days - DO NOT ATTEND. (per CDHP 6/30/2022)
  • If participants tests positive, participants must stay home for at least 5 days after start of symptoms (or after date of first positive test if no symptoms). (per CDHP 6/30/2022)
  • EPATT will provide face masks. Face mask use for participants and staff is optional; however, the CDC highly encourages face mask use.
  • EPATT encourages practicing social distancing indoors and outdoors whenever possible.
  • Participants are responsible for cleaning and disinfecting any equipment used during programming. We have created multiple cleaning and disinfecting stations throughout EPATT with disinfecting sprays, hand sanitizers, disinfecting spray.
  • EPATT can provide same day COVID-19 testing for participants and family members if needed.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending or participating in an EPATT event, program, summer camp, or facility, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 while participating the EPATT program may result from the actions, omissions, or negligence of myself and others, including, but not limited to, EPATT employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, or death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at EPATT or participation EPATT programming (“Claims”).

I have read and understand all COVID-19 protocols and expectations required by EPATT. I am agreeing to follow the above guidelines and understand that if violated, there can be a re-evaluation of participation status and I may be asked to leave

I Agree





First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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