My minor child (“Minor”) has been accepted as a tutee in the Sprout and S.T.E.M. tutoring program (“Program”). It is coordinated by Sprout and S.T.E.M. Inc. (“SAS”). The Minor has my consent to attend. I understand the nature and requirements of the Program. With that understanding, it is my judgment that the Minor is qualified and able to participate in the Program. I acknowledge that the Minor’s participation in the Program is voluntary. Due to the age of the Minor, SAS requires that this Agreement be executed by me in consideration of the Minor’s being permitted to enroll in the Program. I agree to and acknowledge the following:

  1. I am the Minor’s parent or legal guardian.
  2. I agree, for all Program sessions conducted in person, to drop the Minor off just prior to the start of the Program period and will pick up the Minor immediately following the end of the Program period, unless the Minor otherwise remains under the direct supervision of the school. I understand that no tutor, Program faculty member, teaching assistant, any other student nor any administrator, staff member, or volunteer of any capacity of SAS shall be responsible for supervision of the Minor either before or after the Program times. I also understand that Program dates, times, and durations are subject to change at the discretion of SAS.
  3. I agree that the Minor will abide by all rules and regulations and, if found in violation, may be removed from the Program either temporarily or permanently. I understand that SAS may withdraw the Minor’s participation, should these programs be disrupted or altered in any way by the Minor’s behavior. I further agree that, as a parent or guardian of the Minor, I take full responsibility for the behavior and conduct of the Minor and any consequences resulting from his or her actions.
  4. As the parent or guardian of the Minor, I understand that there are safety risks associated with the Minor’s participation in programs and activities designed for children. I acknowledge and agree that I have had the opportunity to ask questions of SAS officials concerning these matters and that all questions have been answered to our satisfaction.
  5. On behalf of ourselves, our heirs, executors, administrators, assigns, and personal representatives, I knowingly and voluntarily waive and release forever any and all rights for claims and damages that I may have against SAS (both individually and jointly), its trustees, officers, employees, volunteers, managers, members, staff, attorneys, agents, heirs, predecessors, successors, and assigns in any manner due to any personal injury or property loss sustained as the result of the Minor’s participation in the Program. I hereby indemnify and hold harmless from and against any and all claims, demands, judgments, losses and expenses, including, but not limited to, attorneys’ fees for personal physical or psychological injury or death to the Minor or damage to the Minor’s property during the Program period arising out of or resulting from the negligent or wrongful acts or omissions of SAS, and its employees and agents, with the exception of gross or willful misconduct.
  6. I agree that, in the event of any accident, incident, illness, or injury, the persons involved with the Program may call for medical assistance and administer appropriate primary medical attention to the Minor. I understand that I will be responsible for any and all costs of medical coverage and treatment provided not covered by my personal insurance.
  7. I agree that should there be disagreements or problems with the implementation of this Agreement, the laws of Rhode Island will govern any resolution. I further agree that should any claims, controversies, or grievances result, they will be settled by the American Arbitration Association and its rules in Rhode Island, where judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. I understand that this Agreement is intended to be as broad and inclusive as permitted by law and that, if any portion is held invalid, the balance of the Agreement will, notwithstanding, continue in full legal force and effect. In the event that any provision contained within the Agreement be deemed to be severable or invalid or if any term, condition, phrase or portion of this agreement be determined to be unlawful or otherwise unenforceable, the remainder of the Agreement will remain in full force and effect, so long as the clause severed does not affect the intent of the parties. If an arbitrator or a court should find any provision of this Agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision will be deemed to be written, construed and enforced as so limited.
  8. As parent or guardian of the Minor, the Minor and I agree that we, either jointly or independently, will promptly communicate any problems or issues associated with the Minor’s participation in the Program with SAS officials. I further agree that I will promptly report and disclose to SAS officials all pertinent information concerning the Minor’s ability to participate successfully in the Program.
  9. In signing this Agreement, I acknowledge and represent that I have read this entire document, that I understand its terms and provisions, that I understand it affects my legal rights and those of the Minor, that it is a binding Agreement, and that I have signed it knowingly and voluntarily.


Dated: January 22, 2022

Please select who will be participating...
First Participant's Name

First Name*

Last Name*

First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Medications or other health considerations (including allergies)
First Participant's Signature*
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Parent or Guardian's Email Address


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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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.
Parent or Guardian's Name

First Name*

Last Name*


Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Medications or other health considerations (including allergies)
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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