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EAST PALO ALTO TENNIS & TUTORING (EPATT) PROGRAM

MEDIA RELEASE FORM

Photo, Film, Digital, Vocal Recording Release For Tutors

I hereby grant to the East Palo Alto Tennis & Tutoring (EPATT) program and to its employees, agents, assigns, and sponsors the right to photograph me and use the photo and or other digital reproduction of me or other reproduction of my physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the Internet. 

I hereby grant to East Palo Alto Tennis & Tutoring (EPATT) the right to film and/or record me vocally. These films and recordings may be used for promotional or publicity purposes and may be published in mass media publications including advertisements, promotional materials, newsletters, magazines, and newspapers, on EPATT’s intranet or internet sites, played on radio broadcasts or shown on television or movie presentations. My name may be used. 

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 records.

April 30, 2024

TEXT MESSAGING SERVICE CONSENT

I hereby authorize EPATT to subscribe me as a member of EZ Texting or RingCentral services. I hereby give EPATT consent to send voice and text messages through the EZ Texting or RingCentral services.

April 30, 2024

GUIDELINES FOR ONLINE MINORS PROGRAMS

Adults should be positive role models for minors, and act in a caring, honest, respectful and responsible manner that is consistent with the mission and guiding principles of the university. The risks and challenges associated with working with minors in-person are also present when working with minors online. Adults working with minors online must follow these expectations to avoid behaviors that could cause harm or be misinterpreted:

  • Do not have one-on-one interactions with minors. There must be at least one other adult or minor participating in any virtual programming.
  • Do not engage or communicate with minors through email or text messages, social networking websites, internet chat rooms, or other forms of social media at any time except and unless there is an educational or programmatic purpose and the content of the communication is consistent with the mission of the program or activity and the university. When communicating electronically, you must copy another Program Staff member or the minor’s parent/guardian.
  • Do not wear unprofessional or inappropriate attire when interacting with minors online.
  • Do not display an unprofessional or inappropriate background when interacting with minors online, such as inappropriate images or words on the wall or on the virtual background.
  • Do not meet with minors in person unless the in-person meeting was a part of the program curriculum approved by the Program Sponsor. Any exceptions require authorization by the Program Sponsor and written authorization by the minor’s parent/guardian. The meeting must include more than one adult from the program or activity.
  • Do not allow unsupervised interactions between minors during the virtual programming, such as in breakout rooms. Immediately stop cyberbullying or any disrespectful comments or inappropriate images.
  • Do not engage in any sexual activity, make sexual comments, tell sexual jokes, or share sexually explicit material (or assist in any way to provide access to such material) with minors.
  • Do not engage or allow minors to engage you in romantic or sexual conversations, or related matters, unless required in the role of resident advisors, counselors, or health care providers.
  • Do not use, possess or be under the influence of alcohol or illegal drugs while interacting with minors online.
  • Do not tell a minor “this is just between the two of us,” or use similar language that encourages minors to keep secrets from their parent/guardian.

Online Programming Best Practices 

  • Virtual interactions that take place between minors during the course of the program, such as in breakout rooms, must be supervised by Program Staff.
  • Recording virtual interactions, such as class instruction and office hours, may allow the minor and parents/guardians to review the instructional materials at a later time. If your program or activity intends to record any virtual interactions, please ensure that minors and parents/guardians are notified in advance, and that an Assumption of Risk, Release of Claims and Hold Harmless Agreement has been signed.
  • Make sure the virtual meeting is set to private and that individuals who have not been invited to the meeting cannot enter the virtual space. Avoid posting any meeting links on public sites. Any meeting should have a password that is only sent to participants.
  • Ensure that comments or chat features are limited to participants and that personal contact information is not being shared.
  • Consider updating your program or activity’s code of conduct, if applicable, to address appropriate online etiquette and cyberbullying.

REPORTING

Immediately report instances or suspected instances of abuse or inappropriate interactions with minors to the Santa Clara County Department of Family & Children Services’ Child Abuse and Neglect Center (650) 493-1186.

 

Today's Date: April 30, 2024

 



First Tutor Name

First Name*

Middle Name

Last Name*

Phone*
First Tutor Date of Birth*
First Tutor Signature*
Second Tutor Name

First Name*

Middle Name

Last Name*
Second Tutor Date of Birth*
Third Tutor Name

First Name*

Middle Name

Last Name*
Third Tutor Date of Birth*
Fourth Tutor Name

First Name*

Middle Name

Last Name*
Fourth Tutor Date of Birth*
Fifth Tutor Name

First Name*

Middle Name

Last Name*
Fifth Tutor Date of Birth*
Sixth Tutor Name

First Name*

Middle Name

Last Name*
Sixth Tutor Date of Birth*
Seventh Tutor Name

First Name*

Middle Name

Last Name*
Seventh Tutor Date of Birth*
Eighth Tutor Name

First Name*

Middle Name

Last Name*
Eighth Tutor Date of Birth*
Ninth Tutor Name

First Name*

Middle Name

Last Name*
Ninth Tutor Date of Birth*
Tenth Tutor Name

First Name*

Middle Name

Last Name*
Tenth Tutor 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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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