EmailMeForm
Parent / Guardian CONSENT FORM
for Little Rock School District school-based enrichment opportunities supported by community and school volunteers.
Student Name
*
First
Last
Student ID
*
Grade
*
School where enrolled
*
My student is allowed to participate in the following school-based activities supported by vetted volunteers during the current school year:
*
Mentoring program
Tutoring program
Book Club
Afterschool club activities
sport or academic team
College readiness programs
(A separate permission form is needed for field trips.)
If my student is successfully paired with a mentor, I would like to personally speak/meet with the mentor prior to placement. (select answer below)
*
Not requested
Requested
Prior to any off campus activities.
Student's phone number:
###
-
###
-
####
Leave blank if student should not be contacted directly by volunteers.
My student has previously worked with a volunteer (mentor or tutor) and is interested in reconnecting:
I, the undersigned, being the parent or legal guardian of the student named above, give permission for student participation in all activities as indicated. I understand that indicating interest does not guarantee placement for my student.
Name of guardian
*
First
Last
Day phone #
*
###
-
###
-
####
Guardian e-mail
*
Date Completed
MM
/
DD
/
YYYY
Signature (Do not leave blank)
*
Clear
On laptops and computers, use your mouse.
On smart devices, use your finger or stylus.
Printed forms can be mailed to you. Call 447-ViPS.
