LINK Leaders Guardian Application 2018
  • Part A

  • Parent/Guardian Contact Information

  • - -
  • - -
  • - -
  • - -
  • Part B

  • Part C

    Emergency Contact Information

    Please complete the chart below for all individuals to whom you the legal guardian gives permission to provide safe passage home and/or can pick up your child in case of an emergency.

    If for any reason these individuals change, then please contact your child's LINK teacher.
  • - -
  • - -
  • - -
  • - -
  • - -
  • - -
  • - -
  • - -
  • Head-of-Household/Household Family Status of Applicant:

    Check the box that applies in one of the following two categories.
  • Part E

  • Student's Name
  • I give permission for my child to do or complete the following:

    • to be photographed or videotaped by the VLP or its partners (e.g. Johns Hopkins/SABES, Single Carrot Theatre, Family League) for marketing, public relations, and educational purposes.
    • to access the Internet in the computer lab under VLP staff supervision.
    • to walk to the Margaret Brent Elementary/Middle school playground on an as needed basis, under close supervision of the VLP staff.
    • to accompany VLP staff and his/her class on walking field trips in the community surrounding the VLP. Students will not travel unsupervised in the community during program hours.
    • to be escorted home by persons that I list on this application as authorized to give SAFE PASSAGE HOME.
  • I will allow staff members of the Village Learning Place to:

    • transport my child between the VLP and neighborhood locations within walking distance as needed
    • give my child reading and math evaluations and assessments
    • access my child’s school records, including test scores, attendance, behavior and suspension records, and applicable information concerning services my child receives such as IEP records, 504 plans, etc.
    • conduct and have students complete program evaluations as pre-determined by program funders
    • communicate with your child’s teacher or other school staff about academic performance and behavior
    • provide on-site minor care for injury or illness
    • provide immediate medical attention in an emergency by transporting my child to the nearest hospital or medical facility
  • I understand that with my support, my child must maintain a good attendance record, actively participate in all activities, and exhibit good behavior in order to remain in the program.

    I release the Village Learning Place, Inc., its partner organizations, and employees from any and all claims or liabilities for any damages or injuries that may be sustained in connection with this program or in transporting my child to and from or during the program. I understand that the program ends at 4:00pm. I will make sure someone picks up my child or that my child can leave on their own by 4:00pm Monday through Friday.
  • Part F

  • Discipline

    Respect for children, their unique personalities, and their feelings are important. We use a system of restorative justice to help students who are struggling with behavior.

    As your partner, it is our goal to assist your child in developing self-control and socially acceptable behavior. The classroom teacher and Program Coordinator will keep you informed of any behavioral problems concerning your child. Every effort will be made to resolve any problems that occur.
  • Part G Permissions

    I understand that with my support, my child must follow all policies and procedures contained within this application and within the LINK Family Handbook. I hereby agree to follow all policies in this application, and I certify that all information in this application is true to the best of my knowledge.
  • / /
  • Use the mouse or your finger to draw your signature.
  • This field is optional. Please include any feedback or questions you have.