Black Liberation Comic Book Club 2022

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This form is for children to sign up to learn about Black Liberation through comic books and arts based activities. Children aged 6-17 will have an opportunity to analyze and respond to text. The program dates will be: Jan 31, Feb 25, March 28 and April 25 from 5-6:30pm and our program will happen virtually using zoom.

Priority of Admission

Tell us about your child - This information is voluntary and will be used to determined priority of admission into Freedom School. Admission to Freedom School is not on a first come-first serve basis, but is dependant on need.

1. Does your child/youth identify as both Black and gender non conforming or transgender? *

2. Does your family identify as Black and LGBTQ? *

3. If your child/youth were not to attend FreedomSchool, would your family have funds to access culturally responsive programming (ex: dance class, choir etc.)? *

4. Does your family have family experience with state violence and/or police brutality? *

5. Does your child/youth have school experience that you/your child would describe as mostly negative? *

Young Freedom Fighter Information

Tell us about your child. This information will help us to program for your child and to keep your child safe.

Name (last/first) *

Gender Pronoun *

Date of birth *

YYYY

Ontario Health Number *

Home Address (Number, street name, unit #, city, postal code. Please indicate if your child lives at one address or alternates between 2 addresses). We will use this address to drop off supplies and materials for your child to do science activities. *

Doctors name and phone number *

Does your child/youth have any pertinent medical concerns? Ex: asthma, diabetes, sickle cell, epilepsy *

Accessibility

Does your child have physical accessibility needs? Ex: Can your child navigate steps/playground climbing equipment etc? Does your child have physical accessibility needs pertaining to dance lessons or sports?

List accessibility needs *

Learning Needs

Tell us about your child's learning needs!

What is your child/youth's cultural foreground? (Ex: Nigerian, Jamaican, Scotian, Bajan, Black American) *

Tell us a bit about your child/youth learns best (Ex: auditory, visual, kinesthetic, hands-on) *

Does your child/youth know how to read independently? What kind of books do they like to read? *

If your child/youth does not know how to read independently will you be available to support them to read one comic book/month in October, November and December? *

Does your child/youth have experience with learning online? How does your child typically handle frustrating interpersonal situations? (Ex: crying, tantrum, hitting, walks away, talks it out) *

How are conflicts or behaviour challenges handled at home (Ex: talking it out, time-out) *

Any suggestions that will help us get to know your child/youth and help them adjust to Freedom School *

Parent(s)/Care giver's Information

Tell us about yourself and your child's parent(s)/guardian(s)

Parent(s) or Guardians (family name(s), given name(s) *

Home Phone *

Work Phone (if employed outside home) *

Mobile Phone *

Email address *

Emergency Contacts (Freedom School - Toronto MUST have on file the names of three people who can help out if your child should become ill/injured and we are unable to solve the issue remotely) *

Media

This course will be conducted online using a learning platform called Zoom. Zoom uses both a mic and video feature. From time to time we may take photographs or videos of children's work or likenesses for freedom school promotion. News/TV stations may feature the children at work.

Do you consent to your child using Zoom - including the video feature? *

Yes

Maybe

Would you be willing to have your child filmed for internal media (ex: freedom school newsletter, promotion) Do you consent to internal media being shared on FreedomSchool - Toronto's website? *

Yes

Maybe

Do you consent to internal media being shared on FreedomSchool- Toronto's social media? *

Would you be willing to have your child filmed for external media (ex: TV, radio, newspaper) *

Are you interested in volunteering? In your answer, please indicate if you have access to a vehicle/drivers licence, as we may need support dropping off materials to families. *

Family Contribution

FreedomSchool is a fully subsidized programs. Contributions are voluntary.

Would you like to make a monetary donation to Freedom School's 2021 program? *

Are there any supplies you would like to contribute? (Ex: books, paper, art supplies, fans, toys) *

Are there any special talents you would like to contribute? (Ex: cooking, sewing, art, design, music) *

SAFETY INFORMATION AND WAIVER

You will be required to sign a safety waiver before engaging in FreedomSchool programming online

Any other information you would like to share with us: *

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