Family Consent Form

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Family Consent Form

We're so excited about your interest in the VITAL Program! This form lays out the expectations and policies of the program so that you understand what is expected of you, your child, and the tutor. By completing this form, you are agreeing to the following expectations.

Email *

Guardian's First Name *

Guardian's Last Name *

I, the undersigned guardian, request voluntary participation for my child to participate in the VITAL Program, which will include academic enrichment in one or more subject areas. I consent to my child's participation in this free tutoring program. *

I consent to my child's participation in the VITAL Program.

I agree to remain in communication with my child's tutor via phone/email to ensure that we are able to communicate and schedule effectively and efficiently. *

The tutor that you have been assigned is your main point of contact in regards to the VITAL Program. However, if you have other comments or questions, please email community.engagement@lawrence.edu

I agree to communicate openly and frequently with my child's tutor.

I understand that if problems arise, or when a tutor is no longer needed, either the tutee, the tutor, or both are expected to notify the VITAL Coordinator at the Center for Community Engagement and Social Change. *

I agree to notify the VITAL Coordinator of any problems or when tutoring is no longer needed.

By participating in the VITAL Program, you agree to the following attendance policy: If you need to cancel a tutoring session, inform your child's tutor preferably 24 hours in advance. If there are unavoidable circumstances that warrant canceling the day of, please let your child's tutor know at least an hour in advance. If you miss 3 sessions without notifying the tutor at least an hour in advance, your child will be unmatched from their tutor. *

The same will be expected of the tutor for communicating with you.

I agree to the VITAL attendance policy.

I agree that photographs, pictures, slides, movies, video, or other media coverage of my child may be taken in connection with my child's participation in the program without compensation from Lawrence University and consent to the use of photographs, pictures, slides, movies, videos, or other media coverage for any legal purpose. *

Screen recordings and screenshots may be useful tools for your child to refer to after the tutoring session, but these will not be taken without your consent.

I consent to media coverage of my child in connection with my child's participation in the VITAL Program.

I do not consent to media coverage of my child in connection with the VITAL Program.

Signature *

Typing your name in this box acts as an electronic signature.

Today's Date *

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