I also understand that my child will be obligated to attend practice and the other instructional and counseling sessions. Failure to do so may constitute ground for exclusion from the program.

 I understand that it is my responsibility to see that my child attends regularly, and my responsibility to see that my child reports to the program on time.

 I give my child permission to participate in the group and individualized recreational, educational, and counseling activities required by CCNY-LPP. 

I agree to be responsible for the return of all equipment, uniforms, and materials issued for temporary use to my child/children. 

To my knowledge, my child has no medical condition or physical disability which should prevent him/ her from participating in any physical activities. 

I assume all responsibility for any physical or medical condition which would have, or should have been detected upon a complete physical examination of my child. 

I assume sole liability for my failure to truthfully disclose any physical and medical condition(s) which jeopardize my child’s health or welfare to the CCNY-LPP.

 I also recognize that the recreational program of the CCNY-LPP requires strenuous physical activity and that my child must be in good health to participate in these programs. 

I recognize and accept that the CCNY-LPP assumes no affirmative obligation to obtain a physical examination for my child, nor is LPP obligated to detect or obtain treatment for any medical or physical condition.

 I understand that LPP features special events both in-school and out-of- school. Media representatives, newspaper and television reporters, photographers, and public-relations personnel may be present at these special events to record them. In some cases they may interview and/or photograph children who participate in these events. These photographs, videos, and interviews will only be used to promote LPP. 

We ask your permission to: 

1. Contact your child's school if necessary, and obtain records showing your child's progress, including information about enrollment, grades, test scores, attendance, promotion between grade levels, and referral to special programs. 

2. Discuss youth development with you and how it impacts you and your child. 

3. Photograph or otherwise record your child during LPP events and activities, and for any and all such photographs to be displayed by City College/Urban Scholars LPP, at the program sites in any medium (books, newsletters, websites, etc.), whether now or hereafter known or developed. 

4. Periodically, the LPP assesses its youth services to evaluate how helpful they are to students and families and how those services can be improved. This evaluation process necessitates obtaining information on all students participating in CCNY-LPP. As a program participant your child may be selected to participate in our study. 

  **Student Electronic Signature and Date: