Youth Registration Form

This application is not a guarantee of enrollment. Newcomer immigrant students will be enrolled based on availability of tutors and qualifying needs: students age 5-18 who are enrolled in an ESOL program in a Florida school, low family income and low English Language Proficiency.

CHILD'S INFORMATION

Child's Name *

First Name

Last Name

Child's School Name

How long has your child been in the US? *

What project/subject are you interested in? *

Arts and Music Well-Being Project

Academic Tutoring: English, reading, math (individual online)

Academic Tutoring: English, reading, math (in person)

Is your child enrolled in the ESOL program in school? *

Only children of immigrants who are in the ESOL program can be enrolled in our youth tutoring program. Please provide the letter from the school.

Yes

I don't know

FINANCIAL INFORMATION

How many people live in your household? *

What is your monthly family income? *

CONTACT INFORMATION

Parent's Name *

First Name

Last Name

Parent's Phone Number *

Email *

Verify Email *

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

TUTORING AGREEMENT

I understand that enrollment in the Youth Immigrant Program is based on low family income, tutor availability, and Low English Language Proficiency. The immigrant students with the biggest need will be enrolled first. *

Yes

I agree to communicate with the tutor about all issues and inform the tutor at least two days in advance of any absence. After two absences without notifying the tutor or presenting a valid reason, the student will be dismissed from the program. *

Yes

I agree that the tutor can contact me by phone or email. *

Yes

I agree that my child will be on time and prepared for each session and will participate actively in activities and communication with the tutor. A computer with wifi conection will be available for the online sessions. *

Yes

I agree that I will contact the Program Director with any issues or concerns I have about my child's tutoring. *

Yes

CONSENT

Photo and Video Recording Permission

I give my permission for NicerFL to film and/or record me or my family during any activity or class. NicerFL may use the pictures or recordings to promote its activities on the website and social media as well as other advertising material. *

I hereby authorize NicerFL to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. I hereby hold harmless, release, and forever discharge NicerFL from all claims, demands, and causes of action which I, my representatives, administrators, or any other persons acting on my behalf or on behalf of my organization have or may have by reason of this authorization.

Yes

SIGNED CERTIFICATION

I certify that the information I have provided on this form is accurate to the best of my knowledge. Please type your full name and today's date as verification. *