By providing initials below, I give permission to Reaching Our Communicaty Kids, licensed by the Department of Licensing and Registery Affairs to secure emergency medical treatment for the above named minor child while in care..
By signing below I certify that my child is in good health and my child's immunizations (waiver) are up to date and are on file with the school.
List all individuals, other than the parents/legal guardians, to whom the child may be released.
Completing this section is completely voluntary, and all information recorded in this section will be kept confidential. The information will be used by The ROCK for statistical purposes, program assessment, and planning, and may aid in securing program funding through grants.Your participation in this section is greatly appreciated.
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The school contact will receive a survey at the end of the year from 32N Funding to help us evaluate our after-school program.
The ROCK Center for Youth Development may revise the Code of Conduct or Release of Liability Statement at any time by updating the pages. You should visit these pages periodically to review the Code of Conduct and Release of Liability Statement, because they are binding on you.
This program receives funding from the State of Michigan to serve your child. Michigan State University and Public Policy Associates are contracted to evaluate program quality and impacts. By enrolling my child in this program, I agree that the program will share the following attendance and demographic information with the contracted evaluators. All data will be kept confidential.