Waiver (Medical Release and Parent Authorization)

Authorization for Academic Reports

As parent/guardian of a Midtown-Metro student, I give permission for information such as quarterly grades and progress reports to be shared with Midtown and/or Metro. I understand that this agreement will be in effect each year for the length of time that my child is a Midtown-Metro student. Copies of all progress reports and report cards should be sent directly to: Metro Achievement Center for girls at 310 South Peoria, Chicago, IL 60607 or by fax to 312-226-6545 OR Midtown Center for boys at 1819 N. Wood St. Chicago, IL 60622 or by fax to 773-292-0203.

Medical Release Waiver

In case of emergency, I hereby grant permission for the Metro Achievement Center for girls/Midtown Center for boys or any successor organization, its officers, employees, representatives, agents or volunteers (“Provider”) to consent on my behalf to the administration of emergency medical treatment and/or any assistance necessary for the health and welfare of my minor child, including the transportation by Provider’s staff members and/or its representatives, whether paid or volunteer, to any health care facility or hospital, or the procuring of an ambulance, and I agree to indemnify and hold Provider harmless from any liability claim arising therefrom, including the payment of any attorney’s fees or court costs.

I further understand that Provider’s staff members are not physicians or medical practitioners of any kind. Nevertheless, I hereby release the Provider and Provider’s staff to render temporary first aid to my minor child and agree to indemnify and hold them harmless for any liability arising therefrom, including the payment of any attorney’s fees and court costs.

This Authorization and Release shall remain valid until expressly revoked. I agree that it is my sole responsibility to update the information contained herein. I agree that I will be responsible for the payment of any and all medical services rendered.

Parent Responsibility Policy

The Midtown-Metro programs operate on the principle that parents are the primary educators of their children. In that light, Midtown-Metro believes that parental involvement is crucial to the success of any educational program.

The admission of your child is a collaborative process that involves Midtown/Metro, your son/daughter, and you as the parents. An offer of admission is conditional and contingent upon the parent's agreement of the following criteria as described below:

* I/We will attend a minimum of ONE workshop, seminar, or class per school year.
* I have reviewed the Midtown-Metro Policy Guidelines for Parents and Students regarding Attendance, Discipline, Computer use, Dress Code, Field Trips, Photos, and the Tutor/ Student Relationship policies of Midtown-Metro.

Failure to complete the above may lead to the Midtown-Metro Waiting List for the following year.

By agreeing to the Terms and Conditions above, I authorize my signature to indicate that all information presented on this application is complete and factually correct. It attests to the fact that I wish my son/daughter to be considered for participation in one of Midtown-Metro's programs with no guarantee of final acceptance. In addition, I agree to fulfill my financial obligation to Midtown-Metro.