APPLICATION & MEDICAL FORM
PLEASE READ:
Bridges will dismiss students at 4:00 PM every Tuesday & Thursday unless you are informed otherwise. All students are expected to provide their own transportation home from KHS (trolley, walk, or picked–up), but if Bridges shuttle service is needed, please contact us to make the necessary arrangements. It is vital that all students have a way home after our program is dismissed at 4:00.
Bridges Outreach is not responsible for students and their actions after we dismiss the students from the High School at 4:00. Students may not stay at school unsupervised between events.
Students with poor attendance, inappropriate behavior, or an inability to maintain the proper work ethic/attitude are subject to being dismissed from Bridges Outreach at the program director’s discretion. Bridges Outreach is set up in a manner that students who have good attendance, behavior, and display hard work in school will be able to attend special events. These events will take place away in & out of town. We will have adequate transportation for all the field trips. The programs of Bridges Outreach have adequate liability insurance as do the vehicles used for our transportation. Your signature verifies that you are aware of your child’s participation in this program, including some activities that occur at off-campus locations. In addition, your signature authorizes KHS teachers, administration, & staff to supply Bridges Outreach with information about your child and authorizes Bridges personnel access to your child’s grades, academic tests scores, transcripts, and other pertinent academic guidance information such as 21st Century Scholar status. Your signature also verifies that you will not hold Bridges Outreach, Inc liable for loss or injury. By signing below, you also agree that we may use photos or videos of your student in promotional material unless a specific request is made otherwise.
I have filled out the medical information to the best of my knowledge. I hereby give my consent for first aid emergency care and /or necessary medical attention to be given while my son/daughter is at functions and activities sponsored by Bridges Outreach. If my son/daughter needs hospital care, I also give permission for the medical personnel of the hospital to render necessary treatment. I understand that they will treat my child at a facility in the immediate area.
Both my family and I assume responsibility for the activities of my son/daughter while attending Bridges events including field trips. As a result, both my family and I waive, release and agree to hold free from all claims for damages or injuries, Bridges Outreach and those associated with it, and its respective collaborative partners. I hereby give my consent for Bridges and its respective collaborative partners to use any photographs, videos, or written materials of my son/daughter that were part of the after-school program to be used for fundraising, promotion, and/or marketing efforts.
