Parent / Guardian Information
*For informational purposes only. Income range is not the sole factor in scholarship award decision.
Please use this space to describe other factors impacting your financial situation that may assist us in understanding your need for tuition assistance.
I have answered all of the above questions to the best of our ability, and I believe them to be correct. We affirm that, without the aid requested above, it would be a struggle financially to enroll my child in this program.
I understand that the completion of this form DOES NOT GUARANTEE my child a place in the 2022 Young Writers Summer Camps and that paid spaces may no longer be available after May 2022.
I certify that I am the legal Parent/Guardian of the child(ren) registering and I voluntarily assume all associated risks and liabilities related to participating in the summer camp for which we are enrolling. Furthermore, I agree to indemnify, defend and hold harmless, Urban Think Foundation/Page 15 including its officers, employees, agents, affiliated entities and representatives, from and against any and all claims, demands, actions, damages, losses, costs, penalties, liabilities, expenses or deficiencies asserted related to or arising from exposure or transmission of COVID-19 or for any injuries which may be incurred by my child in any or all activities at the Summer Camp for which we are enrolling. I understand that Urban Think Foundation Inc./Page 15 may not provide insurance for my child, and I am financially responsible for all treatment or medical care of my child. I understand that Urban Think Foundation (dba Page 15) reserves the right to limit participation of any child for disciplinary reasons or non-payment of fees. My child is required to abide by the policies and procedures of the Urban Think Foundation and Page 15 staff.
I give my consent to Urban Think Foundation/Page 15 or its representative(s) to acquire emergency medical treatment for my child from competent medical personnel/facilities should that become necessary for any reason. In case of a minor accident or illness, I request that the Program Representative contact me. If I am unable to be reached, I request that one of the persons listed on this form be contacted to care for my child.
I agree to allow my child to participate in all Urban Think Foundation/Page 15 programs and activities and to appear in person or in voice, video or photographic presentation for radio, television, website or print media reports and/or media campaign(s) resulting from participation in a Urban Think Foundation/Page 15 program and/or event.
I understand that Page 15 is committed to maintaining a space that celebrates and uplifts all. As such, Page 15 does not tolerate racist, misogynistic, homophobic, or otherwise hateful speech or behavior. I understand and accept that my child may be temporarily or permanently removed from Page 15 programs if they violate this policy. For more information about Page 15’s core values and beliefs, visit page15.org.