Today A Reader.
Tomorrow A Leader.
APPLY TO READING FOR CHANGE
Dear Parent,
Reading for Change is a free after-school and/or summer tutoring program that takes place at 105 South Market Street (top floor) in downtown Troy. RFC is focused on helping your child grow academically as well as in all areas of life. The program consists of structured, one-on-one and group tutoring with supportive adults. It also includes homework help, reading activities, and a snack. Each RFC student is evaluated periodically throughout the school year to assess whether the RFC program is meeting his/her needs.
RFC’s reading tutors are certified teachers and trained volunteers that come from our community. RFC takes all its volunteers through a comprehensive background security check. Additionally, all tutoring will take place in a group environment and no child will ever be left alone with an adult volunteer. It is important to the program’s success that your child attends RFC regularly and is not picked up before we are finished with our session.
If you are interested in your child taking part in this free reading program, please completely fill out the form below. You will be notified if your child has been accepted into the program.
By signing and submitting this form, you also give the program director permission to discuss your child’s grades, scores, and progress with the staff at your child’s school. This is an important factor so we can help your child and focus on their individual needs. Our commitment is to make sure this is always done in a professional and confidential manner.
If you have any questions about the program or the application, you can contact me at (937) 203-0616 or amy@readingforchange.com. We look forward to working with your child and helping them succeed.
Thank you,
Amy Niemi
Program Director
Application Details**
By filling out this online application, I give my child permission to participate in the RFC tutoring program offered during the current school year (the “Program”). By signing this document, I am documenting that I understand and agree to each of the following statements .
• Communication with school: Members of the faculty at my child’s school may discuss my child’s grades, score and progress with his/her Program Director. This will always be done in a confidential manner.
• Emergency Medical Treatment: If my child becomes seriously ill or injured while participating in the Program, any authorized member of RFC may seek and obtain emergency medical treatment for my child as he or she deems necessary.
• Faith-based activities: I acknowledge that the Program may utilize some faith-based materials. My child has permission to participate in faith-based activities as they may be offered during the Program.
• Publicity: RFC may use my child’s name and/or photograph(s)/video for the purposes of duplication, publicity and/or publication.
• Transportation: RFC provides no transportation to or from the facility. It is the guardian’s responsibility to provide transportation and/or approve for the child to walk to RFC and then home. By signing this consent, you are giving your child permission to walk to RFC from school and/or home.
• Attendance: Your child is expected to attend regularly once granted acceptance into the program. If your child has more than 3 unexcused absences, he/she will be given a warning and RFC will contact child’s guardian. After 5 unexcused absences, your child will be asked to leave the program.
Acknowledgement of Understanding: I have read this Consent, I understand the terms used in this Consent and have willingly placed my signature below as evidence of my acceptance of all the conditions stated in the Consent. I sign this Consent with the understanding that I, for my child and for me, am giving up any right to legal recourse against RFC for negligent conduct (but not for reckless or intentional conduct) in return for allowing my child or me to participate in Program activities. I understand that this Consent applies each and every time, and remains in effect for as long as my child or I participate in any Program activities. Because I am signing this Consent on behalf of a minor, I certify that I am my child’s custodial parent or legal guardian with full authority to act on my child’s behalf with respect to everything addressed in this Consent.
Emergency Medical Treatment Authorization
Purpose: To enable a custodial parent or guardian to authorize emergency medical treatment to his or her student if the student becomes seriously ill or injured while participating in the RFC’ Tutoring Program and the custodial parent or guardian cannot be contacted.
Directions and Consent
1. If my student seems to need emergency medical treatment, I direct that my student be transported to a nearby hospital.
2. If, after arranging for my student’s transportation to a nearby hospital, reasonable efforts to contact me are unsuccessful, I then direct that reasonable efforts be made to contact at least one of the medical care providers listed.
3. If neither I nor either of the medical care providers listed can be successfully contacted to discuss emergency medical treatment for my student, I consent to any emergency medical treatment considered necessary by the medical care personnel treating my student. This consent to emergency medical treatment does not authorize surgery unless before the surgery, two physicians agree that surgery is necessary (one of whom must be one of the medical care providers named below – but only if available).
