METCO HQ Student Program Permissions Packet

Hello METCO Parent/Guardian,

We are excited that you have registered your student to participate in one of the programs offered by METCO Headquarters.

In this form, you'll be asked to provide a number of permissions and other essential information to ensure the safety and well-being of your child during our care. Please read each section thoroughly and provide the requested answer.

If you have any questions, you may reach out to Wilmary Tejeda, Chief Student Services and Enrollment Officer, at wtejeda@metcoinc.org.

We appreciate your partnership!

Let's get started.

PARENT/LEGAL GUARDIAN CONTACT INFORMATION

Parent/Legal Guardian First Name

Parent/Legal Guardian Last Name

Parent/Legal Guardian Phone

Parent/Legal Guardian Email

Address Line 1

Address Line 2

City

State

Zip Code

Is the Parent/Legal Guardian a METCO alumni?

YesNo

STUDENT INFORMATION

Student First Name

Student Last Name

Student Phone

Student Email

Student's METCO District

Your Student's Grade

MEDICAL INFORMATION

Who may we contact in case of emergency?

First Name

Last Name

Phone

Relationship

ALLERGIES

Does your child have any allergies (food or otherwise)?

NoYes

Please list your child's allergies:

Does your child carry and Epi Pen or asthma inhaler?

MEDICATIONS

Does your child carry any medications?

NoYes

Please list your child's medications:

Do you authorize METCO HQ to administer over-the-counter medications if needed such as Tylenol, Advil, Benadryl, etc.?

NoYes

Does your child have any medical conditions of which we should be aware?

NoYes

Please provide more detail.

MEDIA RELEASE FORM

METCO, Inc. staff may take photographic and/or video images of you and/or your child(ren) for marketing purposes. Please indicate whether METCO has your permission to take, use, and publish these images and videos in print and/or electronically.

I give permission for my and/or my child's photographs/videos to be used.

YesNo

Permission is granted for the following purposes: (please check all that apply)

Social media accounts and/or websitePresentations for public display (newsletters, slideshows, documentaries)Informational brochures, flyers, etc.Historical documentation of METCO activitiesAll of the above

Student's Full Name, District

Consent Expiration Date (up to five years from today's date)

TRAVEL PERMISSIONS

DISMISSAL FROM PROGRAMS

Your child may participate in METCO programming outside of the regular school day. We need to know how your child will be dismissed at the end of these programs.

How may your child get home at the end of programming?

Who do you authorize to pick up your student? Please list their name, phone number, and relationship.

FIELD TRIPS

As part of our programming, we may schedule field trips with students for educational purposes or community building. Some may require walking in the neighborhood, taking the bus, or public transportation.

Do you give consent for your child to participate in field trips? (Advanced notice with trip details will be shared with parents before the scheduled event.)

YesNo

PERMISSION SIGNATURE(S)

How old is the student?

Younger than 18Aged 18 years or older

Parent/Guardian Signature (if student is under 18)

Please type your full name

Student Signature (if student is 18 years or older)

Please type your full name

Today's Date