TLC Tutoring Program Application

This authorizes Teton Literacy Center and Teton County School District #1 to share written or verbal information regarding my child’s academic performance, diagnosis, history, including medication, progress, psychological and educational testing, medical and legal information, social welfare and rehabilitation, reports and other materials that are relevant to my child's care. I give my permission for the staff of Teton Literacy Center, this 21st CCLC program with services located at Teton Literacy Center, Munger Elementary School, and Jackson Hole Middle School to review my child’s academic and behavior progress reports or their report card in order to document growth and progress in my child during his/her time in this before/after school or summer program. This includes attendance, academic performance, teacher surveys and information about whether my child has an identified exceptionality, an Individual Education Plan or Academic Improvement Plan, and suggestions from my child’s teacher(s) on how my child can best be helped in the program. TLC will send Wyoming Department of Education grade reports from your child’s teacher using WISERID numbers where data will be aggregated at the state level to protect your child’s identification. This data is collected to evaluate the effectiveness of TLC programs.

I understand that my records are protected under the laws regarding confidentiality, and cannot be disclosed without written consent, except in specific situations.  This consent is valid throughout my child receiving services at Teton Literacy Center.

This Teton Literacy Program is funded through 21st Century Community Learning Centers funding, which is a FREE PROGRAM for students that could benefit from a variety of stimulating personal enrichment activities that promote school success and well-being in a safe environment. Active attendance and engagement are essential to the student and program’s success. I understand that the requirements of the program include the following:

• Failure to maintain attendance standards may result in termination from the program.
• Parents/guardians are required to notify the program if a youth will be absent and/or prior to withdrawal from the program.
• Youth will maintain a consistent weekly attendance and may not have more than 2 unexcused absences.  Parents or student must call to inform staff in advance if they will not be attending that day (307-733-9242). 
• Youth will participate in programming activities with an emphasis on literacy skills
• Youth will complete pre, mid-year and post assessments as required by the grant funded contract.
• Parents/Guardians will participate in a survey process at least once per year.
• Youth third grade and older will participate in a satisfaction survey process at least once per year. 

I have read, understand and agree to comply with the requirements of the policies and procedures listed above. I realize that failure to comply with these requirements may result in loss of my funded space within this program. I release the Teton Literacy Center, its staff, Board of Directors and volunteers from any liability.  

To reach our programmatic goals, the following is a list of expectations for our students. Please take some time to review these expectations with your student prior to the start of tutoring. Students must be respectful to the staff, volunteers, and other students, respecting others' physical space, safety and feelings. Staff must also be respectful of students.  

While TLC staff plans and prepares all lessons and activities, we have a robust pool of volunteer tutors who work directly with students to implement the lesson. To volunteer in TLC’s tutoring program, volunteers must go through a rigorous application and training process. Tutoring program volunteers also must commit to working with a student every week throughout the academic year. 

I understand that my tutor is volunteering their time to read with me. I will do my best to be on time. If I cannot attend, I will let Teton Literacy Center staff know as soon as possible. 

Students and families understand that in TLC programs, there can be students of different schools, diversities, cultures and ages. Students will be kind to all and accepting of each other. 

The use of culturally, racially or religiously insensitive remarks/mimics, foul language and/or profanity is not acceptable at any time. 

All students and families are expected to know and follow the rules of both Teton Literacy Center and Teton County School District. All Teton County School District rules apply when students and families are in Teton Literacy Center programs. These policies include playground protocol, wearing shoes at all times, sitting while eating snacks, using inside voices, walking in the hallways, and more. These policies are put in place to keep all students safe. 

Children must remain at their assigned locations for program activities until a parent signs them out, or written permission by their guardian(s) has been given. If there is a change in pick-up (examples: student needs to leave early, someone else will pick them up, walks home, etc.), families must notify instructors by 2:00 p.m. meter. If they are unable to do so, families may contact the TLC office and must complete check-out procedures.

Students and families understand that consequences will be applied to disruptive or dangerous behaviors. These will vary depending on the severity of the behavior.

If there is a discipline problem, the TLC staff will fill out a refocus form or incident report, depending on the severity of the problem. Parents will be notified via written communication. A family meeting may be scheduled. If behaviors continue after the family meeting, TLC may request a break in services. The student and family will work to build more appropriate behaviors.  

I/we understand that my child’s participation in Teton Literacy Center and Jackson Hole Children’s Museum out of school programs is voluntary and that my child and I/we are free to choose not to participate. I understand that participation in voluntary out of school activities includes risk of injury that may range in severity from minor to disabling to even death. Although serious injuries are not common in supervised school programs, it is impossible to eliminate the risk. 

I understand that Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers will not be liable for personal injuries and/or property damage as a result of my child’s participation in such programs or activities.

I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any loss, cost, damage and/or expense of any nature, including all attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s participation in afterschool programs or activities. 

I/We give permission for our son/daughter to participate in all Teton Literacy Center and Jackson Hole Children’s Museum afterschool activities and do forever indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any and all actions, all known and unknown personal injuries or property damage of said minor arising out of said activities, and also all claims or right of action for damages which said minor has or hereafter may acquire. 

I also have made arrangements to secure timely pick up of my child at the conclusion of each scheduled program. I understand that Parents/guardians are responsible for providing student transportation to and from activities.

I have read, understand and agree to comply with the requirements of the policies and procedures listed above. I realize that failure to comply with these requirements may result in loss of my funded space within this program. I/we accept the risk and responsibility of participation in Teton Literacy Center and Jackson Hole Children’s Museum afterschool programs and we Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers from any liability.

I/we understand that my child’s participation in Teton Literacy Center and Jackson Hole Children’s Museum out of school programs is voluntary and that my child and I/we are free to choose not to participate. I understand that participation in voluntary out of school activities includes risk of injury that may range in severity from minor to disabling to even death. Although serious injuries are not common in supervised school programs, it is impossible to eliminate the risk. 

I understand that Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers will not be liable for personal injuries and/or property damage as a result of my child’s participation in such programs or activities.

I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any loss, cost, damage and/or expense of any nature, including all attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s participation in afterschool programs or activities. 

I/We give permission for our son/daughter to participate in all Teton Literacy Center and Jackson Hole Children’s Museum afterschool activities and do forever indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any and all actions, all known and unknown personal injuries or property damage of said minor arising out of said activities, and also all claims or right of action for damages which said minor has or hereafter may acquire. 

I understand that if my student, during the day, has any COVID-19 symptoms, my student cannot attend programs that day unless they have a negative COVID-19 test or written permission from a doctor. Students and families exposed to, or sick with COVID-19, will comply with the current state, county or local orders to quarantine, social distance or wear a mask to limit the risk of exposure to others.

I also have made arrangements to secure timely pick up of my child at the conclusion of each scheduled program. I understand that Parents/guardians are responsible for providing student transportation to and from activities.

I have read, understand and agree to comply with the requirements of the policies and procedures listed above. I realize that failure to comply with these requirements may result in loss of my funded space within this program. I/we accept the risk and responsibility of participation in Teton Literacy Center and Jackson Hole Children’s Museum afterschool programs and we Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers from any liability.

The Teton Literacy Center may photograph, interview or videotape my children to use for volunteer instruction, marketing purposes and/or program fundraising. Please indicate below whether your child’s writings or photograph may be used for these purposes:

Photographic Release. Participant does hereby grant and convey unto Teton Literacy Center all right, title, and interest in any and all photographic images, video and/or audio recordings made by TLC during the Participant's activities with TLC, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. I further grant to the Teton Literacy Center and its representatives the right to reproduce, use, exhibit, display, broadcast, distribute and create derivative works of these images and recordings in any media now known or later developed as well as my/their name for promoting, publicizing or explaining the Teton Literacy Center and its activities and for administrative or educational purposes.

Please let us know what days and times of the week your student is available to attend tutoring. The more availability you list, the easier it will be for us to quickly match your student and get them enrolled in our tutoring program. 

All TLC tutoring sessions take place Monday-Thursday from 3pm-7pm.

This authorizes Teton Literacy Center and Teton County School District #1 to share written or verbal information regarding my child’s academic performance, diagnosis, history, including medication, progress, psychological and educational testing, medical and legal information, social welfare and rehabilitation, reports and other materials that are relevant to my child's care. I give my permission for the staff of Teton Literacy Center, this 21st CCLC program with services located at Teton Literacy Center, Munger Elementary School, and Jackson Hole Middle School to review my child’s academic and behavior progress reports or their report card in order to document growth and progress in my child during his/her time in this before/after school or summer program. This includes attendance, academic performance, teacher surveys and information about whether my child has an identified exceptionality, an Individual Education Plan or Academic Improvement Plan, and suggestions from my child’s teacher(s) on how my child can best be helped in the program. TLC will send Wyoming Department of Education grade reports from your child’s teacher using WISERID numbers where data will be aggregated at the state level to protect your child’s identification. This data is collected to evaluate the effectiveness of TLC programs.

I understand that my records are protected under the laws regarding confidentiality, and cannot be disclosed without written consent, except in specific situations.  This consent is valid throughout my child receiving services at Teton Literacy Center.

I/we understand that my child’s participation in Teton Literacy Center and Jackson Hole Children’s Museum out of school programs is voluntary and that my child and I/we are free to choose not to participate. I understand that participation in voluntary out of school activities includes risk of injury that may range in severity from minor to disabling to even death. Although serious injuries are not common in supervised school programs, it is impossible to eliminate the risk. 

I understand that Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers will not be liable for personal injuries and/or property damage as a result of my child’s participation in such programs or activities.

I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any loss, cost, damage and/or expense of any nature, including all attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s participation in afterschool programs or activities. 

I/We give permission for our son/daughter to participate in all Teton Literacy Center and Jackson Hole Children’s Museum afterschool activities and do forever indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any and all actions, all known and unknown personal injuries or property damage of said minor arising out of said activities, and also all claims or right of action for damages which said minor has or hereafter may acquire. 

I also have made arrangements to secure timely pick up of my child at the conclusion of each scheduled program. I understand that Parents/guardians are responsible for providing student transportation to and from activities.

I have read, understand and agree to comply with the requirements of the policies and procedures listed above. I realize that failure to comply with these requirements may result in loss of my funded space within this program. I/we accept the risk and responsibility of participation in Teton Literacy Center and Jackson Hole Children’s Museum afterschool programs and we Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers from any liability.

I/we understand that my child’s participation in Teton Literacy Center and Jackson Hole Children’s Museum out of school programs is voluntary and that my child and I/we are free to choose not to participate. I understand that participation in voluntary out of school activities includes risk of injury that may range in severity from minor to disabling to even death. Although serious injuries are not common in supervised school programs, it is impossible to eliminate the risk. 

I understand that Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers will not be liable for personal injuries and/or property damage as a result of my child’s participation in such programs or activities.

I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any loss, cost, damage and/or expense of any nature, including all attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s participation in afterschool programs or activities. 

I/We give permission for our son/daughter to participate in all Teton Literacy Center and Jackson Hole Children’s Museum afterschool activities and do forever indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any and all actions, all known and unknown personal injuries or property damage of said minor arising out of said activities, and also all claims or right of action for damages which said minor has or hereafter may acquire. 

I understand that if my student, during the day, has any COVID-19 symptoms, my student cannot attend programs that day unless they have a negative COVID-19 test or written permission from a doctor. Students and families exposed to, or sick with COVID-19, will comply with the current state, county or local orders to quarantine, social distance or wear a mask to limit the risk of exposure to others.

I also have made arrangements to secure timely pick up of my child at the conclusion of each scheduled program. I understand that Parents/guardians are responsible for providing student transportation to and from activities.

I have read, understand and agree to comply with the requirements of the policies and procedures listed above. I realize that failure to comply with these requirements may result in loss of my funded space within this program. I/we accept the risk and responsibility of participation in Teton Literacy Center and Jackson Hole Children’s Museum afterschool programs and we Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers from any liability.

The Teton Literacy Center may photograph, interview or videotape my children to use for volunteer instruction, marketing purposes and/or program fundraising. Please indicate below whether your child’s writings or photograph may be used for these purposes:

Photographic Release. Participant does hereby grant and convey unto Teton Literacy Center all right, title, and interest in any and all photographic images, video and/or audio recordings made by TLC during the Participant's activities with TLC, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. I further grant to the Teton Literacy Center and its representatives the right to reproduce, use, exhibit, display, broadcast, distribute and create derivative works of these images and recordings in any media now known or later developed as well as my/their name for promoting, publicizing or explaining the Teton Literacy Center and its activities and for administrative or educational purposes.

Please let us know what days and times of the week your student is available to attend tutoring. The more availability you list, the easier it will be for us to quickly match your student and get them enrolled in our tutoring program. 

All TLC tutoring sessions take place Monday-Thursday from 3pm-7pm. 

This authorizes Teton Literacy Center and Teton County School District #1 to share written or verbal information regarding my child’s academic performance, diagnosis, history, including medication, progress, psychological and educational testing, medical and legal information, social welfare and rehabilitation, reports and other materials that are relevant to my child's care. I give my permission for the staff of Teton Literacy Center, this 21st CCLC program with services located at Teton Literacy Center, Munger Elementary School, and Jackson Hole Middle School to review my child’s academic and behavior progress reports or their report card in order to document growth and progress in my child during his/her time in this before/after school or summer program. This includes attendance, academic performance, teacher surveys and information about whether my child has an identified exceptionality, an Individual Education Plan or Academic Improvement Plan, and suggestions from my child’s teacher(s) on how my child can best be helped in the program. TLC will send Wyoming Department of Education grade reports from your child’s teacher using WISERID numbers where data will be aggregated at the state level to protect your child’s identification. This data is collected to evaluate the effectiveness of TLC programs.

I understand that my records are protected under the laws regarding confidentiality, and cannot be disclosed without written consent, except in specific situations.  This consent is valid throughout my child receiving services at Teton Literacy Center.

I/we understand that my child’s participation in Teton Literacy Center and Jackson Hole Children’s Museum out of school programs is voluntary and that my child and I/we are free to choose not to participate. I understand that participation in voluntary out of school activities includes risk of injury that may range in severity from minor to disabling to even death. Although serious injuries are not common in supervised school programs, it is impossible to eliminate the risk. 

I understand that Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers will not be liable for personal injuries and/or property damage as a result of my child’s participation in such programs or activities.

I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any loss, cost, damage and/or expense of any nature, including all attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s participation in afterschool programs or activities. 

I/We give permission for our son/daughter to participate in all Teton Literacy Center and Jackson Hole Children’s Museum afterschool activities and do forever indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any and all actions, all known and unknown personal injuries or property damage of said minor arising out of said activities, and also all claims or right of action for damages which said minor has or hereafter may acquire. 

I also have made arrangements to secure timely pick up of my child at the conclusion of each scheduled program. I understand that Parents/guardians are responsible for providing student transportation to and from activities.

I have read, understand and agree to comply with the requirements of the policies and procedures listed above. I realize that failure to comply with these requirements may result in loss of my funded space within this program. I/we accept the risk and responsibility of participation in Teton Literacy Center and Jackson Hole Children’s Museum afterschool programs and we Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers from any liability.

I/we understand that my child’s participation in Teton Literacy Center and Jackson Hole Children’s Museum out of school programs is voluntary and that my child and I/we are free to choose not to participate. I understand that participation in voluntary out of school activities includes risk of injury that may range in severity from minor to disabling to even death. Although serious injuries are not common in supervised school programs, it is impossible to eliminate the risk. 

I understand that Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers will not be liable for personal injuries and/or property damage as a result of my child’s participation in such programs or activities.

I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any loss, cost, damage and/or expense of any nature, including all attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s participation in afterschool programs or activities. 

I/We give permission for our son/daughter to participate in all Teton Literacy Center and Jackson Hole Children’s Museum afterschool activities and do forever indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any and all actions, all known and unknown personal injuries or property damage of said minor arising out of said activities, and also all claims or right of action for damages which said minor has or hereafter may acquire. 

I understand that if my student, during the day, has any COVID-19 symptoms, my student cannot attend programs that day unless they have a negative COVID-19 test or written permission from a doctor. Students and families exposed to, or sick with COVID-19, will comply with the current state, county or local orders to quarantine, social distance or wear a mask to limit the risk of exposure to others.

I also have made arrangements to secure timely pick up of my child at the conclusion of each scheduled program. I understand that Parents/guardians are responsible for providing student transportation to and from activities.

I have read, understand and agree to comply with the requirements of the policies and procedures listed above. I realize that failure to comply with these requirements may result in loss of my funded space within this program. I/we accept the risk and responsibility of participation in Teton Literacy Center and Jackson Hole Children’s Museum afterschool programs and we Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers from any liability.

The Teton Literacy Center may photograph, interview or videotape my children to use for volunteer instruction, marketing purposes and/or program fundraising. Please indicate below whether your child’s writings or photograph may be used for these purposes:

Photographic Release. Participant does hereby grant and convey unto Teton Literacy Center all right, title, and interest in any and all photographic images, video and/or audio recordings made by TLC during the Participant's activities with TLC, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. I further grant to the Teton Literacy Center and its representatives the right to reproduce, use, exhibit, display, broadcast, distribute and create derivative works of these images and recordings in any media now known or later developed as well as my/their name for promoting, publicizing or explaining the Teton Literacy Center and its activities and for administrative or educational purposes.

Please let us know what days and times of the week your student is available to attend tutoring. The more availability you list, the easier it will be for us to quickly match your student and get them enrolled in our tutoring program. 

All TLC tutoring sessions take place Monday-Thursday from 3pm-7pm.