The Skills Center Collaborative Interest Form

Please review and complete the Interest form below.

INTEREST FORM DATA IS USED FOR THE PURPOSES OF MAINTAINING FUNDING TO PROVIDE THESE FREE PROGRAMS.

THE SKILLS CENTER IS CREATING A PLACE WHERE EVERY YOUNG PERSON HAS THE OPPORTUNITY TO SUCCEED, A PLACE WHERE ESSENTIAL SKILLS ARE DEVELOPED, POSITIVE RELATIONSHIPS ARE GROWN AND SOLUTIONS TO SYSTEMATIC CHALLENGES FACING YOUTH ARE ADDRESSED.

Student Information

Student Name
Student Name
First
Last
Student Ethnicity
Free or Reduced Priced Lunch

Parent/Guardian Information

Parent/Guardian Name
Parent/Guardian Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Household Income
REGISTRATION DATA IS USED FOR THE PURPOSES OF MAINTAINING FUNDING TO PROVIDE THIS FREE PROGRAM.
Number of People Living in the Household
REGISTRATION DATA IS USED FOR THE PURPOSES OF MAINTAINING FUNDING TO PROVIDE THIS FREE PROGRAM.

Emergency Contact Information

Emergency Contact Name
Emergency Contact Name
First
Last
What programs are you interested in? (Check all that apply)
What is your preferred method of contact for our Youth Development Specialist to contact you about the programs you are interested in?
Since you selected Cell phone as your preferred method of contact, what is the best time to contact you by cell phone?
PERMISSION WAIVER
I allow my child to participate in The Skills Center Collaborative’s programs and youth focus groups. I understand that my child will participate in in-person, virtual, and/or online self-paced programming.  Your child will be expected to complete surveys and participate in focus groups around better-providing services to young people and the type of program/services of their interest.
EDUCATION DATA
As part of this program, we plan to assess and support your child’s academic success and would like permission to gather the following data when needed during the program about your child from Hillsborough County Public Schools or their charter/private school. We are requesting access to one or more of the following records: report card, progress report, test score, GPA, behavioral, attendance, and/or IEP.

Federal Law (FERPA)
requires us to keep educational information about your child private. We will keep your child’s records private by not sharing with anyone outside of our programs, locking/password protected files in file cabinets when not in use. We will only use the educational data for the purposes explained and we will not save any individually identifiable educational data for your child.
LIABILITY RELEASE

I understand that even when every reasonable precaution is taken, accidents can sometimes still happen. I understand the risk to my child participating in programs in the age of COVID-19 and take full responsibility to ensuring that he/she adheres to the CDC’s safety guidelines on communicable diseases as well as the rules and regulations at The Skills Center. I understand and expressly acknowledge that I release The SKILLS CENTER, INC., as well as all other partners, and their staff members from all liability for any injury, sickness, loss or damage connected in any way whatsoever to participation in The SKILLS CENTER COLLABORATIVE’S program activities whether on or off the program and partners’ premises.

I understand that at the discretion of program supervisor and/or staff my child may be dismissed from the program, for inappropriate behavior and displaying symptoms of Covid-19 or other communicable diseases.

I give permission to us photographs and/or video of my child in publications, news releases, online and in other communications related to the mission of The Skills Center Collaborative and its partners.
EMERGENCY TREATMENT
I understand that if a medical emergency occurs The Skills Center and/or its partners will contact me first, then the emergency contact person designated. If necessary, I authorize the Skills Center to arrange immediate medical treatment for my child’s health and safety. I will be financially responsible for all charges and fees incurred in the rendering of said treatment.

I understand that if my child uses an EpiPen or inhaler, they must bring with them to all programs.