Beat the Streets Weekend Tutoring Program

Permission Slip
Completion of this form is required for participation
Dear Parents,
Your child has been selected to participate in tutoring services combined with wrestling training in the Beat the Streets/John
Hopkins University Sunday program. This is an important opportunity to help your child improve in school. By sending your child
to the program every Sunday you are showing support and helping your child to be a success in the years to come.
The emphasis of the program will be on reading/math and homework tutoring with enrichment opportunities. Your child will report to
tutoring with the Alpha Phi Omega Honor Society during the first hour academic class then he/she will transition to a wrestling
practice with members of the John Hopkins University Wrestling Team. Students will receive lunch during the tutoring session.
During this time they will have homework assistance and then work on either math or reading lessons to help them improve in that
area.
The program will be held on John Hopkins University campus, Mattin Building on Sundays from 1:00 - 3:30 pm. Beat the Streets
will provide transportation during the first 3 weeks of the program. In future weeks, we will coordinate a transportation schedule and
will utilize carpooling with your assistance.
I give my permission for my child to participate in this youth wrestling tournament. I understand that wrestling is a strenuous sport
that involves physical contact. In consideration of this activity, I release all individuals associated with the John Hopkins University,
Baltimore City Public Schools and Beat the Streets - Baltimore, including all coaches, administrators, assistants, volunteers and
referees, from any liability of claims for injury or loss arising out of my childs participation. I consent to any emergency treatment of
my child on my behalf.
In granting this permission, I assume full responsibility for any damage to person or property caused by my child. I agree that if it is
determined that my child needs medical or dental treatment I will be responsible for any such treatment determined necessary by a
physician or dentist.
There will be chaperones accompanying the student or groups of students not only during the scheduled activity but whenever they
leave the activity site, however, parents are welcome to participate and join us.
I hereby give permission for my child, _____________________________________________, to participate in the Beat the
Streets/John Hopkins University program.
Signature of parent/guardian: ____________________________________________
Address: ____________________________________________________________

Date: ___________________________
Phone: _________________________

If you have health insurance, please list:

Health Insurance Company: ___________________________________

Policy Number: __________________________

Group Number: __________________________

In the event of illness or accident, if different from above, please contact:

Name: _____________________________________________________
Phone: _________________________________
Address: ________________________________________________________________________________________________

I acknowledge that I have carefully read this document and understand the information therein. I agree to each of
the terms and acknowledgments above, and agree to permit my child to participate in the trip described above.
Beat the Streets Baltimore