By checking this box, I am indicating consent and authorizing Knowledge Quest to provide first aid and/or to secure medical care in the case of an emergency for the child named on this application. I authorize the physician or hospital I provided in this section to treat my child in the event of an emergency. If this physician or hospital is not available or cannot be reached, I consent to care and treatment being administered by another licensed physician or treatment facility. I realize that I will be responsible for any costs of treatment. I will not hold Knowledge Quest or any of its staff or affiliates liable.

My child has permission to sign himself or herself in and out of KQ programming. I give consent for my child to be released as an independent walker and leave at the end of programming without adult supervision. Knowledge Quest will not be responsible for my child when they leave the program.

MODE OF TRANSPORTATION: By indicating that your child is a walker you agree to indemnify and hold Knowledge Quest, its employees, board of directors, and/affiliates harmless of any such claim, demand, cause of action or any legal or equitable action arising out of relating to your child/children in said mode of transportation. As parent/legal guardian. I waive any rights to litigation regarding accident, injury, and/or expiry after my child has been dismissed from Knowledge Quest.

I give my permission for the child named on this application to engage in all off and on campus learning, recreational, and field trip experiences provided through Knowledge Quest programming during and after standard operation hours.

I agree to release Knowledge Quest, its employees, and affiliates from liability for injuries or loss of life resulting from or occurring during these activities as a result of regular program operations.

I hereby release and hold harmless Knowledge Quest, its employees, board of directors, and/or affiliates from any liability which may arise out of or in connection with my child/children's traveling as a part of Knowledge Quest, including, but not limited to potential claims, demands and causes or action for compensatory or punitive damages, attorney fees, costs, and other legal or equitable relief of any other legal or equitable relief of any kind, for injuries and damages, and the consequences thereof, whether known or unknown, foreseen or unforeseen, arising out of or resulting from Knowledge Quest, its staff, its affiliates or representatives.

I further agree to indemnify and hold Knowledge Quest, its employees, board of directors, and/or affiliates harmless of any such claim, demand, cause of action or any legal or equitable action arising out of relating to my child(ren) in said event. As parent/legal guardian, I waive any rights to litigation regarding accident, injury, and/or expiry through my child's participation in the program.

As a participant in Knowledge Quest's Extended Learning Academy programming, your child receives education support services designed to ensure students succeed academically. This program is monitored through the Tennessee Department of Education. As such, it is vital that KQ has access to your student's records. As a part of program enrollment, Knowledge Quest requests written access to information about a student that is connected to a student's identity, including demographic information, grades, test scores, progress reports, attendance records, discipline records, student ID number, and registration records.

The Family Education Rights and Privacy Act (FERPA) protects students and parents by prohibiting most third parties, including Knowledge Quest, from accessing student records, information, or data without written permission from a parent or guardian if the student is under 18.

The purpose for accessing or sharing education records, information, or data related to your student is to better provide education support services and meet the reporting requirements set forth by the Department of Education. No records, information, or data will be used for any other purpose than those of service differentiation or improvement and reporting.

By consenting below, you are giving written permission for education records, information, or data about your student to be shared with Knowledge Quest. This information may come directly from the school, Memphis-Shelby County School District, or through partnership with Seeding Success.

Records and information from records will not be shared or given to anyone other than the parties mentioned above.

You have the right to revoke this consent at any time if you do not want records, information, or data shared, or if you do not believe the sharing of records, information, or data is in the best interest of your student. You also have the right to obtain copies of any information about your student that is shared as a result of this form. Should you wish to revoke this consent, you must provide to Knowledge Quest written notice of your decision to revoke. Unless and until this revocation is made, this consent shall remain in effect until your student turns 18.

By checking this box I am confirming that I have completed this application to the best of my ability in all honesty. I am the parent/legal guardian of the child listed above. I give my permission for his/her participation in Knowledge Quest programming.