Rising Above Tutoring Program Registration Registration We are very happy that you have chosen to enroll your child in our Rising Above Tutoring Program. Please fill out the registration form below and we will be in touch shortly.Child's First and Last Name *Please enter the names that your child uses (does not need to be their legal names). This is how your child is known to their teacher and peers.Birth Date *Gender *MaleFemaleOtherSchool *Enter the name of the school your child attends OR enter "Home Schooled" if applicable.Current School Grade: *Teacher's Name: *Subject Your Child Needs Assistance With *EnglishMathParent/Guardian's Name: *Please enter the First and Last NameParent/Guardian's Relationship to Child: *FatherMotherGrandfatherGrandmotherUncleAuntLegal GuardianHome Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryHome Phone: Cell Phone: *Email: *How do you wish to be contacted *EmailPhoneTextTutoring Program Director If you have questions regarding the tutoring program, please contact Maria Choy, Tutoring Program Director at 604-512-2338. Authorization and Waiver Information received is confidential and is being gathered for the purposes of serving your child while in the care of Vancouver Urban Ministries. Any medical information collected here serves to authorize Vancouver Urban Ministries, and its staff and volunteers, to obtain medical assistance in emergencies for the school year 2023-2024.Child's Full Legal Name: *Please provide the FULL LEGAL name of your child (also include their middle names if applicable).Child's BC Medical Number *Emergency Contact Name: *Please enter the First and Last NameEmergency Contact Phone: *Relationship of this Emergency Contact to Your Child: *Additional Information: *Does your child have any allergies, physical, emotional, mental, behavioral concerns or limitations that our staff should be aware of?Medical Release I/we, the parents or guardians named above, authorize VUM staff or volunteers to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above. I/we, named above undertake and agree to indemnify and hold blameless VUM staff and volunteers from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Vancouver Urban Ministries activities, as well as of any medical treatment authorized by the supervising individuals representing Vancouver Urban Ministries. This consent and authorization is effective only when participating in or traveling to and from events of Vancouver Urban Ministries. This includes off-site events and events requiring intense physical activity.Release of Photographic Images During VUM events and at other times, I/we understand that you may take photos that will include our child or family which may or may not end up being used for promotional purposes. I/we give permission for my child's and family's photo to be taken and used for VUM promotion purposes.Signature I have read, understood and agree with the above, and sign it to cover all of Vancouver Urban Ministries’ activities. Activities for the program effective from date signed through September 30, 2024. By typing your name here you agree to the terms and conditions of this authorization and waiver.*Name of Person Signing This Waiver: *Please enter the First and Last NamePhone Number of Person Signing This Waiver: *Purpose and Extent Vancouver Urban Ministries is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities in our ministries. This information will be maintained indefinitely, as it is a requirement from our board and legal counsel. If you wish Vancouver Urban Ministries to limit the information collected, or to view your child’s information, please contact us.Text Email VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
