Xposure Club X After-School Program Pre-Registration Survey (2020-21)

Grade *
Are you an DSS/HRA client or are eligible to receive financial assistance through DSS/ACS Vouchers?
Are there extenuating circumstances that affects your current financial situation?

Please list any adults that will be allowed to pick up your child and a contact number for this person (Also give relation to child)

I, being the parent/guardian, hereby consent that the photographs and/or motion picture/video film, or internet recordings from the filming or taping of activities at the Xposure Foundation Science, Technology, Finance and Employment Institute for Youth may be used by Xposure Foundation Inc., their assigns or successors, in whatever way they desire, including television, the world wide web and other electronic purposes. The purpose of this release is to give Xposure Foundation Inc. the ability to create materials, products and awareness that will aid in a variety of marketing, fundraising and educational projects.

This would include posting said photographs and/or motion picture/video on the Xposure website and/or other sites, television, marketing, fundraising tapes/DVD's and other mediums. Furthermore, I hereby consent that such photographs, film, video recordings, videotapes and all other visual mediums, internet radio or music recordings may be used free and clear of any claim whatsoever on my part and is the sole property of Xposure Foundation Inc.

This application does not guarantee admittance, once all information is reviewed, we will notify each parent regarding acceptance.