PREP'd Connect Application

* First Name

Middle Name

* Last Name

* Date of Birth

* Address

* City

* State

* Zip Code

* Student's Phone Number

The best number to reach you

* School

* Current Grade Level

* Student's Email

* Parent/Guardian First Name

* Parent/Guardian Last Name

* Parent/Guardian Relationship

* Parent/Guardian's Email

* Parent/Guardian's Phone

* Emergency Contact Name

* Emergency Contact Phone

* Emergency Contact Relationship

* Primary Language Spoken at Home

* T-Shirt Size

* How could this program help you achieve your educational and career goals?

* Are there any special circumstances we should be made aware of? (Individualized Education Plan Accommodations, 504 Plan Accomodations, etc.)

Please list any Allergies/Food Allergies/Health Concerns

Release of Photograph and/or Name: If selected to participate in the futurePREP’d program, I give permission for Ottawa Area Intermediate School District (OAISD) and it’s futurePREP’d partner organizations to use photographs or digital images/ recordings for display and/or promotional purposes as and when required, including in print, video or any other format or publication determined by OAISD. I also give OAISD permission to publish my name in conjunction with the use of these photographs or images, and to quote or record statements from me for promotions, advertisements, publicity, and other purposes. I understand and agree that the OAISD may use these images on the Internet, and may copyright or otherwise protect its use of these images.

* Student/Parent agrees to the photograph/name release:

Student/Parent Statement of Commitment: Acceptance into a futurePREP’d program brings with it certain responsibilities for the student, parent/guardian, and the partnering companies/organizations. The futurePREP’d program will offer a variety of opportunities for academic and personal development. Meeting these requirements listed below is essential to success in the program. Responsibilities for the student will include, but are not limited to:

Adhere to proper dress code
Attendance & participation
Professional behavior
All regular school work Is maintained
Positive behavior

***If these responsibilities are not met, program membership may be terminated***

* Student/Parent agrees to the futurePREP'd commitment:

Student/Parent Academic Transcripts Permissions: I give my permission for the futurePREP’d program staff to obtain any of my/my students' academic or personal records which are deemed necessary to assist me/my child before, during or after participation in the program.

* Student/Parent agrees to the Academic transcript release:

Transportation Permission: Upon drop off at your child's designated location, the team will have an OAISD-approved vehicle to transport students for various field trips/lunch/other outings as needed. I hereby grant permission for my child to ride in OAISD transportation with an OAISD-approved driver during the program. I agree to assume all risks associated with any group transportation, including but not limited to risks of injury, property damage, and loss; as well as not holding the District responsible for any injuries, damages, or losses that may occur during the course of any group transportation.

* Parent agrees to transportation permission:

* - Required Value

The OAISD does not discriminate on the basis of race, color, religion, sex, national origin, age, height, weight, marital status, handicap, disability, or limited English proficiency in any of its programs or activities. The following office has been designated to handle inquiries regarding nondiscrimination policies: Human Rights Officer, Human Resources Department – Ottawa Area Intermediate School District – 13565 Port Sheldon Street Holland, MI 49424 – 1-877-702-8600 (toll free)