Programs for At-Risk Youth, Sullivan County, NY

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Dream Tank Activities & Field Trip Consents
- I give permission for my child to participate in ALL program activities, events, and field trips
- I give permission for program staff to transport my child in their own personal vehicle.
- I give permission for MCSD to transport my child to all programs, activities and field trips (MCSD Students Only)
There may be certain days where after school Dream Tank activities last longer than 4:30pm. When that occurs, MCSD late buses will be unavailable to bring your child home. Please see activity schedule for days which that will occur. That schedule is subject to change and there may be other activities that require your child to find their own means of transportation home. Please note below how you would like your child to get home:
Please indicate which program you would like your child to attend:
- Wednesday After School Sister Sister Program from 2:30pm-4:30pm (MCSD Females Only)
- Thursday After School Program from 2:30pm-4:30pm (MCSD Students Only)
- Saturday Music Enrichment Program from 11:00am-2:00pm (Open to ALL residents of Sullivan County)
- Wednesdays 2:30-5:30 Recording studio
My child is allowed to walk home if activity is located at school or close to home in Monticello:
Circle One:
- YES
- NO
If no, student will be required to be picked up by parent/guardian or person(s) noted below:
Person Picking Up Child / Relationship & Phone Number:
I acknowledge that my child is in good physical health and suffers from no condition that would restrict her/him from participation in any program activities.

Liability Clause: I understand that Monticello Central School District and Creative Think Tank inc. (a.k.a. Dream Tank) shall not be responsible or legally liable for any bodily injuries or the result thereof incurred and suffered by my child while engaged in any activity, unless such loss or injury results directly from negligence or willful act of any employee or volunteer of the Monticello Central School District or Creative Think Tank inc. (a.k.a. Dream Tank) acting outside the scope of their employment duties.

Medical Consent: I consent that my child be transported and given medical treatment if needed.

Other: I also give consent for my child to have their photo or video published for advertisements, publications, social media or press release.

By signing I am confirming that I have read and understand this document in its entirety and I am in full agreement. I am granting permission for my child to participate in all programs and activities. Should any circumstances arise during the event, I will be available to pick up my child. My child knows that inappropriate behavior may result in removal from activities and ineligibility from future events.
Name of child enrolling in MBK:
Name of parent / legal guardian:
Address of parent/ legal guardian:
Phone number of parent / legal guardian:
Signature of parent / legal guardian:
Date
MM slash DD slash YYYY
Please state any food allergies or any other information about your child that we should be aware of:

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P. O Box 159 Kiamesha, N.Y. 12751

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