Voluntary Participation for The Acorn School

I am requesting that my family be included in my child’s classroom roster. I understand that my decision to participate is purely voluntary. I will leave the Family Information form (below) blank if I choose to opt out.

I understand the classroom roster will be printed and published and released to the other families in my child’s classroom and provided to the Parent CONNECT group. The intent of the roster is to support community through the development of peer relationships by identifying one way for children and their families to engage for playdates and recreation.

Access to this information may not be used for marketing, research, or other business purposes.

This agreement is completed for Child name This agreement is completed for Child name First Last
Parent Name Parent Name First Last
AGREEMENTS
I have read The Acorn School Family Handbook and agree to comply with the policies and procedures contained therein.

I have read The Acorn School Family Handbook and agree to comply with the policies and procedures contained therein. I have been provided a copy of and thoroughly read the Family Handbook. I understand that a copy is also available on the VCFC website. I have read and understand and agree to comply with the policies and procedures set forth in the Handbook. I understand and agree that neither Vanderbilt Child and Family Center, Vanderbilt University, nor any of their officers, agents, or employees are liable for bodily injuries or illnesses suffered by my child(ren) or for damages to personal belongings. I understand that Vanderbilt cannot promise or guarantee that my child will not be exposed to Covid-19 or any other infectious disease. I understand that if my child is immunocompromised my child could be at greater risk of infection and complications. I knowingly accept these risks. I understand that the illness and exposure procedures contained in the FAQ section of the program application are fluid and that procedures may change depending on the Vanderbilt Return to Campus Plan as well as DHS, Metro Nashville, and the CDC guidelines and recommendations. I understand that failure to comply with procedures may result in disenrollment of my child. I understand that VCFC reserves the right to update this Handbook at any time, to ensure compliance with Vanderbilt University and State of Tennessee Department of Human Services (DHS) policies and practices and for the continued safety of children and staff. I give permission for staff to include my child on walking/stroller field trips. I understand children will be accompanied by staff and stay within 1.5 miles of the classroom. I give permission for my student's image to be used in photographs and or any media within the Acorn program's creative space (e.g., bulletin boards, crafts, booklets.)
I give permission for my student's image to be used on the VCFC website and VU website and publications. I give permission for staff to apply sunscreen to my child as needed. I understand that I am responsible for supplying the sunscreen and that the sunscreen I supply must be in the original container, labeled with my child's first and last name. I give permission for staff to apply insect repellant to my child as needed. I understand that I am responsible for supplying insect repellant and that the insect repellant I supply must be in the original container, labeled with my child's first and last name.
Name of Child to be Enrolled Name of Child to be Enrolled First Last
Date
Parent/Guardian Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
I give permission for my child’s image to be shared on The Acorn School classroom electronic updates (including Tadpoles) and on the electronic bulletin board in the center lobby.

I give permission for my child’s image to be shared on The Acorn School classroom electronic updates (including Tadpoles) and on the electronic bulletin board in the center lobby. Yes No
I give permission for my child’s image to be used on VU social media, websites and publications.

I give permission for my child’s image to be used on VU social media, websites and publications. Yes No
Parent Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
A copy of this form will be maintained in your child’s file
Please provide only the information that you want to be included in the July 2021-August 2022 School Year classroom roster. You may choose to leave lines blank. Print clearly.
Child's Name Child's Name First Last
Date of birth Date of birth / MM / DD YYYY
Nickname
Parent's Name Parent's Name First Last
Phone Phone - ### - ### ####
Email
Parent's Name Parent's Name First Last
Phone Phone - ### - ### ####
Email

Voluntary Participation for The Acorn School

Voluntary Participation for The Acorn School

AGREEMENTS

Please provide only the information that you want to be included in the July 2021-August 2022 School Year classroom roster. You may choose to leave lines blank. Print clearly.