Please print all three release forms and mail completed copies, along with the completed Registration Form, to Generation Xcel, 9 East 7th Street, New York, NY 10003, or fax them to 212-673-5595.

X-PRESS
ACTIVITY RELEASE FORM

September 2003      

I hereby give permission for my Child to attend X-press @ The 88-Step Theater, a performing arts after school program by teens for teens between the hours of 3:00 p.m. and 7:00 p.m., Monday through Friday, from September 15, 2003 to June 4, 2004, at 9 East 7th Street, corner of 3rd Avenue (the “Premises”).  I also permit my Child to participate in any activities and/or outings hosted, sponsored, or conducted in connection with Generation Xcel including, but not limited to, athletics, dance or drama workshops, and field trips throughout New York City.

I understand that once my child signs out from the Premises, or is picked up by an authorized individual, the Generation Xcel Staff is no longer responsible for my child.

I certify that the information contained in the attached registration form is true and accurate to the best of my knowledge.

I hereby release Generation Xcel and Community Solutions, Inc. from all legal liability for my child.

Child's Name: ______________________________________

Parent/Guardian: ____________________________________

Address: ___________________________________________
No. Street Apt.

City/State: _________________________ Zip Code: _______________

Telephone: _______________________________________________
Home & Work

___________________
Date

_______________________________
Parent/Guardian Signature
               

Audio and Video/Film and Photography Release

I give my child, _________________________, permission to participate in any audio or video/film or photography projects with Generation Xcel that may from time to time arise in connection with the activities of Generation Xcel. I understand that his/her participation may be used in audio productions or video/film productions or on the Internet for educational or promotional purposes; video/film festivals; television exposure; public service announcements; and all other broadcasting or non-broadcasting purposes in any matter of media, in perpetuity throughout the United States and abroad. I understand that my child's participation offers no remuneration, unless expressly noticed in writing at the time of a specific project.

I grant permission for Generation Xcel to use my child's first name and/or likeness for publicity or institutional promotional purposes, and to edit, produce, and record for duplication and distribution that likeness as appropriate. I expressly release Generation Xcel, Community Solutions, Inc., and any of their licensees, assignees, affiliates and successors from any privacy, defamation, or other claim I may have arising out of any audio or video/film or photography project or the use thereof.

Child's Name: ______________________________________

Parent/Guardian: ____________________________________

Address: ___________________________________________
No. Street Apt.

City/State: _________________________ Zip Code: _______________

Telephone #: _______________________________________________
Home & Work

___________________
Date

_______________________________
Parent/Guardian Signature

Academic Information Release Form

I_____________________________________ (print full name of parent/guardian), as parent/guardian of ___________________________________________________ (print full name of child), authorize the New York City Department of Education, _______________________________ (print full name of child's school), and their representatives, to release information about my child, including, but not limited to, attendance records, standardized test scores, assessments, report cards, progress reports, and other information related to my child's academic and social performance in school, to the site director or education coordinator for Generation Xcel. Generation Xcel agrees to keep all such information strictly confidential, and to use it, in consultation with the child's educators and parents, to craft an after-school education strategy that supplements and supports the education received at school.

_____________________________
Print full name of parent/guardian

_____________________________
Parent/Guardian Signature

_____________
Date

_______________________
School Code

_________________________
Student ID#

The information released to Generation Xcel and its representatives will be kept confidential. Failure to maintain confidentiality will subject parties to all penalties and/or sanctions applicable under the full extent of the law.