After School Makerspace @ Costano ELementary

Robotics, Fashion Design, 3D Design, and Much More!

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Student Information

Student Name*

Student Email*

Please input a personal email. Do not use your school or work email, as they will block StreetCode from sending emails through to you.

Student Phone Number*

We need your phone number to be able to follow up with your class selections and to let you know when your classes are in session!

Student Ethnicity*

Student Gender*

Female

Male

Non-binary

Prefer not to answer

Student Birthdate*

Student Age (Auto-Calculated)*

Student Address*

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Counties

San Mateo

Alameda

Santa Clara

N/A

Language Preference*

English

Spanish

Tongan

Parent/Guardian Information

Parent/Guardian Name*

Parent/Guardian Email*

Please input a personal email. Do not use your school or work email, as they will block StreetCode from sending emails through to you.

Parent/Guardian Phone*

We need your phone number to be able to follow up with your class selections and to let you know when your classes occur!

Relationship to Student*

Parent/Guardian Ethnicity

Parent/Guardian Gender

Female

Male

Non-binary

Prefer not to answer

Parent/Guardian Birthdate*

Parent/Guardian Address*

Same As Student Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Has The Student Attended StreetCode Academy Programs Before?

Yes

i.e. Classes, Pop-Ups, Workshops, Level Up Program, etc.

What other tech classes have you taken before?

How did you hear about us?

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Are you involved with any of our Partner Organizations?

Consent to StreetCode Marketing Emails

Send me free StreetCode classes, educational events, job opportunities, community resources, and more... Note: You will still receive emails about your class if you choose "no"

Yes

Emergency Contact Information & Liability Release

Emergency Contact Name*

Emergency Contact Phone Number*

Relationship with Emergency Contact*

Waiver and Release of Liability*

Introduction
StreetCode strives to reach families in their existing communities through a combination of offerings that include both onsite instruction and digital curriculum. In line with its mission, StreetCode Academy believes that courses on coding, entrepreneurship, and design should be accessible to all.

Technology Vision Statement
Technology is purposefully integrated to elevate and transform learning experiences. Each interaction with technology empowers students to become resourceful creators, confident inquirers, and critical thinkers. Guidance about how to act safely and ethically helps our students thrive as citizens of an extremely connected world.

Accounts
StreetCode Academy utilizes several computer software applications and web-based services, created, operated, and serviced not by StreetCode Academy directly, but by third parties. Some of these include but are not limited to, Dropbox, Adobe Suite, Google G-Suite, Tynker, Nearpod, and similar educational programs. Our instructors’ thoughtful and developmentally-appropriate use of these programs provides yet another way for us to engage students and individualize learning.
So that StreetCode students can use these and other web-based software programs and services, certain personal identifying information (generally a student’s name, age, and email address) must be provided to the website or software owner or operator, so that, for example, student accounts or folders can be opened. Under federal law, these websites must provide parental notification and obtain parental consent before collecting personal information from children.
US law permits programs such as StreetCode Academy to provide consent to the collection of personal information on behalf of all of its students, thereby eliminating the need for parents to provide direct consent to each digital service we utilize.
Your acceptance of these terms will constitute your consent for StreetCode Academy to provide personal identifying information for you/your child required by the web site and/or software owners or operators noted above and to any additional web-based educational programs and services StreetCode Academy may add during the upcoming session.

Recordings
StreetCode Academy’s programs occasionally involve the use of video and/or audio recording for lessons, meetings, and virtual communications. These recordings are necessary in order for us to make available this important learning information for any students who are unable to participate in real-time due to illness or other reasons, to give students repeated access to these learning materials as appropriate, and to allow us to learn from and improve upon our online learning efforts and platform. It’s also important to protect participants and staff in any one-on-one interactions.
Given the ability of video and audio recordings to pick up a broad range of sights and sounds, personal information about you, other members of your household and your home may be recorded.
While our intent is not to record any private moments or to invade your privacy in any way, this outcome is inevitable when using technology in a learning environment. Recorded information may be shared with others, including third parties (such as Dropbox or Google when Zoom recordings are uploaded to the platform for sharing or review) who may necessarily need access to our learning materials for various purposes, including implementing our online platform. That said, the intent is to keep all recordings accessible to only the StreetCode Academy community. In addition, any virtual communication, including lessons and meetings, may be monitored by StreetCode at any time.

Privacy
We are committed to respecting the privacy of and protecting any personal information of our constituents. When partnering with a third party, we ensure their privacy policy adheres to and is compliant with applicable student privacy laws, including COPPA, FERPA, and CCPA.
We only give access to the appropriate employees the information they are entitled to see. All links to sensitive information, scheduled Zoom calls, and recordings are either shared directly with constituents or password protected.

Safety
For my safety and that of others, I will comply with StreetCode Academy’s instructions and directions.

Medical Care Consent
In the event that I should require medical care or treatment, I authorize StreetCode Academy to provide me first aid and/or to arrange medical assistance, transportation, and emergency medical services for me if I get hurt during my participation in the Classes. I agree to be financially responsible for any costs related to my medical treatment and transport. I understand that StreetCode Academy does not provide health, medical, disability, or other insurance coverage for me. I am aware and understand that I should carry my own health insurance. In the event of an emergency, please contact the aforementioned "Emergency Contact" presented above in this form.

Use of My Name and Image
During my participation in StreetCode programs, StreetCode Academy may take photos or videos of me and any works I create through my participation. I consent to the use by StreetCode Academy of my image, voice, name, works, and/or story in any format, including video, print, or electronic (collectively, “Materials”), as StreetCode Academy may deem appropriate for other programs, archival, promotional or other purposes. StreetCode Academy may make the Materials available on its website, in its publications, or through any other media, including social networking platforms. I waive any right to inspect or approve the Materials or to receive any payment. I grant to StreetCode Academy all copyrights in the Materials and waive any legal claims relating to the Materials, including those relating to copyright or rights of publicity or privacy.

Information Collection
I consent to StreetCode Academy collecting personal information from me and for those I have also signed up. I consent to StreetCode Academy using this personal information for planning, organizing, promoting, and conducting their programs as well as for following up with me after my participation.

Understandings
I understand that StreetCode Academy does not control, and is not liable for, the conduct of participants or others present onsite or online, and that StreetCode Academy is not staffed to monitor participants at all times.

Awareness and Assumption of Risk
I confirm my understandings as stated above. With that information and awareness, I am knowingly participating in the programs, and I knowingly assume and accept the risks of all injury, illness, disease, death, property damage or loss, financial obligation, loss of privacy, and all other consequences that may result, directly or indirectly, from my participation in the programs or my presence at or travel to the site, regardless of the cause.

In the event that any damage to equipment used in the programs occurs as a result of my or my family's gross negligence, fraud, or willful misconduct, I acknowledge and agree to be held liable for any and all costs associated with such gross negligence, fraud or willful misconduct.

Conclusion
These Terms and Conditions were accepted at arm's-length, without duress or coercion, and are to be interpreted as an agreement between two parties of equal bargaining.

I and StreetCode Academy agree that these Terms and Conditions are clear to its terms, and that no other evidence will be used or admitted to alter or explain, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.

By signing below, I warrant that I am of the age of consent (18 years or older), and I acknowledge that I have completely read and fully understand the above and agree to be bound thereby.

I have read and agree to these terms

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Liability form & acceptance Checked Work Around

Yes

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