Parent Commitment Form

Children’s Literacy Center, a 501(c) 3 non-profit community organization, provides individual assistance to students who are reading below grade level. Our curriculum is appropriate for children who are reading at the second semester 1st grade through 6th grade levels (middle school and high school students welcome). The Peak Reader program is not appropriate for children who have Dyslexia, are currently enrolled in an IEP at school, or have special education needs.

Enrollment is available at no cost to families.

Our tutors are community volunteers who undergo an application and background screening process and are trained to use the Peak Reader curriculum. A qualified site coordinator is present during all tutoring sessions.

This form must be completed to enroll your child in the Peak Reader program. 

 

Please briefly describe any medical and/or support services you child receives:

This information is kept confidnetial and is only for Children's Literacy Center's use. 

Select three locations at which you would like to have your child tutored:

Locations

Please check the appropriate answer to provide accurate grant information in support of our program (this information does not determine your child's enrollment in our program):

Does your child qualify for free or low-cost lunch program?
Is your child a military dependent?
Is English the primary language spoken in the home?
Parent Commitment
Parent/ guardian commitment and support are critical to your child’s success. Therefore, you must abide by the requirements listed below for your child to participate in the Peak Reader® program.
  • Attend a mandatory parent orientation
  • Arrange for your child to be dropped off and picked up on time
  • Read for at least15 minutes a day with your child, and keep a reading log which is provided by the site coordinator or tutor
  • Provide an update on the status of your child's educational needs
  • Complete Children's Literacy Center program survey
Consent to Share Assessment Results
  • In order to demonstrate the success of the Peak Reader Program, I understand that CLC will publish student assessment results on its website, grant proposals and other publications so that I, as well as other interested parties, will have access to this information.
  • I understand that Children’s Literacy Center (CLC) will protect my child’s privacy and his or her name will never be revealed when assessment data is shared.
  • I understand that student growth data may be used to make comparisons in gender, the length of time a student has been in the Program, grade level, etc.

I am the child’s parent or legal guardian. I have read this document and by submitting it I am signing it freely and voluntarily. For the benefit of the Children’s Literacy Center, I acknowledge that my child is participating in the Peak Reader Program offered by the Children’s Literacy Center. I understand that my child’s participation in the Program is subject to any and all rules, procedures, and requirements established for the Program, and by the Children’s Literacy Center personnel, tutors, and any other person(s) conducting, leading, and /or directing the activities involved in the Program. I hereby release, forever discharge, and indemnify Children’s Literacy Center, its directors, employees, staff, volunteers, and other agents from all liability and responsibility for any personal injury, accident, damage, expenses, or other loss caused, suffered, or incurred to me or my child during, or arising out of, my child’s participation in the Program. Further, I acknowledge that I have read and understand the legal consequences of the above statements, and that if I am unable to do so for any reason I have had them read to me and am confident that the individual has read and/or translated the statements truthfully and in their entirety. This release and waiver has been executed on behalf of me and my child, with full knowledge and assumption of possible risks involved in the Program and any events incidental to the Program, and with the understanding that I am waiving my right to sue the Children’s Literacy Center. This instrument has been executed in and shall be interpreted according to Colorado law.