Key School Summer Program Registration

Please complete 1 form per child.


Parent/Guardian #1

Parent/Guardian #2

Emergency Contact Information

Class Selection

Key Center Program Evaluation/Study Consent

You are invited to participate in a year-long evaluation study that explores the effectiveness and will provide continuous quality improvement of the Key Center programs including Key School and Key School Academic Language Therapy Program (KSALT). What is the purpose of the study? An estimated 20% of the population has a language-based learning difference. Without the appropriate support these children are at risk for poor long term social and economic outcomes. Key Center’s mission is to provide equitable educational opportunities for the students we serve and in the community. In order to ensure we are providing the very best and most effective services for our student’s; program evaluation is integral in order to provide the data and research to support all the programs Key Center offers.

The purpose of this study is to determine if our programs are effective. Your involvement in this study will provide valuable information to help determine future and effective methods of educating children with learning differences. Will my information be shared with others? Your information is not shared with others. Everything is completely confidential. A unique number is assigned to each participant to protect privacy. Furthermore, the data collected is used to assess Key Center’s effectiveness in service delivery and not individual student performance.

Why me? We are asking you to participate in this study because you meet one or more of the following criteria:

1.Your child attends Key School and/or Key School Summer Program
2.You are a parent of a child at Key School and/or Key School Summer Program
3. You are a teacher at Key School
4. You have attended a training or professional development seminar provided through the Key Center for Learning Differences.

Your participation in this study is completely voluntary. If you decide to take part in this study, you may withdraw your consent and remove yourself from the study at any time and without any penalty whatsoever. If you decide not to participate in this study, you will continue to receive your current level of services.

What will I be asked to do? If you choose to participate, you will be asked to complete one 2-5-minute survey or questionnaire. In addition, data will be collected from assessments and demographic data.

What are the benefits to participating in this evaluation study? Participants in this study will be encouraged to share their ideas, opinions, and recommendations to improve Key Center programs. Additionally, it will help us understand if our programs are effective and provide crucial insight in quality improvement.

What are the risks? There are no known risks to participating in this study. If there is anything that makes you uncomfortable you can remove your consent at any time. Remember everything is completely confidential.

Please use your mouse, finger or stylus to sign.

Consent to Photograph or Videotape

Your child may be photographed or videotaped by Key School or its designated agents, and that photograph, video or image of your child maybe recorded or reproduced.

I represent that I am the parent or guardian of the above-named student/individual. I hereby consent to the forgoing on his/her behalf.