I am the parent/legal guardian of the "Student" named above in the registration form, and I understand that my permission and authorization is required to register my child and have my child participate in the Coding the Coal Region Project.

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I hereby consent to public disclosure of the education records listed below, collected during the Coding the Coal Region Project:

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a. Course Attendance

b. Student Assessment Data

c. Work completed within the Coding the Coal Region Project

d. Feedback provided through surveys on instructors and coursework

e. Photos of my child during program hours to be used for marketing and reporting documents

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I desire for my child's education records listed above to be released to the following persons/organizations associated with the Coding the Coal Region Project:

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a. Wilkes-Barre Connect: Entity managing the registration process and overall program

b. Codelicious: Entity providing the courses/curriculum and assessment exams

c. Institute for Public Policy & Economic Development: Entity handling the data collection, analysis, and reporting for the Coding the Coal Region Project

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I, the undersigned, certify that I am the parent or legal guardian of the Child/Student, named in this application form, and that I have the right to make decisions for my child that affect his/her well being.