Skip to main content

Dyslexia Fundamentals Day | Family/Individual Registration

If you are a school district and need to register a group of students, fill out this form.

Student 1 Information

Student Breakout Session Options

By selecting yes, you give permission this student to be video recorded and/or photographed during educational activities with East Texas Baptist University (ETBU) and the Region 7 Education Service Center on February, 27, 2024.

I further consent to allow ETBU and Region 7 Service Center to retain any work product created by my child in conjunction with the said educational activities.

I understand that my child will be identified by his/her first and last name. I also understand that the name of the class, school and city in which my child is located may be identified during the videotaping and/or photography or in any corresponding reproductions in publications and on the Internet.

I further understand that these videotapes, photographs and/or work products of my child are property of ETBU and Region 7 Education Service Center. I acknowledge the intended purpose and provide permission for the recording, photographs and/or work product to be used to explain the programs and services, to illustrate teacher instruction activities, or to allow participation in a video event. Permission to publish the videotapes, photographs and/or work product includes permission and consent to reuse, disseminate, copyright, print, reproduce, publish and republish for any commercial, advertising, public purposes and for educational use.

In addition to the consent provided by my signature below, I hereby release and discharge ETBU and Region 7 Education Service Center staff from any and all claims and demands arising out of or in connection with the use of any of the foregoing, including defamation, invasion of privacy, or violation of any statutory right.

Student 2 Information

Student Breakout Session Options

By selecting yes, you give permission this student to be video recorded and/or photographed during educational activities with East Texas Baptist University (ETBU) and the Region 7 Education Service Center on February, 27, 2024.

I further consent to allow ETBU and Region 7 Service Center to retain any work product created by my child in conjunction with the said educational activities.

I understand that my child will be identified by his/her first and last name. I also understand that the name of the class, school and city in which my child is located may be identified during the videotaping and/or photography or in any corresponding reproductions in publications and on the Internet.

I further understand that these videotapes, photographs and/or work products of my child are property of ETBU and Region 7 Education Service Center. I acknowledge the intended purpose and provide permission for the recording, photographs and/or work product to be used to explain the programs and services, to illustrate teacher instruction activities, or to allow participation in a video event. Permission to publish the videotapes, photographs and/or work product includes permission and consent to reuse, disseminate, copyright, print, reproduce, publish and republish for any commercial, advertising, public purposes and for educational use.

In addition to the consent provided by my signature below, I hereby release and discharge ETBU and Region 7 Education Service Center staff from any and all claims and demands arising out of or in connection with the use of any of the foregoing, including defamation, invasion of privacy, or violation of any statutory right.

Student 3 Information

Student Breakout Session Options

By selecting yes, you give permission this student to be video recorded and/or photographed during educational activities with East Texas Baptist University (ETBU) and the Region 7 Education Service Center on February, 27, 2024.

I further consent to allow ETBU and Region 7 Service Center to retain any work product created by my child in conjunction with the said educational activities.

I understand that my child will be identified by his/her first and last name. I also understand that the name of the class, school and city in which my child is located may be identified during the videotaping and/or photography or in any corresponding reproductions in publications and on the Internet.

I further understand that these videotapes, photographs and/or work products of my child are property of ETBU and Region 7 Education Service Center. I acknowledge the intended purpose and provide permission for the recording, photographs and/or work product to be used to explain the programs and services, to illustrate teacher instruction activities, or to allow participation in a video event. Permission to publish the videotapes, photographs and/or work product includes permission and consent to reuse, disseminate, copyright, print, reproduce, publish and republish for any commercial, advertising, public purposes and for educational use.

In addition to the consent provided by my signature below, I hereby release and discharge ETBU and Region 7 Education Service Center staff from any and all claims and demands arising out of or in connection with the use of any of the foregoing, including defamation, invasion of privacy, or violation of any statutory right.

Parent/Guardian Information
Parent/Guardian Information
Sign above