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  • About Us
    • Who We Are
    • Partners
    • Board of Directors
    • Our Staff
    • Our Communities
    • Financials & Annual Report
    • News
      • E-News
      • TML Times Newsletters
  • Programs
    • Our Programs
    • Youth Development
    • Parenting and Adults
    • Healing and Justice
    • Kiwanis Swimming
    • Aquaculture
  • Our Stories
  • Volunteer
  • Events
    • Community Block Party
    • TML 30th Anniversary
    • Move with Love 5k
    • Give Miami Day
    • Christmas at TML
  • Partner with Love
  • Housing Initiative
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  • Apply Today!
  • Connect with Us
    • Contact Us
    • TML News Signup Form

TML Summer Application 2025 (Child/Youth Information Form)

"*" indicates required fields

Step 1 of 9

11%
Child's Name*
Child's Date of Birth*
Child's Gender*

Address*
Child's Caregiver (Full Name)*
Is this a cell/mobile phone?*

Please note that The Children’s Trust may contact you via postal mail, email, or text to ask about your satisfaction with services and inform you of other Trust-funded programs, initiatives, and events that may interest you.

ALL STUDENTS ATTENDING PUBLIC OR CHARTER SCHOOLS MUST HAVE A SCHOOL ID # ENTERED.
Pre-K - 12th Grade
Is your child proficient in English?*
Other languages spoken in your home*
Child's Ethnicity*
Child's Race*

Interested in adult literacy?
Emergency Contact(s) other than parent/guardian (If I can can't be reached, please try to contact my designated alternate[s])*
Tap or click the "+" sign on the right of the Phone Number field to add additional contacts
Name
Phone Number
 

We want to get to know your child better so that we can provide the best possible experience in our programs. Please tell us more about your child.

What are the main ways in which your child communicates?*
Mark all that apply
What, if any, help does your child receive at this time?*
Mark all that apply
What conditions does your child have that are expected to last for a year or more?*
Mark all that apply
Do any of the conditions noted make it harder for your child to do things that other children of the same age can do?*
To support your child’s successful participation in this program, in which areas might s/he need extra assistance?*
Mark all that apply
Does your child have health insurance?*
(ex., private insurance, KidCare, Medicaid)

We may be able to help you find affordable coverage. Call 211 or visit www.thechildrenstrust.org/parents/health-connect/insurance.

Dependency System? (Foster System)*
Delinquency System? (Juvenile Detention)*
Child receives free/reduced lunch?*
Has your child ever been retained?*

CHILD’S MEDICAL INFORMATION

EXCEPT AS NOTED, this child is in good health, has no allergies and no chronic conditions which would affect treatment.

Food allergies?*
Drug allergies?*
Other allergies?*
Chronic conditions?*
Are your child's Immunization records current?*
Does your child know how to swim?*
Does your child take medication?*
Please list the medications that your child takes:*
Tap or click the "+" sign on the right to add additional medications
Name of medication
How often is this taken?
 
Has your family ever experienced gun violence?*
Has your child ever experienced any psychological or physical trauma?*
(death, divorce/separation, parent jail/prison, witness to accident/crime)
Has your child ever received psychological or psychiatric counseling or treatment?*
Does your child have any past/present illnesses of which we should be aware?*

DISMISSAL INFORMATION

Dismissal is at 5:45 PM during the School Year and 5:00 PM during the Summer Months.

  • Jam Nights: (8th-12th grade only) 6:00-8:00 PM
  • Overtown Site: Wednesdays
  • Homestead Site: Thursdays
Select one category for your child's dismissal:*
List the person(s) authorized to pick up your child:*
Tap or click the "+" sign on the right to add additional names
First Name
Last Name
 
List the person(s) NOT authorized to pick up your child:
Tap or click the "+" sign on the right to add additional names
First Name
Last Name
 
List the person(s) that your child is authorized to go home with:*
Tap or click the "+" sign on the right to add additional names
First Name
Last Name
 
List the place(s) where your child is authorized to get dropped off:*
Tap or click the "+" sign on the right to add additional places
Name of place
Address of place
 
Touching Miami with Love is NOT responsible for student(s) who do not get on our bus at the designated pickup areas after school.

PARENT, GUARDIAN, OR PRIMARY CAREGIVER INFORMATION FORM

Please note that The Children’s Trust may contact you vial postal mail, email and/or text to ask about your satisfaction with services, and to make you aware of other Trust-funded programs, initiatives and events that may interest you.

Are you a parent, guardian or primary caregiver?*
What is the highest level of education you’ve completed?*
Are you proficient in English?*
Other language(s) spoken in your home:*
Select all that apply
Please select your ethnicity:*
Please select your race:*
Migrant family?*
Military family?
Parent in jail/prison?*
Is there a computer in the home?*
Is there internet access in the home?*
Head of household type*
Monthly family range:*
Do you receive any assistance?*

NON-DISCRIMINATION POLICY: Touching Miami with Love does not discriminate in any program or activity on the basis of sex, race, immigration status of children or parents, health, religion, color, national origin, age, sexual orientation, gender expression, gender identity, disability, or ability to pay for services. Children with physical, emotional or behavior disabilities/conditions may find programs specially designed to meet their needs through other Children’s Trust Programs; efforts will be made to assist with a referral to the most suitable placement for each child.

PARENTAL CONSENT RELEASE AND WAIVER OF LIABLITY FOR TOUCHING MIAMI WITH LOVE

By signing the application below, I agree I have read the following and certify the following:

  1. I acknowledge that the application information and medical information I have provided above is true and complete to the best of my knowledge and ability. I understand that every effort will be made to reach me for instructions if my child should become ill or injured while on the site or on a field trip. If, in the judgment of the staff or a medical professional, delay in reaching me might jeopardize the child’s well-being, I hereby authorize the staff or medical professional to secure whatever medical treatment is deemed necessary, including the administration of anesthetics and surgery.
  2. I acknowledge and I am aware of the risks and hazards connected with the that participation by my child in the Program sponsored by Touching Miami with Love and its partners and funded by the Children’s Trust involves physical education, organized sports, meals, and off-site field trips. As these activities may carry some degree of risk to my child’s physical and emotional health, and may include risks and hazards unknown to me or my child.
  3. I understand that part of the risk involved in undertaking any activity is relative to my child’s own state of fitness. I acknowledge that my child has no physical condition that would prevent him/her from safely participating in these activities.
  4. I, for myself, for my child hereby release, hold harmless, relinquish, and waive Touching Miami with Love, the Children’s Trust, and all employees, officers, directors, agents, and volunteers associated with the out-of-school program from all claims, demands, damages, actions, and cause of actions arising out of injuries, damages, or death sustained by me or my child resulting from participation in this out-of-school program.
  5. I further expressly agree that this release and waiver of liability is intended to be as broad and as inclusive as the Laws of the State of Florida will allow, and that, in any portion thereof is held to be invalid, it is agreed that the balance shall, notwithstanding the invalid portion, continue in full force and effect.
  6. I agree to make every effort to ensure that my child participates in the program daily, unless he/she is too ill to attend.
  7. I also agree that I or my representative will sign-out my child every day he/she attends the program.
  8. I agree to all the program standards. I am aware that if I (parent) is LATE picking up my child at the end of the day after 5:00 PM, there is a $25 Late Fee. If not paid within one week, I understand that my child will be suspended and possibly removed from Touching Miami with Love programs.
  9. I understand that some of the program sites are being held on the premises of religious institutions for the primary purpose of providing academic enrichment and a safe environment during out-of-school time. In some cases, religious instruction may be offered as an option to the children on the premises, but only with written parental permission. Unless express written permission has been given for my child to participate in religious instruction, an optional non-religious activity will be conducted. No Children’s Trust funds will be used for teacher stipends, books, curriculum or other expenses related to religious instruction.
  10. I understand that TML follows strict client confidentiality policies. TML will not release any confidential information to unauthorized persons. All records are kept in locked filing cabinets and access is granted only to direct care staff members. In addition, HIPPA confidentiality laws are followed if applicable.
  11. I understand that TML is not responsible for your child once he/she is dropped off home/destination. It is my responsibility to have either myself or someone home/destination to meet my child.
  12. I consent to allow the taking of photos or videos of my child and/or me during program activities. Photos/videos may reveal my child’s and/or my identity without any compensation paid to my child, to me or to others. All photos and videos shall be the sole property of TML and may be used for educational and/or promotional purposes. And all recordings taken of you, your children or wards, shall be the property of TML. With regard to the use of any Recordings taken of you, your children or wards, you hereby waive any and all present and future claims you may have against TML their staff, service providers, employees, agents, affiliates and Board members.
  13. I authorize my data to be shared with a 3rd party for research and evaluation purposes. Any data will be kept confidential and reported anonymously.
  14. I give my permission for this information to be submitted to The Children's Trust for program quality and evaluation purposes. The Children’s Trust provides funding for the program. For questions go to www.thechildrenstrust.org or call The Children’s Trust at 305-571-5700.
  15. I acknowledge that I have received and understand the “Parent Guidebook”.

Completing an application does NOT mean that it is approved. You will receive a phone call once it's approved.

Date*
Select today's date
I give my permission for this information to be submitted to The Children's Trust for program quality and evaluation purposes. The Children’s Trust provides funding for the program and follows strict data privacy protections for the information collected (for example, following the Family Educational Rights and Privacy Act/FERPA guidelines).
Clear Signature

Since 1995, Touching Miami with Love has been serving the children, youth, and families of our communities with holistic programming as we inspire, educate , and empower . Our impact can be seen in the lives of those we serve.

Address

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Miami Location

711 NW 6th Avenue, Miami, FL 33136

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Homestead Location

1350 SW 4th St, Homestead, FL 33030

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Historic D.A. Dorsey Memorial Library

100 NW 17th St, Miami, FL 33136

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Contact

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Miami Office

+1 (305) 416-0435
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Write Us

P.O. Box 01-3279, Miami, FL 33101
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Email

info@touchingmiamiwithlove.org

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