Information Release

Students must apply to be considered for at-home internet services. In order to apply, students must fulfill all eligibility requirements.

Parents or guardians submitting the application form on behalf of the student must agree to the Citywide Classroom information release detailed below. Consent is required by SBCSC, School City of Mishawaka, PCs for People, Comcast, and enFocus to share data collected in the application form.

Citywide Classroom Information Release

I certify that I am over the age of 18 acting on behalf of the student mentioned in the application form.

I certify that the information in the application form is true and accurate. I understand that misrepresentation of any material fact may be grounds for ineligibility of internet services or devices and/or future support.

I grant permission to Citywide Classroom, South Bend Community School Corporation, the City of South Bend, School City of Mishawaka, enFocus, and other Partner Organizations affiliated with this program to receive and store the data collected in the application form. I authorize SBCSC to release the student's free-and-reduced-lunch status to PCs for People, a non-profit providing low-cost computers and affordable internet to families, for the purpose of collecting and compiling data to assess and report on the effectiveness of Citywide Classroom and PCs for People's programs more generally.

I assume all liability associated with the use and disposal of the provided equipment and services. It is my responsibility to follow all applicable Federal, State, and Local recycling laws. I also release Citywide Classroom and its Partner Organizations from all liability, including any claim for indemnification or contribution. Citywide Classroom shall not be liable under this agreement for any economic or personal damages including loss of profits or revenues, business interruptions, and loss of information or data.

I agree on my behalf of myself and my children or constituents that we may be photographed, recorded, and videotaped by Citywide Classroom, its Partner Organizations, or any media without receiving compensation of any kind. I grant Citywide Classroom and its Partner Organizations the right to edit, use, and reuse this footage as deemed appropriate for future productions and publications, which may be viewed by public and private sector audiences. I also hereby release Citywide Classroom and its Partner Organizations from all claims, demands, and liabilities whatsoever in connection with the above.

I grant permission to Citywide Classroom and its Partner Organizations to send a text message and/or email and/or mail to remind me to renew my internet services (if applicable).

I have read and accept Mobile Beacon's Terms of Service (if applicable).