I, __________________________, the parent or legal guardian of the above-named minor, do hereby authorize Imagine Science Omaha (Build A Hut) and the Imagine Science national partnership permission to evaluate my child for the purposes of program improvement, collection of my child’s demographic information, and to track my child’s attendance. I understand that my child’s participation is voluntary and that I may withdraw my consent at any time. I also understand that my child’s privacy will be protected which means that my child’s name will not be in any report or publication, individual responses will not be made public, and their  information will be secured.

If I sign, I understand that it will be assumed that I have agreed to the use of my child’s information in the evaluation. This agreement will remain in effect until I withdraw my permission.