in partnership withCity of Miramar

Parent / Guardian Permission & Consent Forms

City of Miramar AI Boot Camp · July 27–31, 2026 · Ages 13–15

Draft for the City of Miramar to review and merge with its standard registration forms. This is a plain-language consent draft, not legal advice. Please have your City Attorney or risk management team review before use.

The program at a glance

Program: City of Miramar AI Boot Camp

Ages: Teens 13 to 15

Dates: Monday–Friday, July 27–31, 2026

Backup week: Aug 3–7, 2026

Hours: 9:00am – 3:00pm daily

Where: A City of Miramar facility

Cost to families: Free (sponsor-funded)

Group size: Up to 15 students, 2 certified teachers

Staff: Broward-certified, background-checked teachers

Ends with: Friday showcase (parents invited)

Over one week, students work together to celebrate the diversity of the City of Miramar. They make a themed song, help build a collective story that becomes a digital comic book, and see it animated into a video. Each student takes home the album, the digital comic book, and the video.

Please read each section below. Check the box, add your initials, and sign at the end. One form per student.

AI Tools Use Consent

Your student will use a small set of AI tools during camp. This always happens under teacher supervision, on program-managed accounts. Students never share personal information publicly.

ChatGPT (Team)	Used by students to help build a collective story and characters. Program provides the Team account. Students do not use personal logins.
Suno	Used by students to create their themed song for the "Miramar Presents…" album.
Video / animation	Operated only by the teacher to animate the comic into a video. Students watch and direct, they do not log in.

All tools are age-appropriate (13+) and supervised at all times. Content is moderated. Accounts are program-managed. No student personal data is shared publicly.

I consent to my minor child using these supervised AI tools during the camp, as described above.

Initials

Photo / Video / Audio Release

Your student may be photographed and recorded during camp. This helps us build the deliverables and share the program's success. This release covers your student's name, likeness, voice, and the work they create.

Recordings and photos may be used for:

The final music-video deliverable
The end-of-week showcase
Parent and student testimonials
City of Miramar and MetAiBlock promotion

I grant permission for my student to be photographed and recorded, and for that content to be used as described above.

Initials

OPT-OUT (optional): I do not want my student's photo, video, or voice used for promotional purposes. My child can still fully attend and take part in the camp. (Recordings still needed to build my child's own deliverables are fine.)

Initials

Student Work & Showcase

Your student will create real work during the week: a song, a comic, and a shared video. We would love to celebrate it. These creations may be shown at the Friday showcase and used in program and city promotion. Your student always keeps their own copy to take home.

I give permission for my student's creations to be shown at the showcase and used in program and city promotion.

Initials

Responsible AI Use Acknowledgment

We teach students to use AI thoughtfully and safely. By signing, parent and student understand that:

AI is a supervised learning tool. It is not a friend, a therapist, or a source of advice.
AI output can be wrong. Students are taught to fact-check what the tools produce.
Students follow a code of conduct for respectful, safe, and honest use.
Teachers supervise all AI activity and step in when needed.

My student and I have read and understand this Responsible AI Use acknowledgment.

Initials

Health, Safety & Logistics

These items are standard for youth programs. The City may merge or replace them with its own registration paperwork.

Emergency contact

Full name

Relationship to student

Primary phone

Alternate phone

Medical conditions, allergies & dietary needs

Please note: breakfast and a snack are served each day. List any food allergies or dietary needs so staff can plan safely.

Allergies (food, medication, other)

Medical conditions staff should know about

Medications taken during camp hours (if any)

Dietary needs / restrictions

Authorized pickup persons

Only the people you list here may pick up your student. Photo ID may be required.

Name 1

Relationship

Phone

Name 2

Relationship

Phone

Name 3

Relationship

Phone

May the student sign themselves out at the end of the day? Yes No

Participation & liability acknowledgment

I understand my student will take part in camp activities and supervised use of AI tools. I confirm my student is able to take part. To the extent allowed by law, I release and hold harmless the City of Miramar, MetAiBlock, and program staff from ordinary claims arising from normal participation, except for gross negligence or willful misconduct. In an emergency, I authorize staff to seek medical care for my student if I cannot be reached right away.

[placeholder] The City to insert its standard liability, media, and emergency-medical language here.

I have read and agree to the participation and liability acknowledgment above.

Initials

Code of conduct

My student agrees to treat others with respect, follow staff direction, use the AI tools responsibly, and help keep the camp safe and positive for everyone.

My student and I agree to the camp code of conduct.

Initials

Signatures

By signing below, I confirm I am the parent or legal guardian of the student named here, I have read all sections above, and I give the consents I initialed.

Parent / Guardian printed name

Parent / Guardian signature

Date

Student printed name

Student age

Grade

For City / program office use only: Received by ______________________ Date ____________ Registration merged Yes Opt-out on file Yes