The Calais School BOC Member Registry

The Calais School BOC Member Registry

Beads of Courage and The Calais School are excited to partner together to launch the first Beads of Courage Program to provide emotional support and encouragement in a therapeutic special education school! This new pilot program is exclusive to the students at The Calais School, who for the first time, will have their courage recognized and celebrated with Beads of Courage. Since 2005, Beads of Courage has established collaborative partnerships with organizations worldwide to provide emotional support and encouragement through the artform of beads and we are so happy to add The Calais School to this worldwide collaboration of caring.

We recognize the need to advance the science of caring in special education settings, so we created a new pilot program with The Calais School. A pilot program is a new trial program done with a small group. You have been selected to be part of this group!

Your feedback on this new program (and any photos you wish to share) are so valuable to us! You can help us grow this program into the best it can be. Your voice matters! Thank you for taking the time to fill out this form.

Parent/Guardian Name: Parent/Guardian Name: First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Phone Phone - ### - ### ####
Parents/Guardians: What does the Beads of Courage Program mean to you?
How can the Beads of Courage Program be improved?
Student Name Student Name First Last
Student Date of Birth: Student Date of Birth: / MM / DD YYYY
Are you of Hispanic, Latino, or of Spanish origin?

Are you of Hispanic, Latino, or of Spanish origin? Yes No Prefer not to say
How would you describe yourself?

How would you describe yourself? American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Prefer not to share
Student: Check the boxes that you would answer "yes" to:

Student: Check the boxes that you would answer "yes" to: My Beads of Courage make me happy My Beads of Courage help me feel like the school staff really care for me My Beads of Courage help me feel proud of myself My Beads of Courage give me encouragement to want to reach my goals My Beads of Courage help me tell my stories of courage to others My Beads of Courage help me feel listened to and not alone I do not feel like I can say "yes" to any of the above so I will select this option Other Other
What do you love most about the Beads of Courage Program? (Please indicate if this is an answer from a parent or the student)
Optional: Please upload 1-5 photos (or video). We love to see photos of The Calais School Students as BOC members with their beads! Additional photos/videos may be emailed to beth@beadsofcourage.org
Optional: Please describe the photos/videos you uploaded, include the names of those pictured:
If Yes, photos/video was taken by a professional photographer, enter their name and email/social media handle so we can contact them for permission to use their work:
Were these photos taken by a commercial photographer?

Were these photos taken by a commercial photographer? Yes No
I hereby give Beads of Courage, Inc. and The Calais School permission to use this photo/video and content I have provided, in perpetuity, for any purpose deemed appropriate by Beads of Courage, Inc. and The Calais School including but not limited to: fundraising/grant proposals, print materials; newsletters; signage; on the Beads of Courage and The Calais School websites and social media accounts; for media coverage (television, blogs, newspaper, magazine, ezine, ebook, etc.); for educational purposes; for publicity benefiting Beads of Courage, Inc.

I hereby give Beads of Courage, Inc. and The Calais School permission to use this photo/video and content I have provided, in perpetuity, for any purpose deemed appropriate by Beads of Courage, Inc. and The Calais School including but not limited to: fundraising/grant proposals, print materials; newsletters; signage; on the Beads of Courage and The Calais School websites and social media accounts; for media coverage (television, blogs, newspaper, magazine, ezine, ebook, etc.); for educational purposes; for publicity benefiting Beads of Courage, Inc. Yes, I give my permission No, I do not give my permission
Date of Photo/Video/Feedback Release Date of Photo/Video/Feedback Release / MM / DD YYYY
ELECTRONIC SIGNATURE: By placing your signature in the box below, you are hereby waiving any right of compensation or ownership thereto.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Thank you for sending us your feedback!

This information is so valuable to us so we can make the BOC program at The Calais School the best it can be!