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Registration

This document provides a registration form for Whitmore Charter's after-school academic activities program for the 2018-2019 school year. It requests student information including name, grade, school, address, emergency contacts, medical conditions, and dismissal plan. It outlines the program hours and rules regarding behavior and discipline. Parents must sign agreeing to comply with procedures and allowing their student to participate.

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79 views1 page

Registration

This document provides a registration form for Whitmore Charter's after-school academic activities program for the 2018-2019 school year. It requests student information including name, grade, school, address, emergency contacts, medical conditions, and dismissal plan. It outlines the program hours and rules regarding behavior and discipline. Parents must sign agreeing to comply with procedures and allowing their student to participate.

Uploaded by

api-428082540
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Charter-After School Academic Activities

Registration For- (K-8th) Whitmore Charter


2018-2019 School Year
Please submit a separate form for every student you wish to enroll
Please use a blue or black ink pen when completing this form

Student’s Name Grade School d

Address City Zip Code d

Parent/Guardian’s Name Home Phone Work Phone d

Parent/Guardian’s Name Home Phone Work Phone d

The following are adults whom I authorize to pick up my child or be called in an emergency. Photo identification
will be required

Emergency Contact’s Name Phone Relationship d

Emergency Contact’s Name Phone Relationship d


d(Infinite Campus contacts will be used- photo I.D. will be required-for additional space please use other side of form)

Please note any medical conditions that your child may have:

Is there a current court order on file? ⎸ No ⎸ Yes If yes, please provide a copy for the C-ASAA program. If there are
changes, please provide copies to the C-ASAA site supervisor.

⍅ My child will be picked up ⍅ My child will be allowed to walk home

The C-ASAA program starts immediately after school and ends


at 6 p.m.
C-ASAA Rules and Discipline Policy
Expectations All steps are documented and Parent will be notified
Follow all regular-day school Step 1 = Verbal Warning
rules and procedures at all Step 2 = Written Warning
locations (bathroom, cafeteria, Step 3 = Student suspended from program for 1-5
classroom, playground.) days
Follow directions the first time Step 4 = Student suspended from program for 1-5
given from staff. days
Keep hands, feet, and objects Step 5 = Student suspended from program for the
remainder of the session
to self.
Speak respectfully to others
Session schedule: August to December & January to June
and staff. **If student is removed from program during first session, they
will return in Jan. on 3rd step.

Note: We reserve the right to skip disciplinary steps depending on the


severity of the action.

I have read the information and give my student permission to participate in the program. I have read and agree to
comply to the standards and procedures described above.

Required: Parent/Guardian Signature: Date:

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