A.C.E. Academy

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Before/After-School Program Registration Form

Please complete a registration form for each child in your family. If you have any questions, please contact the Director Mrs. Dawn Hammond at 704-968-5230 or slconsultants.dawn@yahoo.com. Completing the registration form does not automatically guarantee participation. Students must meet the following eligibility criteria in order to participate: (1) must be a Kindergarten - 7th grader; (2) show respect to all participants, staff, and nature; (3) be pleasant to others and refrain from using foul language; (4) refrain from causing harm to self, other participants, and staff; (5) use equipment, supplies, and facilities properly; and (6) able to exhibit appropriate group behavior and stay with the group.

 

VERY IMPORTANT: The registration form below may take 10-15 minutes to complete. Please complete the form in its entirety. When complete, be sure to hit “Submit” at the bottom of the form. You CANNOT save data typed in this form. After hitting submit, be sure to scroll down and ensure all items are complete; any missing items will cause the form to be rejected and will be highlighted for your convenience.   A.C.E. Academy or Academic Achievers/S&L Consultants LLC. will not provide transportation for before or after school. 

1. I affirm that I am of legal age to consent and am the parent and/or guardian of the child listed below on this form.*
2. Which program are you applying?*
3. Which days would you like to attend? *
6. Student's Gender*
10. Sibling #1 Gender
14. Sibling #2 Gender
22. I give The Before & After School program permission to contact me by email regarding my student's registration and/or participation in the program? Please select "No" below if you are unable to provide an email. *

The well-being of all students is very important to us. The following information will help us provide the best care for each student during the program and will help in the event of an emergency. Please provide accurate and thorough information. Please select on all that apply.

26. Does the student/sibling have asthma/breathing problems?*
27. Does the student have any dietary needs or requirements?*
28. Does your child have any known allergies*
30. Does your child carry an epi-pen?*
31. Does the student take any medication?*
32. Will the student need medication administered during The Before School and/or After School Program hours?*
33. Will the student need special assistance or accommodations due to his/her health condition?*

The Before & After School Program staff is committed to the principle of equal opportunity in education. The Before & After School staff does not discriminate against individuals on the basis of race, color, sex, sexual orientation, gender identity, marital or family status, religion, disability, age, ancestry, or national or ethnic origin. In accordance with these policies, the information on our documentation may be used by any Before & After School official only for appropriate administrative and research purposes.

35. Please check the disability status of each student?*
None
Emotional Disability
Learning Disability
Speech Disability
Physical Disability
Student
Sibling #1
Sibling #2
36. Please select the ethnic group of each student.
Yes, Hispanic or Latino
No, not Hispanic or Latino
Student
Sibling #1
Sibling #2
37. Please select each student's race (select all that apply).*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Student
Sibling #1
Sibling #2
38. Are the student(s)/siblings currently receiving free or reduced lunch?

Dismissal Procedures: Please list all Authorized Adults that will be allowed to drop children off and pick them up at the before and after school program.

 

Please list 2 or more adults or older siblings who are authorized to pick up the student along with their contact information and relationship to the student. We will ONLY release your child with the people listed here. 

Emergency Contact

In the event of an emergency and you cannot be contacted, please list names of individuals we should contact, their relationship to the student, and phone numbers. 

 

Educational Records Release  

Academic Achievers & A.C.E Academy Charter School ensures the confidentiality of student records in accordance with the Family Educational Rights and Privacy Act (FERPA). In order for The Before & After School staff (employees, agents, and volunteers) to be able to discuss your child’s education record with their classroom teachers or other persons who you designate, you must provide your authorization. “Education record” includes those records, files, documents and other material that contain information directly related to the student and are maintained by A.C.E. Academy Charter School & Academic Achievers such as grades and transcripts; attendance records; psychological & educational testing; verbal Information; school health records; special education records; and/or disciplinary records. An education record includes information recorded in any medium but does not include personal notes, records only available to law enforcement personnel, or medical records.  

In accordance with the Family Educational Rights and Privacy Act (FERPA), I authorize A.C.E. Academy Charter School and Academic Achievers to release the above mentioned student’s record to The Before & After School staff (employees, agents, and volunteers) for the purpose of keeping the staff members informed of my child’s progress at his/her school. I understand that by entering my initials below, I am waiving my rights of nondisclosure of these records under federal law only to the organization specifically listed. This release does not permit the disclosure of these records to any other persons or entities without my written consent or as permitted by law. This consent will remain in effect until revoked by me, in writing, and delivered to the A.C.E. Academy Charter School main office and the Before & After School Program but that any such revocation shall not affect disclosures previously made by Academic Achievers.

I give The Before & After School staff permission to obtain educational records for the student and communicate the student's progress with A.C.E. Academy Charter School.*

Attendance Policy  

Regular daily attendance is expected of all students as frequent absences from the program disturb the students’ and their peers’ academic and emotional social progress. All registered students are to attend all activities regularly and promptly for which they are scheduled. If a student plans to be absent or has to leave the program early, Mrs. Hammond must be notified in advance by letter or phone call (704-968-5230). If a student needs to leave the program early, parents should contact Mrs. Hammond before 4:30pm on the same day. Parents cannot pick up children before 4:30pm due to higher amounts of school traffic during school dismissal. s. This assures that the student(s) are dismissed properly and all the teachers can be informed of the student’s absence and plan the student’s work accordingly. Certain absences are considered excused absences for recording purposes, however, a written notice is still required. Excused absences include: those due to illness, quarantine, medical, dental, optometric, or chiropractic appointments; the student’s attendance at a funeral for a member of the student’s family and exclusion of students failing to meet immunization requirements.  

If a school day teacher has to work with a Before & After School participant, the teacher must provide a notice and inform the Director by email. Students not following these procedures will be withdrawn from The Before & After School Program unless he/she provides a valid excuse in writing.

Authorization to Produce and Use Audiovisual Materials  

I voluntarily consent and agree that Before & After School Program, and their employees, contractors, or agents have the right to produce photographs, movies, videotape, audiotapes, or digital recordings of the student named below, and to use these images in any and all media, now or hereafter known. Such use will be for the purpose of community education or program promotion and includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my child for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as those on the A.C.E. Academy web site. 

I agree that The Before & After School staff has the right to produce photographs, movies, videotape, audiotapes, or digital recordings of the student named on this form, and to use these images in any and all media*

Internet Usage

Use of the Internet will allow The Before & After School Program to enhance the educational experience as well as existing collection of resources and materials. The Before & After School Program staff recognizes and shares your concern about your child’s exposure to inappropriate materials. There will be safeguards imposed upon the Internet usage at Before & After School Program.

I grant permission for my son or daughter to access networked computer services such as electronic mail and the Internet. I understand that individuals and families may be held liable for violations. I understand that some materials on the Internet may be objectionable, but I accept responsibility for guidance of Internet use - setting and conveying standards for my daughter or son to follow when selecting, sharing or exploring information. I agree to hold The Before & After School Program employees harmless for any consequences resulting from the use of the Internet and/or electronic mail. I understand that this permission continues as long as my student participates in The Before & After School Program. If I want to revoke this permission, I need to send a written request to The Before & After School Program Site Coordinator.

Liability Waiver

By entering my name below, I agree to the above and the following terms: The Before & After School Program reserves the right to dismiss any participant who does not show respect for the facility, including not limited to: property, equipment, policies, other members and staff. The Before & After School Program staff assumes no responsibility for personal property. By entering my name below, I hereby waive any and all claims against The Before & After School Program. I understand that use of the facilities and equipment at The Before & After School Program may involve risk of bodily injury or property damage, and I agree to assume any such risks. I understand that it is up to me to consult physicians and other professionals to make sure that the child registered above can safely participate in activities and events at The Before & After School Program. I also understand and agree that by entering my name below, I am giving up my (or the minor for whom I sign) right to make any claim against The Before & After School Program and/or their agents, employees and volunteers, including the right to sue them, for bodily injury or property damage or any other loss that my child might suffer while using The Before & After School Program facilities and services, except as limited by law. By entering my name below, I hereby represent that I understand and am familiar with the nature of activities in which my child will participate and have personally read and understand this waiver. 

Confirmation Email