Arts for Learning After School Registration 2024-2025

Welcome to the DC Public Schools Registration Page for the Arts for Learning After School program, a FREE Elementary/Middle after school learning program! The program is being operated by Arts for Learning and is offered to students CURRENTLY in grades 3rd-5th and attending the schools listed below. Schools grade levels served varies based on site. Students must be enrolled Students must also be up-to-date on their immunizations.

NOTE: Applications are reviewed on a rolling basis, and registration is first come, first served. The program fills up quickly, so apply today!

For more information about the program click here.

Child's Medical Information

1. Is your child on any medication?

YesNo

If yes, please list the medications and any side effects below:

2. Are any medications to be taken during the program?

YesNo

If yes, please list the medications to be taken during the program as well as the time/s to be taken, the dosage and any other information staff needs to know.

3. Please list below any special limitations or concerns your child may have, such as dietary restrictions, allergies (including the reaction and treatment required should your child become exposed to the allergen), or chronic health conditions.

Student's Transportation Plan

2. My student will DEPART from the program at 5:45PM by (choose one):

Program Commitment

This program will take place Monday through Friday between 3:30pm- 6:00pm starting October 30, - June 17th. Can your child commit to attending most if not all of these days excluding holidays and school closures.

Yes. I can commit to my student attending Monday through Friday.No, we expect to miss several days. This question is specific to planned absences like vacations. If a student is sick they are strongly encouraged to stay home.

Will your student be involved in any other after school programs or activities that take place during our program?

Yes, my student is involved in another after school programNo, my student is not involved in another after school program

What is the name of the program and what is the commitment?

Are there any dates that your student will miss due to prior commitments (family vacation, religious observation, medical appointment, etc.)?

YesNo

Please record dates below.

Parent/Guardian Information

Parent/Guardian #1 Contact Information

Parent/Guardian First Name

Parent/Guardian Last Name

Relationship to Student(s):

Home Phone (If N/A Please Leave Blank):

Cell Phone:

Work Phone (If N/A Please Leave Blank):

Email Address:

Address

City/Town

State/Province

ZIP/Postal Code

What ward do you live in?

What is the primary language spoken by this parent/guardian?

EnglishSpanishOther (please specify)

Other Parent Primary Language

Please list any other people you want to authorize to pick up your child

Parent/Guardian #2 Contact Information

Parent/Guardian First Name

Parent/Guardian Last Name

Relationship to Student(s):

Home Phone (If N/A Please Leave Blank):

Cell Phone (If N/A Please Leave Blank):

Work Phone (If N/A Please Leave Blank):

Email Address (If N/A Please Leave Blank):

Check here if the home address for this parent/guardian is the same as Parent/Guardian #1

Parent / Guardian 2 Address

Home Address

City/Town

State/Province

ZIP/Postal Code

Emergency Contact Information

Emergency Contact #1

At least one emergency contact is required. This person must be different from the parent/guardian listed on the previous page.

First name

Last Name

Relationship to Student(s):

Home Phone (If N/A Please Leave Blank):

Cell Phone:

Email (If they do not have one, please leave blank):

Emergency Contact #2

First Name

Last Name

Relationship to Student(s):

Home Phone (If N/A Please Leave Blank):

Cell Phone (If N/A Please Leave Blank):

Email (If they do not have one, please leave blank):

Consent Form

I am the Parent/Guardian of

a minor child (the “Student”). Arts for Learning Maryland. (“Arts for Learning”) is the operator of DC Public Schools Summer Arts for Learning Academy (“SALA”).

Arts for Learning After School 2024 CONSENT, WAIVER AND RELEASE STATEMENT

By checking the CONSENT box below and signing this document, I agree and consent to all of the following terms and conditions:

1. I give permission to DCPS nurses and the staff in the Arts for Learning After School Program to administer basic first aid and/or CPR to my child and/or take the Student to a hospital to secure medical treatment when I cannot be reached, or when delay would be dangerous to my child's health. I also give permission to staff to administer medication in the event that a nurse is not available to do so.

2. I certify my understanding that I will receive policies and procedures and related information about Arts for Learning After School. Upon enrollment of my child in Arts for Learning After School, I agree to follow the policies and procedures described.

3. I give Arts for Learning Maryland, Inc. (“Arts for Learning”) permission to access and keep copies of my child's/children's academic record(s), including report cards, IEP's, standardized test scores and cumulative records. Arts for Learning will keep these data confidential and use them only for analysis and program planning. I understand that Arts for Learning may share data collected during the program, including attendance, demographics, and academic outcomes, with program funders and sponsoring organizations; however, any information shared will not specifically identify program participants. 4. I give DC Public Schools and Arts for Learning permission to contact me (using telephone, email, mail, SMS text message, or robo-call via telephone) using the contact information I provided about the status of enrollment, my child's attendance, upcoming events and programs, schedule changes and program updates.

5. I certify my understanding that I will be given a Field Trip Permission Form to authorize my child's participation in any field trip or other off-site activity planned by the program and that alternate care will not be provided should I choose not to grant such permission for the Student’s participation. Additionally, I acknowledge that the Student’s participation in Field Trips is at the sole discretion of the Arts for Learning Team.

6. I release Arts for Learning as an organization, as well as its employees, contractors, volunteers, and agents (collectively, the “Arts for Learning Team”) from any liability suit or claim for property damage or loss, or personal injury to the Student, except to the extent such claims arise directly from the gross negligence of, Arts for Learning and/or the Arts for Learning Team. 7. Arts for Learning takes great care in capturing thoughtful, high-quality images of students’ incredible artwork, their pride, excitement, determination, friendship, and joy. I give permission for the Student to be included in the documentation/promotion of Arts for Learning and its partners, including photographs, audio/visual/video recordings, interviews, reproductions of academic and artistic work, participation in surveys, and written quotations or descriptions of activities. I also understand that resulting materials may be exhibited before the community, fundraising, or other groups and individuals and/or included in media articles, partner publications, and SALA funder promotional materials.

8. I certify that the Student will attend every day of the program except in the event of an emergency. I acknowledge that students who miss multiple days with no notice or exceeds 7 of the program may be removed so that their spot can be given to another student.

9. I certify that the entered information is true and correct to the best of my knowledge.

THIS IS A CONSENT, WAIVER, AND RELEASE OF LEGAL RIGHTS. READ IT CAREFULLY AND BE CERTAIN YOU UNDERSTAND IT BEFORE SIGNING. PLEASE CHECK ONE OF THE BOXES BELOW, THEN SIGN YOUR NAME.

CONSENT: I have read this Consent and Release and agree and consent to the terms and conditions set forth in it. I agree that I and the Student, and all of our heirs, legal representatives and assigns, are and shall be legally bound by the terms in this Consent and Release, and understand that Arts for Learning will rely on my consent and agreement. NON-CONSENT: I do not agree or give my/our authorization or consent to the terms in this Consent and Release on behalf of the Student, AND HEREBY WITHDRAW MY APPLICATION IN THE PROGRAM.

By signing below, I represent and certify that I am the parent or guardian of the Student, at least eighteen (18) years of age, and fully competent and authorized to sign this Consent and Release.

Please sign this form digitally by typing your first and last name: