ASAP Online Registration 2023-2024
By filling out the application you are allowing your child to begin attending ASAP on the next available day.
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Email *
Student First Name *
Student Middle Initial *
Student Last Name *
Student Address - Street *
City *
State *
Zip Code *
Student School Email Address *
Student Phone Number (If they have one)
Grade *
Parent/Guardian 1 (Name) *
Cell Phone # *
Work Phone #
Lives with Student *
If No, Please Provide Address (including City, State, Zip)
Parent/Guardian 2 (name)
Cell Phone #
Work Phone #
Lives with Student
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If No, Please Provide Address (including City, State, Zip)

ASAP is a recorded school-age program. One requirement is that the child’s attendance to the program, or to leave the program is solely between the child attending and their parent.

Staff at ASAP may not prevent a child from leaving the site. ASAP has safeguards in place if a child requests to leave; the parent will be called immediately, to speak with their child. Staff will try and encourage the child to stay by offering an activity, snack, etc.

Staff at ASAP encourage the parent and child to set up a weekly schedule outlining their attendance to the program.

Please type your name and date in the field below indicating that you have read and agree to the statement above. *
People Authorized to Pick Up Your Child (name, relationship, and phone number for each person) *
Emergency Contacts - In case of a serious accident or illness, your child will be sent to an emergency medical facility. The parent/guardian(s) will be contacted immediately and thus held responsible for all expenses. The individuals below will be contacted should such an incident occur.
Emergency Contact # 1 (name, phone, relationship to student) *
Emergency Contact # 2 (name, phone, relationship to student) *
Medical Information - The staff at ASAP encourage you to share your student’s medical information so we can ensure their safety while enrolled in our program. This is private information that is only required so we can be aware of any medical issues that might come about during our program.
Food Allergies *
If Yes, Please Explain
General Allergies *
If Yes, Please Explain
Medical Conditions/General Medical Info *
If Yes, Please Explain
I give permission for my student's picture to be used for ASAP marketing initiatives (Initial needed in person)                                                                                              

 *Parent permission is required in order for your student’s picture to be used on behalf of ASAP. Our program utilizes pictures of our students for marketing purposes on our Facebook page, Instagram page, website, and various local newspaper articles. Media Representatives and ASAP staff may interview and photograph students involved in ASAP programs and activities as needed. Information obtained directly from students does not require parental approval prior to publication. Parents who do not want their student interviewed or photographed should direct their student accordingly.  
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I give permission for ASAP Staff to access my child's schedule and Pinnacle Sign in/password codes (signature needed in person)                         

*I understand that in order for the staff of my child’s school and the ASAP staff to work efficiently with my child, they will need to access schedule and assignment information. Most often my child will bring their homework and all necessary materials with them to ASAP, but on the occasion when they don’t, I understand that the tutors will be attempting to help him/her to complete work and may need to assist my child by investigating what assignments are due and the nature of the assignments. I give my permission for my child’s schedule and Pinnacle sign in/password codes.I am also aware that ASAP staff will be viewing my child’s homework site with my child on occasion in order to clarify assignments. By signing this form I allow ASAP tutors and staff to contact teachers and work with school staff if necessary to clarify an assignment and better assist my student with his/her academic needs.
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I give permission for ASAP staff to access my child's future academic information to track program success. (Signature needed in person)                                                  

 *In order to track the effectiveness of ASAP and to improve the services we offer ASAP staff would like to follow up with you, your student, and your student’s teachers to collect academic progress data. This data will include attendance, grades, and behavior information. This information may be used for grant proposals, in the case of data sharing all names and identifying information will be removed to protect you and your student.By signing this form I allow ASAP staff to contact future teachers and administrators staff to gather follow up data including attendance, grades, and behavior
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Student Behavior Contract: My child is willing to read, sign, and be accountable to the ASAP behavior contract (shown below) before beginning participation in ASAP. *

Behavior Policy:

 

Goal:

 

To keep all students at ASAP safe and to work out any issues internally. At ASAP it is our last resort to send students home.

 

Expectations:

1. I will arrive at ASAP on time. Upon arrival at ASAP, I must sign in with a staff member.

2. I will sign out with a staff member upon departure from ASAP and understand that my family and I are responsible for my transportation home by 6pm.

3. I will treat other students and the volunteers/staff of ASAP with respect. I will be polite and courteous in my actions and conversations with others.

4. I will keep myself and those around me safe by following the ASAP and school rules.

5. I will use personal/ASAP materials and equipment in a safe manner so items are not damaged or lost. If I break or damage something in a purposeful manner, I am responsible to replace it (If you break it you buy it).

6. I will listen and respond to the directions given by staff/volunteers of ASAP.

7. I will receive a warning if I fail to follow the rules. If I continue to ignore the rules, I will be given a consequence for my behavior.

8. If I have a problem with the rules, other students or other behaviors, I will ask the staff of ASAP for help and communicate my needs with them.

9. I will only consume ASAP foods and beverages while checked in to the program. Everything else needs to be stored in the kitchen, backpack, or consumed outside before checking into ASAP.

10. I will not use my phone during ASAP program hours unless there is an emergency or I need to contact my parents. Cell phones are collected at the start of the ASAP day and are held until the student checks out of ASAP. If there is an emergency, communicate with an ASAP staff immediately. I will ask to use the ASAP phone to call parents/guardians if needed.

11. I will remember that no more than one student may be in the restroom at one time and will ask for permission before leaving to use the restroom.

12. I will wear appropriate clothing at all times during the program. ASAP and School Policies about appropriate clothing are the same.

13. I agree to abide by all the “Safe School” Policies from my school and this ASAP student behavior contract.
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Required
By typing your name and your students name below, you are agreeing to the Behavior Policy above. *
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