Step By Step WEST VIRGINIA DREAMERS/ 21ST CENTURY   BIG UGLY COMMUNITY CENTER :
After School Application 2022
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Welcome to Step by Step's electronic Afterschool Student Application!


APPLICATIONS ARE CURRENTLY OPEN.  Our Program will begin on Monday September 17 2022

Please fill out the attached form for EACH child in K-12th grade that you are interested in enrolling in Step By Step's Afterschool and school time Tutoring Programs. For more details about Step by Steps programs please visit: Stepbystepwv.org 


Child’s First  Name to Enroll in Program *
Child's Last Name to Enroll in Program *
WEVIS/Lunch Number *
Age *
Date of Birth *
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Sex *
What Best Describes you *
Grade *
IEP/504/Special Needs *
School *
Student E-mail: *
Parent/Guardian Name(s): *
Home Address: *
Mailing Address: *
Daytime Phone Number *
Evening Phone Number *
Parent or Guardian E-mail Address *
Tell Us about your child
Does your child have an allergy?   If yes, please explains     *
 If yes, please explains    
Does your child have special dietary needs? *
 If yes, please explains     *
ANY PERSON NOT ON THE LIST WILL NOT BE ALLOWED TO PICK UP YOUR CHILD. If someone is not listed, even if they are a close relative, they will not be allowed to leave with your child. *
PERSONS TO CONTACT IN CASE OF EMERGENCY OR AFTERSCHOOL CLOSURE *
I understand and acknowledge that participation in the West Virginia Dreamers Afterschool Program is completely voluntary. I understand and acknowledge that such participation may pose the potential risk of injury or illness to my child(ren). I agree to assume full responsibility and liability for any and all potential risks which may be associated with my child(ren)’s participation in program activities. I further agree that Step by Step, Inc., it agents and employees shall not be liable for any injury or illness suffered by my child(ren) which is incident to and/or associated with participation in the afterschool program. *
Required
Please list the people in your household: Please list ALL persons (first and last names) living in the household with your child.

Example Answer: Susan Example, 34, Mother

Person 1 (Name, Age, Relationship to Child)
Person 2 (Name, Age, Relationship to Child)
Person 3 (Name, Age, Relationship to Child)
Person 4 (Name, Age, Relationship to Child)
Person 5 (Name, Age, Relationship to Child)


Student Arrival
Step by Step’s program will be open to their program participants starting at their scheduled start time. Your program will not be responsible for students who arrive at the program before programing hours. During afterschool students must check in/ be present at the start of programming, 

Dismissal Procedures
Unless proper notification has been provided, we will only release your child to the people that you have specifically indicated on the authorized release form. We must receive a phone call or email from you in order to release your child to someone not on your list. We will require identification of anyone whom you have given permission to pick up your child if he or she is not familiar to our staff. Approved forms of identification are,
-Valid Photo ID
-Work ID with photo and legal name
-Student/Parent ID Badge

Late Pick-up Policy
Step by Step’s Late Pick-up Policy has been developed to maintain the integrity of the program and to respect the hours of operation of the program. If a child will not be picked up on time, your program must be contacted immediately via phone. If your program has not been contacted within five minutes of closing, staff will attempt to contact the parent/legal guardian. If the parent/legal guardian cannot be reached, your program will call from the child’s authorized emergency contact and pick-up list. Your afterschool program will continue to attempt contact with the parent/legal guardian and/or the authorized emergency contacts 

Attendance Policy
All participants enrolled in a Step by Step program are required to attend programming a minimum of
2 Days a week for programs that operate Monday through Thursday
3 Days a week for programs that operate Monday through Friday
to maintain their enrollment in the program, this does NOT automatically qualify them for any attendance biased incentive trips or events. This policy is implemented to better support our program participants and our amazing program staff when it comes to implementing program curriculum. If your child becomes habitually absent from programming, their enrollment within the program will be terminated due to failure to comply with Step by Step’s Attendance Policy. If your child will be out please communicate that with your program coordinator to ensure the absence does not count against them. Most absences with proper and timely notification to your program coordinator can be excused within reason.

Accidents/Illness/Emergency: When a child becomes ill or is injured during the afterschool program, the parent/guardian will be contacted immediately. If the parent cannot be reached our staff will adhere to the emergency contact information on your child's registration form. Please notify us immediately if changes occur in addresses, phone numbers or emergency contacts for your family. Should we not be able to reach anyone, we will call 911 for transport to needed medical facilities.

Big Ugly Community Center Family Service Center:
Step by Step's Big Ugly Community Center  Family Service Center  . This is so we can provide resources and support for your entire family. All participants who enroll in a Step by Step program will automatically be enrolled in the BUCC FSC. An will receive communications, benefits and resources through the FSC program. If you do NOT want to be automatically enrolled in the BUCC FSC  please contact your program coordinator to unenroll.

Complaints: Should you have a complaint against our program, please talk to anyone on staff and they will direct you to the Area Coordinator or Director. We always want to know if a parent is dissatisfied so we can remedy the situation for you.
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I understand and acknowledge that throughout the program year Step by Step, Inc., its agents and employees will administer screenings, conduct evaluations, and access student achievement data related to my child(ren) in order to determine overall performance and change from year to year. I understand and acknowledge that information collected for evaluation purposes will be held in strictest confidence. My child(ren) has permission to take part in screenings, surveys, and other evaluation processes conducted by Step by Step, its agents and employees.  Step By Step, its agents and employees have permission to gather any relevant information from Kanawha, Lincoln and/or Logan County Schools as pertains to my child(ren). I understand that all information will remain confidential and my child(ren) will not be identified individually in any public reports. *

School Records Release Authorization
 
 
I hereby grant permission for the Step by Step to secure my child’s report cards directly from his/her school during the school year.

I hereby grant permission for Step by Step to secure my child’s 504 Plan and/or I.E.P. from his/her school during the school year.

I hereby grant permission for Step by Step to secure my child’s standardized test scores directly from his/her school during the school year.

I hereby grant permission for Step by Step to secure my child’s attendance records directly from his/her school during the school year.

I hereby grant permission for Step by Step to speak to my child’s teachers about his/her schoolwork during the school year.

I hereby grant permission for Step by Step to my child’s school counselor about his/her needs and/or behavior during the school year.


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I hereby consent to the participation of my child(ren) in interviews, the use of quotes, and the taking of photographs, movies, audio recordings, and video tapes by Step by Step, Inc., its agents and employees.  I also grant Step by Step, Inc., its agents and employees the right to edit, use, and reuse said products for educational, promotional, and/or marketing purposes including use in print, on the internet, and all other forms of media. I hereby release Step by Step, Inc., its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above. *
Contact Us:
Tamara Boling- Big Ugly Community Center 
 e-mail- tboling@stepbystepwv.org e-mail
Phone- 304-855-5402
Address- 15 Rosewood Rd Harts WV 25524
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