CCLC - Registration Form for K-2 - 2023-2024
- This form is ONLY for grades K-2 seeking enrollment into CCLC.
- For grades 3-5 seeking enrollment into the program, please complete the 3-5 Registration Form.
- For grades 6-12, registration is NOT required. If a homeschool or parochial school student in grades 6-12 is interested in attending, please email the Director of CCLC at joel.bramhall@creteschools.org for details.

Directions:
- This form is to be completed by a parent/guardian.
- One form per student.
- Upon submission, you will receive an email with your responses.
- After district processing, please expect an email, phone call, or voicemail by August 11 to confirm enrollment or waitlist status.
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Email *
Priority Enrollment: Please check any that apply, as a student qualified in these categories will be deemed ‘priority’ in the enrollment process. (This question ensures CCLC's compliance with federal and state grant guidelines by reflecting the school building’s demographics.)
Student Grade *
First Name of Student *
Last Name of Student *
Enrollment Status: I understand that my student is NOT enrolled until I am contacted via email, phone, and/or voicemail by program staff confirming enrollment. *
Required
Waitlist: I understand that my student may be placed on a waitlist due to staffing and spacing limits. If so, I will be contacted via email, phone, and/or voicemail by program staff confirming waitlist status. *
Required
Attendance: To support the program’s grant guidelines, my student will regularly attend for a minimum of 1 hour each day, unless prior arrangements have been communicated to, and confirmed by, the site coordinator at least 24 hours in advance. *
Required
Behavior: I understand the policy for physical aggression. Any such behavior will result in immediate dismissal from that day’s programming, an automatic two (2) week suspension from the program, and possible expulsion from the program for the remainder of the school year. *
Required
Health: I understand that CCLC staff are NOT required to administer any medication, including emergency medications, during programming hours. CCLC staff are trained in, and will implement, CPR and First Aid protocols in an event of an emergency, which includes calling 911. (Note: There will NOT be a school nurse onsite during programming hours.) *
Required
Dinner: My student will eat dinner during CCLC. *
Field Trips: I authorize my student to participate in field trips traveling within the city limits of Crete, NE. If a field trip is scheduled to travel beyond the city limits, an itinerary will be issued in advance requiring a parent/guardian signature or confirmation. *
Photo Release: As a parent/guardian, I hereby consent to the use of photographs/recordings taken of my student during CCLC programming for publicity, promotional and/or educational purposes (including publications, presentations, broadcasts, newspapers, social media, internet or any other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages. *
Release of student: I understand that ONLY Parents/Guardians and Authorized Individuals listed within this registration form will be able to pick up the student from CCLC. If a sibling will pick up a student, please include them as an Authorized Individual on this form. *
Required
First & Last Name for Parent/Guardian #1 *
Phone Number for Parent/Guardian #1 *
First & Last Name for Parent/Guardian #2
Phone Number for Parent/Guardian #2
First & Last Name of Authorized Individual #3 *
Phone Number for Authorized Individual #3 *
Relationship to Authorized Individual #3 *
First & Last Name of Authorized Individual #4
Phone Number for Authorized Individual #4
Relationship to Authorized Individual #4
First & Last Name of Authorized Individual #5
Phone Number for Authorized Individual #5
Relationship to Authorized Individual #5
First & Last Name of Emergency Contact #1 *
Phone Number for Emergency Contact #1 *
Relationship to Emergency Contact #1 *
First & Last Name of Emergency Contact #2 *
Phone Number for Emergency Contact #2 *
Relationship to Emergency Contact #2 *
Siblings: How many K-5 siblings will be registered for CCLC? *
Siblings: Although not guaranteed, CCLC works diligently to ensure that when it is time for enrollment, registered K-5 siblings enter CCLC together --- even if they attend different CCLC site programs. *
Required
Sibling #1: First name and last name
Sibling #1: Grade level
Clear selection
Sibling #2: First name and last name
Sibling #2: Grade level
Clear selection
If additional siblings in grades K-5 will be registered for CCLC, please list below by first name, last name, and grade level.
Agreement: I understand and agree to the CCLC Student/Parent Handbook and its associated forms and content. Access the handbook: https://drive.google.com/file/d/12vmzhdxuD5fDD6rmuLCvbqAE5_xK_jCg/view *
Required
Electronic Signature: I understand that my electronic signature is the legal equivalent of my physical signature. *
Required
Electronic Signature: Type the First & Last Name of the Parent/Guardian completing this registration form. *
A copy of your responses will be emailed to the address you provided.
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