Learning Labs Interest Form

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Parents/Guardians, complete this form to express interest in enrolling into the In-Person Learning Lab. The program coordinator will contact you to confirm enrollment within two (2) school days. *Space is limited. If the program is full, your child will be added to the Waitlist. For questions or concerns, please email learninglabs@ycschools.us.

Email *

Student Last Name *

Student First Name *

School *

Grade *

Parent/Guardian's Name *

Phone Number *

Email *

Emergency Contact *

Emergency Contact Phone Number *

List any siblings or other students in your household that you are registering for the program. *

Please check each box to acknowledge that you understand the following: *

My child must wear a mask at all times and maintain 6ft distance between other students.

My child must bring their electronic device to engage in remote learning.

If my child becomes ill, someone must pick up my child immediately.

Breakfast & Lunch may be provided by YCS daily

No transportation will be provided. Families are responsible for dropping off and picking up their child(ren) at the designated times identified by each Learning Lab

YCS will provide an iPad or Chromebook that the student must bring daily. - The site may not extras.

Instruction will be delivered by a YCS teacher remotely either synchronously or asynchronously.

Special Education staffing support will not be provided.

Required

I am interested in registering my child in the Parkridge Learning Lab. The contact person for the program will confirm your enrollment within two (2) school days after submitting this form. *Space is limited. If the program is full, your child will be added to the waitlist. *

Academic Support - Parkridge Community Center: Grades K-5/9am - 3pm/Monday - Thursday

I give consent and permission for my child to participate in the YCS Learning Lab program and its related activities. Also, by typing my name, I understand the services provided by YCS. (Parent/Guardian, please sign by entering first and last name) *

I agree to have my child follow all program guidelines and understand that any violation on my child’s part may result in removal from the program. (Parent/Guardian, please sign by entering first and last name) *

I release Ypsilanti Community Schools and its partners of both on-site and in-person Learning Labs of all liability of injury, death, or other damages to me, my child, family, estate, heirs, or assigns that may result from his/her participation in the program, including but not limited to transportation, and hold harmless any tutor, mentor, program staff, or other representatives, both collectively and individually, of any injury, physical or emotional, other than where gross negligence has been determined. (Parent/Guardian, please sign by entering first and last name) *

I agree to allow YCS and its partners of the Learning Labs to use any photographic image of my child taken while participating in the mentoring program. These images may be used in promotions or other related marketing materials. (Parent/Guardian, please sign by entering first and last name) *

Yes, I give YCS Learning Lab permission to use my child's image.

No, I do not give YCS Learning Lab permission to use my child's image

Required

Send me a copy of my responses.

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