Southside Scribblers Fall 2019 Registration Form

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Southside Scribblers is a free after-school creative writing class taught by University of Chicago students on Friday afternoons from 4-5 PM.
Our fall session will take place from October 11th to November 22nd.
If you have any questions or concerns, please reach out to the email uchicagoscribblers@gmail.com. On behalf of all our teachers, we look forward to working with your children and seeing all the creative and thoughtful ways your students bring their stories to life!

Student Name *

Student's Teacher *

Grade Level *

2nd Grade

3rd - 4th Grade

5th Grade and Above

Returning Student?

Has your student been enrolled in the Southside Scribblers program in previous years?

Yes

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Parent/Guardian Name *

Parent/Guardian E-Mail *

Primary e-mail. We will mainly communicate to parents through e-mail; please ensure that you have a working e-mail account.

Parent/Guardian Phone Number *

Other Contact Name *

Other Contact Phone Number *

Pick-Up Information *

Pick up is by the main entrance and must occur within 10 minutes of class dismissal.

My child may be picked up by the adults named below.

My child may may walk home or be picked up by the adults named below. I understand that a parent/guardian is required to pick up the student in the first 2 weeks of classes until registration and fees are completed or settled.

My child attends Ray's After School Fun and should be sent there after class

Names of adults allowed to pick up child

Media Consent *

I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs or movies of the Student named above. I also grant Ray School and its partners the right to edit, use, and reuse said products for non-profit purposes including use in print, on the internet, and all other forms of media. I also hereby release the Chicago Public Schools and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above. I understand that media consent is not required for program participation.

Yes, I consent

No, I don't consent (consent not required for participation)

Participation Consent *

I consent to my child's participation in the Ray School program(s) chosen above for the specified dates.

Yes, I consent

Expectations for Behavior, Attendance, and Pick-Up

Ray students are expected to adhere to the same behavioral expectations in before and after school programs that they follow during the school day.

We use the Three Bs: Be Respectful, Be Responsible, Be Safe.

If a student violates these expectations, before and after school program directors may contact parents and/or remove students from the program at their discretion. For fee-based classes, refunds may or may not be made at the discretion of the program director.

Unless given consent otherwise, parents/guardians are responsible for picking up their children on time at the end of class by the Ray Main Entrance. If student is not picked up after 10 minutes, he/she may be taken to the main office under the care of the front desk attendant, Assistant Principal, or Principal.

If a student is chronically picked up late or absent from the program, the student may be removed from the program at the discretion of the program director.

Working together we hope that these procedures and protocols will never have to be utilized. They exist to ensure that students will always be safe and supervised. Thanks in advance for your cooperation.

Parent/Guardian Signature (Required) *

By typing your name you are acknowledging you have read the above policies

Comments, Questions, or Concerns (Optional)

Submit

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