Pleasantville Elm. Fall Program Registration Form
The Texas ACE After School Program will provide students with a great opportunity to engage in academic enrichment virtually for Fall 2020 (via virtual platforms). Students will be able to log in online for their activities. All After School Program activities will continue virtually until the district reopens for in-person regular school day instruction.  Students participating in virtual activities will have priority placement when campus reopens for instruction.


 If you have any questions or concerns please contact the Site Coordinator on campus.
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Student First Name, Middle Initial *
Student Last Name *
Student School ID Number ,if known
Student Gender *
Student Ethnicity *
Student Current Grade Level *
Parent/Guardian 1 (First & Last Name) *
Parent/Guardian 1  (Cell Number) *
Parent/Guardian 1  (Work Number)
Parent/Guardian 1 E-mail Address *
Parent/Guardian 2 (First & Last Name)
Parent/Guardian 2 (Cell Number)
Parent/Guardian 2 (Work Number)
Parent/Guardian 2 E-mail Address
Authorized Person
Please sign me up for the Parent Workshops via virtual platforms? *
Required
Once students return back to school, face to face, how will your child get home? *
Does student have any known allergies *
If you selected yes, what allergies does the student have?
I, hereby, give permission for my student to participate on virtual learning platforms, such as: Zoom and Microsoft Teams during the After School program. *
Can student participate in enrichment activities? *
Secondary Emergency Contact Information Name, Cell Number and Relationship to student *
I, hereby, give permission for the participant to take part in the Texas ACE activities, which include academic assistance, continuing education, and recreational programs.                                                               I further give my consent to the school district and the Texas ACE program, to share the participant’s student records with each other for purposes of providing educational support and assistance.                                                                          In addition, I understand that HISD and/or Texas ACE will use participant records to evaluate individual progress and improvement. As well as to evaluate the impact of the program on student achievement and to obtain continued funding for the program. By typing my name below, I certify that I have read and do understand the above information. *
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