After School Application 6-12
Sept. 7- May 25 (subject to change)

This is the application for our FREE after-school program.  We are trying to make the application process faster for our families.

After school is held on Monday - Thursday from 3:10-6:00pm.  Transportation is provided to the Boys and Girls Club, up 298 to Rock Springs Church, and also a HSV drop off location (to be determined).

Homework/tutoring is held from 3:30-4:30 each day unless 2 hours of tutoring can be provided.  Enrichment classes ( Exploration of Robots:  Coding, Exploration of 3D, Hunters Education for the Family, and Zumba, etc.) will be held from 4:30-5:30 each day or at 5:30 PM if it is for the Families.   If your student ONLY attends from 3:30-4:30 for tutoring, they must be picked up at 4:30 in the Elementary office. Enrichment activities may change days depending on student needs!

Middle School and High School students who attend the program for tutoring or enrichment classes or both are required to come to the cafeteria each day to sign in and go to the Elementary office to sign out if you are leaving earlier than 5:30.  Please do not leave campus without first signing out.  All 6-12 student car riders will be picked up at the cafeteria and all bus riders will need to depart at the designated area from 5:30-6:00.

On the activities portion please fill out only your child's grade level and pay close attention to the activities dates.  If you have more than once child enrolling, please fill out multiple forms.

If you have questions or concerns please contact Nancy Hendrix, nancy.hendrix@jsdlions.net
Nancy is a Middle/High School Teacher and is busy teaching during school hours.  Sending her an email is the best way to contact her during school hours.

There is a program calendar on the Jessieville website under ASCENT after-school program.

It is very important for the parent  contact information to be correct in case of emergency.
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Email *
What grade is your child in?   *
Child's last name: *
Child's first name: *
DOB *
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DD
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YYYY
Is your child allowed to be photographed? (photos could be used on the Jessieville website, newspaper, or other media). *
Address *
Parent(s) phone number for emergencies *
Parent(s) name *
Is it OK to send you info and reminders through...
check all that are a YES
Allergies:
Other health problems we should be aware of:
Transportation:
Select one for the week. Parents must be present at the stop you select or the student will be brought back to the school.
Choose one for transportation *
Enrichment Activity
All students will have 1 hour of homework help from 3:30-4:30. If you want your child to receive 2 hours of tutoring/ homework help please mark below. All enrichment activities change every 6-10 weeks and thus starts a new session. If your child wishes to remain in the program you do not need to re-enroll your child.
Please select the subject(s) that you would like your child to receive tutoring.
Signature *
By electronically signing you are approving this form.
A copy of your responses will be emailed to the address you provided.
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