~MHS ASP Session 4 and Remote Wednesday Registration~ February 22-April Break 2021

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Session 4 of the After School Program @ Mount Holly Elementary School begins Monday February 22 and continues through April 6. Please complete the registration form below to enroll your child in Session 4. Enrollment is required for each ASP session.

~Enrollment for Session 4 is due by Friday, February 12 in order to attend Monday, February 22.

The MHS After School Program will be continuing with the same schedule as this year's previous sessions:
M, T, Th, F 3:00-4:30.

~Programming will take place outside, as much as possible - please be sure your student has the appropriate clothing for our chageable Vermont weather.
~Students will be placed in cohorts that will remain the same throughout the year
~Enrollment is limited and based on a first come first serve basis
~Pick-up time is 4:30 .
~Programming from 3:00-4:30 cost $4/child

~VT Subsidy is available for eligible families. For eligibility information or to apply, visit:
http://www.brightfutures.dcf.state.vt.us/vtcc/process.do?0Mmr3gjumkz13-SgYEjWekr3%3dxguw3YEa.aU7zaju.xnn.xGOGO-SO-GS%2bSd%256U6D%256UOh.S0SgwEkeUs3peYY.wjRszYgwUVm3wjR_YY_ujRuz1rgsUWVjUVm3mWgwkmpwUVm3wjR_mszVzR_zWLEgkz13SdO66SGdFq0dd_q

~ASP is available for students enrolled in the TRVLA Program

The TRSU ASP will continue to provide in-person Remote Wednesdays @ the former Black River High School.

More information about TRSU After School Programming can be found in the parent handbook and other resources located on the TRSU ASP website Please continue to access this site for future information regarding 2020 programming. This link will lead directly to the handbook:
https://docs.google.com/document/d/15alEqGDCTjnsnsUIVr9X9w_H44QzRVmpD9mtWmOMUWo/edit?usp=sharing

*You must complete one form per child. Any forms with multiple children will not be accepted. The form will be deleted and you will have to start again.

Email *

Student's Full Name: (First, last) *

Student's Date of Birth: (You can edit the year) *

YYYY

Home address (if no change from Session 1 - write no change): *

My child is enrolled in: *

In-person learning @ MHS

TRVLA

Other:

What cohort will your child be in: *

Ms. Craver

Ms. Kennedy

Ms. Gibney

Ms. Manney

Ms. Dunne

Mr. Ruley

TRVLA

Days we would like to enroll our child in after school programming: *

Monday

Tuesday

Thursday

Friday

Required

We would like to enroll our child in Remote Wednesdays @ ASP: This is not available for students enrolled in the TRVLA. SPACE IS LIMITED! *

Yes

Please help us to plan ahead for Remote Wednesdays

My child will eat breakfast at home

My child will bring their own lunch

My child has a sibling also signed up for Remote Wednesdays

Parents Name and Telephone Number: *

Emergency Contact Info (Not Parents) (if no change from previous Session - write no change) *

Emergency Contact Info #2 (Not Parents) (if no change from previous Session - write no change) *

Doctors Contact Info: Name and Phone Number (if no change from previous Session - write no change) *

Dentist Contact Info: Name and Phone Number (if no change from previous Session - write no change) *

Please tell us about your child's physical and mental health. Be sure to include; allergies, medications currently prescribed, fears, triggers, things that could cause anxiety during the school year. We want to serve your family to the best of our ability. (if no change from previous Session - write no change) *

Please check all boxes *

I give my child permission to participate in the activities at TRSU After School program.

I give consent for my child to be transported to and from any activity, including in private vehicles as necessary. (This is rare and for emergency use only)

I give permission for my child to be photographed/videoed as a program participant, and I understand that these photographs, without my child’s name, may be used in reports about the program including, but not limited to; the news media, partner organizations, the school’s web sites, reports to local governing bodies, and reports to the federal government.

I give permission for my child to receive emergency medical treatment deemed necessary during TRSU ASP activities.

I give my child’s school, and the after school program permission to freely share academic and medical information with TRSU and TRSU ASP staff as needed.

I understand the rules and guidelines outlined in the TRSU After school parent handbook

I understand that my registering for Remote Wednesdays does not mean my child has a slot

I have read the parent handbook and understand the policies and practices of TRSU ASP 2020

I understand that all TRSU ASP activities will be held outside, even when it rains, and it is my responsibility to dress my child appropriately

Required

My child may be picked up from the After School Program by the following individuals: (if no change from previous Session - write no change) *

In the event of an early dismissal from school, and cancellation of the After School Program, my child will be: *

Parent Pick-Up

Bus

Other ____________________________________________________________________

Payment information: Please check all that apply

Sibling Discount; This only applies to full schedule After School Programming and NOT Remote Wednesdays

Qualify for state subsidy

Need scholarship information - (Please apply first for state subsidy: https://dcf.vermont.gov/benefits/ccfap. Scholarships are available to families who do not qualify for assistance.)

Parent Signature *

Any Questions please reach out to Julie Goraj regarding ASP and Venissa White regarding Remote Wednesdays.

Julie.goraj@trsu.org or 802-259-2392
Venissa.white@trsu.org or 802-591-2294

A copy of your responses will be emailed to the address you provided.

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