I certify that the indicated participant(s) is/are in good physical and mental health and has/have never been declared medically ineligible for athletic competition. I further certify that the above mentioned participant(s) has/have had no previous pre-existing medical condition or injury, listed as, but not limited to exercise induced asthma, cardio or pulmonary (lung) disease, abnormal organ deficiencies, and head or neck injuries which may limit playing abilities. I understand that participation in the Mount Pleasant After-School program activities requires an acceptance of risk.  With my signature, I hereby release and hold harmless the sponsors, promoter, the City of San Jose and all other persons and entities associated with Mount Pleasant After-School and events from any and all injury by the participant(s) indicated. Furthermore, I hereby grant full permission for all the foregoing to transport the above participant(s) upon request; and to use the above participant(s) photograph in video tapes, publications, motion pictures, recordings, or other records of events. I understand that the most reasonable care will be provided to the above participant(s) in the event of injury or illness during any Mount Pleasant After-School sponsored activity and authorize emergency medical care should it be needed. I have read and fully understand the foregoing and certify and represent that, as parent/guardian for the above child all registration and release information provided is true.  I hereby represent that I have authority to bind and sign on behalf of all parent/guardians of the above participant(s).                                                                 *****************************************************************************************************************Certifico que los participantes indicados están en buena salud física y mental y nunca han sido declarados médicamente inelegibles para la competencia atlética. Además, certifico que los participantes mencionados anteriormente no han tenido ninguna afección o lesión médica preexistente previa, enumeradas como, entre otras, asma inducida por el ejercicio, enfermedades cardiovasculares o pulmonares (pulmones), deficiencias de órganos anormales y enfermedades de la cabeza. o lesiones en el cuello que pueden limitar la capacidad de juego. Entiendo que la participación en las actividades del programa después de clases de Mount Pleasant requiere la aceptación del riesgo. Con mi firma, por la presente libero y eximo a los patrocinadores, promotores, la ciudad de San José y todas las demás personas y entidades asociadas con Mount Pleasant After-School y eventos de cualquier y toda lesión por parte de los participantes indicados. Además, por la presente otorgo permiso total para que todo lo anterior transporte al participante(s) mencionado(s) a pedido; y utilizar la fotografía de los participantes anteriores en cintas de video, publicaciones, películas, grabaciones u otros registros de eventos. Entiendo que se brindará la atención más razonable a los participantes anteriores en caso de lesión o enfermedad durante cualquier actividad patrocinada por Mount Pleasant después de la escuela y autorizo la atención médica de emergencia en caso de que sea necesaria. He leído y entiendo completamente lo anterior y certifico y declaro que, como padre / tutor del niño mencionado anteriormente, toda la información de registro y divulgación proporcionada es verdadera. Por lo presente declaro que tengo la autoridad para vincular y firmar en nombre de todos los padres/ tutores de los participantes anteriores.                          

Enrollment:  Enrollment is limited.  Our hope is to have enough room for all children wishing to participate in our Mount Pleasant After-School program, however we can’t always accommodate everyone.  After receiving your completed forms, the Site Supervisor will call to let you know if your child will be participating in the program and the date that they may begin. Each school holds registration at the principal’s discretion. Attendance:  Students must attend program 5 days a week/3 hours a day and until 6:00pm. Regular attendance is mandatory. Children who have 3 unexcused absences will be asked to leave the program.  Students may attend the program only on days they attend school. Children are expected to stay for the entire duration of the after school program each day. If a student is absent, written or verbal notification must be submitted to the site supervisor the next program day. Students may be asked to return home until verification of absence in turned in. Students participating in out of school activities will be asked to leave program for duration of the activity. Student Pick-Up:  Children participating in the Mount Pleasant After-School program must be signed out by you or someone designated on the registration form (designated person must be 16 years of age and on registration forms).  Your child must be picked up promptly at the end of the program. If your child has not been picked up by the end of the program, site staff will try to contact you and/or those individuals designated as emergency contacts. Three late pick-ups will result in your child being dropped from the Mount Pleasant After-School program. In the case of not being able to contact an adult, CPS (child protective services) may be called. Discipline:  Participation in the Mount Pleasant After-School program is a privilege.  A child must follow the rules of the program. Mount Pleasant After-School supports all core day school rules. Disruptive or disrespectful behavior towards other students or staff is cause for dismissal.  We encourage you to discuss concerns about your child’s behavior with the Site Supervisor. Parental Involvement:  While Mount Pleasant After-School Staff are committed and qualified, your help is needed to make the program the very best it can be.  You are an important partner in our program’s success, and we look forward to your involvement with events and activities, tutoring, field trips and other projects. Mount Pleasant After-School programs periodically use photographs of program participants for local, regional or state publicity of the after school program.  By my initials, I acknowledge receipt of this document and give permission for the Mount Pleasant After-School to use my child’s photo for publicity purposes for the after school program.                                                                                                                  *****************************************************************************************