Cardinal After-School Program (ASP) Enrollment Form 2023-24
We are excited to provide our Cardinal ASP to your student(s)!  Please know that if you have any questions regarding our program you can contact Linda Lowery, Program Coordinator, at 565-2256 ext. 105.
This form is a required component of enrolling student(s) into our Cardinal After-School Program.  
Please plan to use this same form for each student who is in 3rd - 12th grade from your household you would like to enroll into our program.  
The program is funded by the Nita M. Lowey 21st Century Community Learning Center Grant and the Be Here Foundation.
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Name of your student: *
Grade *
Expectation: What would you like your student to improve upon while participating in the Cardinal After-School Program?  Choose any/all that apply. *
Obbligatorio
My student is interested participating in the following ASP CLUB(s) ONLY.  All ASP Club participants will follow our ASP schedule until the beginning time of the Club and will remain with the Club throughout the duration of the ASP day.  Clubs conclude at 5:30 unless otherwise noted.  Stay tuned to communications as we add ASP CLUBS to our schedule throughout the year. 
What needs might your family have that would assist your student and family in being most successful during this 2023-24 school year? *
We have two dismissal times.   5:30   Bus and Parent/Guardian Pick Up   6:00  Parent/Guardian Pick Up only.   Which dismissal option should we plan for your student(s)? *
If you are interested in bus ride option (within Necedah School District only) please indicate the address you would like your student ride the bus to.  If no bus ride, please indicate NO BUS *
Parent/Guardian Name:   *
Communication is shared often through email.  Parent/Guardian Email Address: *
Parent/Guardian phone number: *
Emergency Contact Name: *
Emergency Contact Relationship to Student: *
Emergency Contact Phone Number: *
Regular Participation.  I understand that I intend to have my student attend our Cardinal After-School Program (ASP) as often as possible or as specifically scheduled with the ASP Coordinator so that he/she may receive the full benefit from what the ASP has to offer.  Any changes in participation must be made in the morning of planned program attendance unless it is an emergency.  Third through eighth grade students enrolled in our Cardinal ASP are not to make the decision if whether or not they are attending our program on any particular day.  This decision must be made by the adults (parent/guardian and/or if need be school teacher/principal) through an advanced conversation with the student.  High school students are able to make this decision  *
Regularly Scheduled Field Trip Permission.  I give permission for my student to attend regularly scheduled LOCAL field trips off campus offered by the Cardinal After-School Program during our program hours.  Communication about these LOCAL field trips will be through monthly newsletters shared via email, hard copy pick up at school and our ASP calendar link within school website. This permission does NOT include the Friday Field Trips scheduled throughout the year.  The Friday Field Trips will have a separate permission form.
 *
Cardinal After-School Program Surveys.  The Cardinal After-School Program has my permission to administer surveys to my student.  These surveys help evaluate our Cardinal ASP so that we can continue to offer the most optimal program with activities that best suit the needs and interests of our students.
 *

Academic Practice Time.  

Our Cardinal ASP is funded primarily through a federal grant that includes Academic and Enrichment Goals. All ASP students who are attending the Legacy program (regularly scheduled program) are highly encouraged to participate in both the Academic Practice and the Enrichment components. Having said this your student may not complete all of his/her academic work during our program.  

I understand our Cardinal ASP is not meant to be a replacement for parent/guardian participation in my student's academic growth and my student may have academic responsibilities to take care of after the conclusion of our ASP.

 *
Behavioral Expectations.   I understand that the dayside school and bus expectations apply to our Cardinal After-School Program.  I also understand that if my student is missing out on instruction during the school day it may mean that he/she may not be in a frame of mind to attend our Cardinal ASP on that day.  If this is the case a call will be made to the number associated with this form and the student will be dismissed from school as usually planned at the 3:20 bell. *
Photo Release.  The Cardinal ASP has my permission to use photos/videos of my student for program promotional purposes. *
Nutrition Release.   I understand that my student may be participating in nutrition and cooking classes and will be using kitchen equipment/utensils including knives with close supervision.  Any foods your student may be allergic to or cannot eat must be on file with our School Nurse.  Our Cardinal ASP follows our School Nurse notes.
 *

Physical Fitness Activity Permission.  I understand my student may be participating in physical fitness classes or activities.  Any activities that your student cannot participate in must be on file with our School Nurse.  Our Cardinal ASP follows our School Nurse notes.


 *
Signature line:  By typing your signature signifies you have completed this form *
If you have Questions/Concerns or you would like to provide more information regarding the sections above please do so within this section.  Thank you!
Once this form is received Mrs. Lowery will be in contact with parent/guardian indicated on this form either via email or phone to confirm enrollment and start date.  Thank you!
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