PHSD Safe Spaces SUMMER Program Registration
The Penn Hills School District has teamed up with community partners to create a SUMMER program for Penn Hills High School students in grades 9-12. The Safe Spaces program is a continuation of the after-school program that debuted in winter/spring 2023. The program aims to provide an opportunity for students to gather in a safe environment that will include hot food, activities (sports, arts, music, etc.), on-site programming with community partners, off-site visits in the Penn Hills community and transportation. 

Safe Spaces SUMMER Program details:

Dates: Monday, June 12, 2023 through Thursday, July 27, 2023 (with the exception of June 19 and July 4)
Days: Mondays, Tuesdays, Wednesdays, and Thursdays
Times: 10:00am until 2:00pm.
Who can register? Any PHHS students who will be in grades 9-12 in the 2023-24 school year (currently in grades 8-11). 
Is transportation provided? Yes! Round-trip transportation is provided through Krise. 

Sample Schedule:

10:00-11:00am   Arrival at PHHS/Check-In/Light Breakfast/Supervised Social Time

11:00-12:00        Gym Time (when available) /Chill Space

12:00                    Lunch

12:30-2:00          SPECIAL PROGRAMMING (or continued Gym Time/Chill Space)

2:00pm               Departure via Krise Shuttle

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Email *
Student's First Name *
Student's Last Name *
Grade Level for 2023-24 School Year: *
Name of Emergency Contact (after hours) *
Phone Number of Emergency Contact (after hours) *
Emergency Contact's Relationship to Student (mother, father, guardian, grandparent, etc.) *
Student’s Health Condition(s) or Known Allergies of Which an Emergency Physician or Other Medical Personnel Should be Aware. 
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I understand that off-site programming on selected days may include topics that reflect community group mission statements, including religion. It will be the students' and/or parent/guardian's preference to attend off-site programming. The default option will be staying at PHHS for programming. 
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I consent for an emergency medical care provider to administer any emergency medical care deemed advisable to the welfare of the herein named student while the student is participating in the Safe Spaces Program. Further, this authorization permits, if reasonable efforts to contact me have been unsuccessful, for the program director(s) to transport the student to the nearest hospital for care. 
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I give consent to allow my child to participate in the Safe Spaces Program at the Penn Hills School District. My child has permission to be matched with a volunteer mentor/mentors. I understand that my child may be contacted regularly by staff and volunteer mentors.

I give permission for my child to be transported by Krise Transportation to the summer program, for off-site programming and/or transportation home via the activity shuttle. 

I understand that in order to participate in the program, my child’s basic information will be shared with appropriate staff, volunteer mentors, and partners.

I authorize release of my child’s name and photograph for possible news or social media about the Safe Spaces Program. I understand that the Safe Spaces Program may take photographs or videos of the programs or activity in which my child is participating. I give permission for the Safe Spaces Program to use photographs or videos of my child for the purpose of promoting the program and its services/programs in print or electronically.

I give my permission with the following understanding: No compensation of any kind will be paid to me or my child at this time or in the future for the use of my child’s likeness.

I give permission for the program coordinator to contact my child’s school for access to his/her grades and/or behavioral records for tracking and reporting purposes.

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I, parent or legal guardian of the herein named student, do hereby approve and consent to him/her participating in the Penn Hills School District's Safe Spaces Program. I further certify that he/she is in good health and physically capable of participating in the program's activities. In further consideration of the opportunity of my son/daughter participating in this capacity, I release the Penn Hills School District, its employees, representatives and elected and appointed officials from any and all liability, claims, judgments, or demands for damages arising as a result of injuries sustained by my son/daughter during his/her participation in any activity related to the Safe Spaces Program, indemnify and hold Penn Hills School District harmless on same.  

I understand that any student who is posing a danger to self, others or is a disruption to the program may be excluded. 

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