Cloverland ASPIRE Reg Form

CLOVERLAND ASPIRE

2021-2022
Students may begin to attend ASPIRE the day following receipt of the registration forms and payment. As deemed necessary, there may be an enrollment waiting period in order for staff to identify student needs and to plan for accommodations and supports for participation. The waiting period will not exceed two weeks.
STUDENT INFORMATION
Student Name *

First Name Last Name
School *
Grade *
Special Education (IEP/504) *

Yes No
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name *

First Name Last Name
Cell Number *

Area Code Phone Number
E-mail
Parent/Guardian

First Name Last Name
Cell Number

Area Code Phone Number
E-mail
example@example.com

PROGRAM POLICIES
LATE PICK-UP

The ASPIRE program begins immediately after school is released and ends at 6:00 pm daily. If your child is picked up after 6:00 pm, a late pick up fee of $10 per 15 minutes per child will be applied. Children who are picked up after 6:00 pm more than two times in a school year will be dropped from the program.
PAYMENT AND FEES

Program payment is due by the first (1st) of the following month. Payments not received by the fifth (5th) are subject to a $10 fee. Bills for ASPIRE will be available at each school site by the 25th of each month. Bills not picked up at the ASPIRE sign-out location by the 25th will be mailed the following day.

ASPIRE fees:
- Full rate of pay for one child - $130 per month
- Full rate of pay for each additional child - $90 per month
- Reduced rate for one child - $90 per month
- Reduced rate for each additional child - $50 per month
(Students qualifying for free or reduced lunch, qualify for the reduced rate of pay.)
DROP POLICY

To withdraw your child from ASPIRE, complete the program drop form for each child prior to the first (1st) of each month to avoid being charged for that month. The drop form is available on the OJUSD afterschool program website.
EARLY RELEASE POLICY

A child may be released early from the after school program prior to the end of program time at 6:00 pm based on the following conditions:
- Off-site enrichment programs
- Participation in school athletic programs and team sports
- Family emergency
- Medical appointment
- Transportation
- Child accident/injury
- Safety issues (darkness, weather)
- Other conditions (state reasons)
The parent/guardian/authorized adult shall sign the child out and record the time of release daily.

DISCIPLINE POLICY
Students in the ASPIRE program receive emotional, intellectual, and physical support that is essential for a child's development. The ASPIRE staff provides fun, educational, and challenging activities which help create a better learning atmosphere for all students.

To ensure that every student is in a safe, constructive environment, all ASPIRE participants will adhere to the OJUSD conduct code and the program rules.
PROGRAM RULES
- Students will be kind and respect self, others, and property.
- Students will not behave in a way that disrupts the classrom or campus.
- Students will be on time and prepared for ASPIRE activities.
- Students are not allowed to bring toys or expensive equipment. ASPIRE is not responsible for lost, stolen, or broken items.
DISCIPLINARY ACTIONS

First Warning - Student will receive a verbal warning

Second Warning - Parents of the student will meet with ASPIRE staff and student may be temporarily suspended from the program

Third Warning - Student may be permanently expelled from the program

Grounds for Immediate Expulsion - In the event of fighting, misuse of facilities, illegal or sexual activities, possession of drugs or firearms, or other extreme disruptive behavior, ASPIRE staff have the right to immediately expel the student from the program. The guardian of the student will be contacted, as will local authorities, if necessary. Decisions will be made based on all the information on hand and will be final.

STATEMENTS OF UNDERSTANDING

I understand that it is my responsibility to notify the ASPIRE program regarding any change to the information included on this form.

I understand that my child may not be released to anyone without prior written documentation and presentation of a valid photo identification.

By signing and submitting this form, I agree to follow all program policies as stated in this document. I understand that copies of these policies may be downloaded from the OJUSD website or provided to me directly upon request.

I agree that this signature will be an electronic representation of my signature for all purposes when I use them on documents, including legally binding agreements - just the same as a wet ink signature on paper.
Parent/Guardian Name *
First and Last Name
Sign above the line by using your mouse or finger (if on a tablet or smartphone).

Clear
Date Signed
Please direct all questions to the ASPIRE program office

at (209) 848-4884.
It is the policy of the ASPIRE after school program to provide equal access to its program and not to discriminate on the basis of gender, race, national origin, religion, disability, or any other legally protected class. Affirmative steps will be taken to reasonably accommodate otherwise qualified individuals in its program in a manner that is consistent with state and federal law.
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CLOVERLAND ASPIRE