After School Program Enrollment Form

Tutoring Program and Summer School Enrollment Form

2021
Ralph J. Bunche Academy, Ecorse Public Schools, is pleased to offer our after school tutoring program for virtual and in person Bunche students. Please review and sign all attached documents.

All forms must be completed and submitted before enrollment shall be approved. Please use one form and list all of your children on your Enrollment Form.
Email
Parent Information

Please Complete
Student(s) Information

Please list your child or children's information below:
Name

Last Name
Program enrollment--Select all that apply

Raider's Week: Winter Break-February 15-18th Raider's Week: Spring Break-March 29th-April 1st
2nd Student's Name *

First Name Last Name
Name

Hadassah Gee
Student's Name *

First Name Last Name
3rd Student's Name

First Name Last Name
4th Student's Name

First Name Last Name
5th Student's Name

First Name Last Name
Grade (Parents with multiple students, please list your children's name and grade level in the box below). However, middle school and high school students must complete their school's application. *

Grade 1 Grade 2 Grade 3
List multiple students enrolling in the box below:
Kindergarten tutoring -
Please indicate your child's default dismissal plan:
My child will remain in the After School Tutoring Program until being picked up on:

Monday Tuesday Thursday
My child will take the school bus on:

Monday Tuesday Thursday
Please note that the after school tutoring program will be held Monday, Tuesday, Thursday, 3:30-5:30 pm, Feb. 1, 2021-May 27, 2021. Students will regularly attend the program. Please check to attendance policy agreement box to affirm your understanding. *

Agree with the attendance policy.
Please specify each person, including the name of parents, family member, and or friend(s), who has permission to pick up your child from the After School Tutoring Program.
Authorized Person 1:
Phone Number 1:

313 471 8655
Authorized Person 2:

Chris Agee
Phone Number 2:

313 614 6349
Authorized Person 3:

Natasha Mitchell
Phone Number 3:

313 704 4327
Health Information
Please note any known allergies/medication/health concerns and medical plans:
If a child becomes ill while at the program, the parent will be called immediately to pick up the child. Parents will be notified regarding contagious illnesses. Children will be readmitted when they are no longer contagious
Statement of Policy
- K-3rd grade students remaining on campus after 3:00 p.m. must have a completed enrollment pack on file.
- Student(s) abide by the Behavior Contract.
- Only persons authorized by the parent or guardian may pick up your child from the After School Tutoring program. Please notify the Coordinator in writing/electronic communication if anyone other than a parent/guardian will pick up your child.
- On campus students will receive a meal and a snack.
- An Enrollment Form, Field Trip Form, and Photo Release Form are required for all students participating in this program.
- The after school tutoring program ends promptly at 5:30 p.m. After 5:30 p.m., student(s) one warning. Thereafter, student(s) will be reassigned to a virtual afterschool tutoring classrooms.
I have read and understand the Statement of Policy contained here. *

Agree

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Tutoring Program and Summer School Enrollment Form

Parent Information

Student(s) Information

Health Information

Statement of Policy