2022-2023 Middle & High School Sports/Clubs After School Program Enrollment Form

2022-2023
After School Program Sports/Clubs Enrollment Form

Middle and High School
A late fee of $1.00 per minute per child will be charged for children picked up after 5:00 p.m.

Clubs:

Offered every quarter:

Clubs will be based on students' needs, interests and requests. Students are encouraged to participate and stay the entire club hour to maximize the club experience and field trips.

Rate: $45.00 per club

Club Schedule: Mondays: 3:45-5:00 p.m.

5th Grade to 9th Grade ONLY: Sports:

Quarter Basis:

Sports are available for students in 5th-9th grades. The sports program will be under Jeffco League Sports Program. We must have a minimum of 7-10 players to create a team with Jeffco League. If we do not have enough players signing up to create a team, will become a sports clinic.

Rate: $65.00 per sport, per quarter

Sport Schedule: Practice on Tuesdays, Wednesdays, and Thursdays. 3:45-5:00 p.m.

General:

Any pick-up changes or early pick ups, contact the after school phone: 720-525-9194
Upon arrival, text the after school phone, staff will send your child to you.
If you child missed a school day due to illness or any absence, they may not attend the program that day.
Registration and payment are due one week prior to the start of the club and/or sport.

A late fee of $1.00 per minute per child will be charged for children picked up after 5:00 p.m.
Student Registration
Student Name #1

First Name Middle Name Last Name
Nickname/Prefer to be called:
Name
Age
Grade
Student Name #2

First Name Middle Name Last Name
Nickname/Prefer to be called:
Name
Age
Grade
Student Name #3

First Name Middle Name Last Name
Nickname/Prefer to be called:
Name
Age
Grade
Emergency Contact #1: Must be available anytime after 3:30 p.m.

First Name Last Name Text Number/Cell Number
Emergency Contact #2: Must be available anytime after 3:30 p.m.

First Name Last Name Text Number/Cell Number
Pick-Up Authorization Form:

To provide maximum safety for the children during after school program, we ask you to fill out this form to inform the staff who is allowed to pick up your child at the end of the day. Please provide three people to are authorized by you to pick up your child if you, the parent, cannot pick your child up:
#1 Authorized Person Name:

First Name Last Name
Relationship:
Phone Number

Area Code Phone Number
#2 Authorized Person Name:

First Name Last Name
Relationship:
Phone Number

Area Code Phone Number
#3 Authorized Person Name:

First Name Last Name
Relationship:
Phone Number

Area Code Phone Number
Field Trip/Activity Information:

Walking Off-Campus Permission Form
I ___________________________ hereby give consent for my child to participate in the event on Mondays and Wednesdays with Rocky Mountain Deaf School. In consideration of my child’s voluntary participation in this activity and related activities, I understand that:

My child will be walking off-campus with their group with their club/sports leader/teacher/supervisor.
- D’Evelyn Fields and outside the campus
- Disc Golf Field
- Large Field next to RMDS, across from D’Evelyn
- Harriman Lake Park and Trail
Rocky Mountain Deaf School and Jeffco School District are relieved of any or all liability for accidents or injuries connected in any way with the activity program.

It is the responsibility of the parent or guardian to provide insurance protection for the student while participating in activities.

My child will follow the COVID-19 safety and its guidelines.

By signing this consent form, I hereby release and discharge the Jefferson County School District, Rocky Mountain Deaf School, and their/its successors, heirs, assigns, directors, officers, employees, supervisors, agents, attorneys, and representatives, from any and all actions causes of action, claims, demands, losses, damages, costs, attorney fees, judgments, liens, indebtedness, and liabilities whatsoever, known or unknown, suspected or unsuspected, past, present or future, with regard to all matters that could have been raised in action on the merits regarding the aforementioned activity in which I and my child have elected to voluntarily participate.
Signature

Clear
Date

MonthDay Year
Date
Bus Permission:
During the sports season's away games, your child will be riding the activity bus:

Your child will leave RMDS at the end of the day or will be released early, depending on the game schedule.

I ________________hereby give my consent for my child ________________________ to participate in the events outlined on the previous page (other than any exceptions I have listed below) with Rocky Mountain Deaf School. In consideration of my child’s voluntary participation in this activity and related activities, I understand that:

Transportation for these trips is provided by the RMDS Activity Bus driven by a trained staff member, or a JeffCo Public Schools Bus. Therefore, I give those persons permission to transport my child.
Rocky Mountain Deaf School and JeffCo School District are relieved of any or all liability for accidents or injuries connected in any way with the activity program.
It is the responsibility of the parent or guardian to provide insurance protection for the student while participating in activities.
By signing this consent form, I hereby release and discharge the Jefferson County School District, Rocky Mountain Deaf School, and their/its successors, heirs, assigns, directors, officers, employees, supervisors, agents, attorneys, and representatives, from any and all actions, causes of action, claims, demands, losses, damages, costs, attorney fees, judgments, liens, indebtedness and liabilities whatsoever, known or unknown, suspected or unsuspected, past, present, or future, with regard to all matters that could have been raised in action on the merits regarding the aforementioned activities in which I and my child have elected to voluntarily participate.
My child has my permission to ride the activity bus. Signature:

Clear
Release/Liability:
I hereby give my consent for my child to participate in the above activity with Rocky Mountain Deaf School. In consideration of my child’s voluntary participation in this activity, I understand that:

*Rocky Mountain Deaf School and Jeffco School District are relieved of any or all liability for accidents or injuries connected in any way with the activity program.
*It is the responsibility of the parent or guardian to provide insurance protection for the student while participating in activities.
*This liability form applies to all clubs, sports and after school programs activity as stated above for the school year 2022-2023.

By signing this consent form, I hereby release and discharge the Jefferson County School district, Rocky Mountain Deaf School, and their/its successors, heirs, assigns, directors, officers, employees, supervisors, agents, attorneys, and representatives, from any and all actions, causes of action, claims, demands, losses, damages, costs, attorney fees, judgements, liens, indebtedness and liabilities whatsoever, known or unknown, suspected or unsuspected, past, present, or future, with regard to all matters that could have been raised in action on the merits regarding the aforementioned activity in which I and my child have elected to voluntarily participate.
Signature

Clear
Date

MonthDay Year
Date
Sports/Clubs Registration:
I have filled out, read, understood and will abide by the registration and enrollment agreement.
Signature

Clear
I would like to enroll my child(ren) in:
$45.00 per club:
Mondays Club:

1st Quarter: August 22-October 10: Robotics Club2nd Quarter: October 17-December 5: 3-D Club3rd Quarter: January 9-March 6: Rockclimbing/Pickleball ClubMarch 13-May 8: Driver's Education (*14 years old and up*)
5th-9th Grade Sports:

Practices are on Tuesdays/Wednesdays/Thursdays from 3:45-5:00 p.m. The sports program is under Jeffco League. If we do not have enough players, will become RMDS' sport clinic program and will open only to 6th-12th grades.
$65.00 per Sport:
Sports:

1st Quarter: August 17-October 13: Flag Football2nd Quarter: October 18-December 8: Volleyball3rd Quarter: January 10-March 9: Basketball4th Quarter: March 13-May 11: Soccer
TOTAL Amount Due to RMDS:
- Payments are due the day before the start of the sport or/and club.
- Payment may be made in cash, credit, or through the parent Jeffco Connect account.
- If payment is not received before the first of day of sport/club, the student cannot participate and will be sent home.
- There is no reduction in fees or refunds for days missed.
High School Students ONLY!!

E-Sports: Mario Kart
$65.00 for the season
- Only 9th to 12th grade students can register for E-Sports.
- January 25-May 23
- Wednesdays
- 3:45-5:00 p.m.
- The players will be playing Mario Kart games!
- Device: Nintendo Switch
- If you have a Nintendo Switch, please bring it!
- Cost: $65.00 for the season
E-Sports:

Yes! My child will participate in E-Sports.No, my child will not participate.
Additional Comments or Anything you would like for the after school team to know:
Should be Empty:

2022-2023

After School Program Sports/Clubs Enrollment Form

Student Registration

Pick-Up Authorization Form:

Field Trip/Activity Information:

Bus Permission:

Release/Liability:

Sports/Clubs Registration:

I would like to enroll my child(ren) in:

$45.00 per club:

5th-9th Grade Sports:

$65.00 per Sport:

High School Students ONLY!!

$65.00 for the season