Bridges Academic Center of Excellence

AFTER SCHOOL @ BRIDGES

(Academic Advisement, College Preparation, Homework Lab, Tutoring & STEM Exploration Activities)
After School @ Bridges Now in Session

In-person

Location: Glory Christian Fellowship Church

225 West Torrance Blvd, Suite D, Carson, CA 90745

Tuesday - Thursday: 4:00-7:30pm*

*Wednesday: 4:00-8:15pm

**Schedule is subject to change weekly.**

Online Tutoring Start Date - TBD
Contact Information:

Complete the required contact information for parent/guardian(s) and student applicant.
Parent/ Guardian Contact Information*

First NameLast Name
Parent/ Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/ Guardian Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/ Guardian Email*
example@example.com
Parent/Guardian Relationship to Student:*
Parent/ Guardian Contact Information

First NameLast Name
Parent/ Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/ Guardian Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/ Guardian Email
example@example.com
Parent/Guardian Relationship to Student:
Student Name*

First NameLast Name
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Student Email*
example@example.com
MaleFemale
Student Date of Birth

MonthDayYear
1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade
AlgebraGeometryAlgebra 2TrigonometryStatisticsPre CalculusCalculus
Name of School*
Current Cumulative GPA*
Tuesday, Wednesday and ThursdayTuesday and WednesdayTuesday and ThursdayWednesday and ThursdayTuesdayWednesdayThursday
Emergency Contact Information*

First NameLast Name
Emergency Contact Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Student:*
PARENT/GUARDIAN AUTHORIZATION
I,Print Parent/ Guardian Name* hereby give Student Name* , a minor child permission to participate in the Bridges Academic Center of Excellence (Bridges ACE) Afterschool Programs. I understand that the primary objective of Bridges ACE is to support and encourage students to excel in school and receive needed academic supplemental resources in a safe environment.
AUTHORIZATION
I hereby authorize Bridges ACE's director(s), staff, and their volunteers to engage in the following:

1. To have access to, make and receive copies of my child’s academic school records while actively enrolled in one or more of our programs. I understand that these records will be kept in strict confidence and will be used solely to a) monitor my child’s academic progress and b) determine what academic support services are needed as they progress to graduation.

2. To reproduce any original materials submitted by and any image of participants in our programs. I understand that participants’ compositions or likenesses may be reproduced in part or in whole for the purpose of on-going program promotion and evaluation. I release Bridges ACE of any obligation to compensate me, my children, or any party acting on my behalf, for the use of the above-mentioned media.
I, Parent/ Guardian Name* , give my consent to allow my child to participate in activities at the Bridges ACE. In the event of an accident on or away from the site, I hereby give the staff permission to see that my child receives medical treatment. I understand that I will be financially responsible for all charges incurred in the rendering of emergency treatment, regardless of my insurance coverage. In addition, I authorize emergency medical treatment for my child at the nearest medical facility.
[APPLICABLE FOR IN-PERSON MEETINGS].
Parent Signature*

Clear
Bridges Academic Center of Excellence

Policies and Procedures
1 ) Students must be on time for all scheduled academic sessions, academic workshops, and presentations for which they are registered.

2) Students should be respectful to all teachers, tutors, workshop facilitators, staff, and each other at all times.

3) Students must wear appropriate dress attire.

4) Computers are for academic use only. Other activities, such as playing games, downloading pictures, music, etc. will not be tolerated.

5) All required documents should be signed and submitted in a timely manner.

In addition, the following will NOT be tolerated:
- Playing or loud talking during sessions
- Profanity
- Hitting or fighting
- Hats, caps, or “du-rags”
- Cell phones and electronic devices turned on during classroom sessions
- Drugs or alcoholic beverages
- Bullying will not be tolerated.
Failure to meet these expectations will result in a conference with the staff, the student, and parents and may result in dismissal from the program. There is a zero-tolerance expectation for misbehavior or anything deemed distracting to the environment and counterproductive for learning.
I UNDERSTAND AND AGREE TO ADHERE TO THE POLICIES AND PROCEDURES AS STATED ABOVE.
STUDENT SIGNATURE*

Clear
PARENTS/GUARDIAN SIGNATURE*

Clear
Questions or Comments
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AFTER SCHOOL @ BRIDGES

PARENT/GUARDIAN AUTHORIZATION

Bridges Academic Center of Excellence

I UNDERSTAND AND AGREE TO ADHERE TO THE POLICIES AND PROCEDURES AS STATED ABOVE.