2024-2025 Academic and Enrichment Campus Information Form

- #1 Child's Full Name*
  
  First NameLast NameSuffix
- Birth Date*
  
  MonthDayYear
- MaleFemaleChoose to decline
- Grade Level*
- First TermSecond Term 2022/2023Both
- Charter School/ Responsible Party*
- 504IEPOther
- If you chose "other", please explain.
- Allergies, restrictions, special needs, and necessary medication
- YES
- #2 Child's Full Name*
  
  First NameLast NameSuffix
- Birth Date*
  
  MonthDayYear
- MaleFemaleChoose to decline
- Grade Level*
- First TermSecond TermBoth
- Charter School/ Responsible Party*
- 504IEPOther
- If you chose "other", please explain.
- Allergies, restrictions, special needs, and necessary medication
- YES
- #3 Child's Full Name*
  
  First NameLast NameSuffix
- Birth Date*
  
  MonthDayYear
- MaleFemaleChoose to decline
- Grade Level*
- First TermSecond TermBoth
- Charter School/ Responsible Party*
- 504IEPOther
- If you chose "other", please explain.
- Allergies, restrictions, special needs, and necessary medication
- YES
- #4 Child's Full Name*
  
  First NameLast NameSuffix
- Birth Date*
  
  MonthDayYear
- MaleFemaleChoose to decline
- Grade Level*
- First TermSecond TermBoth
- Charter School/ Responsible Party*
- 504IEPOther
- If you chose "other", please explain.
- Allergies, restrictions, special needs, and necessary medication
- Parent 1*
  
  First NameLast NameSuffix
- E-mail*
- Phone Number*
  
  Area CodePhone Number
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Preferred way to be contacted*
- Parent 2
  
  First NameLast NameSuffix
- E-mail
- Phone Number
  
  Area CodePhone Number
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Preferred way to be contacted
- Please list primary emergency contact first.
- Contact 1*
  
  First NameLast Name
- E-mail
- Phone Number*
  
  Area CodePhone Number
- Relationship*
- Contact 2
  
  First NameLast Name
- E-mail
- Phone Number
  
  Area CodePhone Number
- Relationship
- Authorized Pickup 1*
  
  First NameLast NameSuffix
- Phone Number*
  
  Area CodePhone Number
- Relationship*
- Authorized Pickup 2
  
  First NameLast NameSuffix
- Phone Number
  
  Area CodePhone Number
- Relationship
- Authorized Pickup 3
  
  First NameLast NameSuffix
- Phone Number
  
  Area CodePhone Number
- Relationship
- Authorized Pickup 4
  
  First NameLast NameSuffix
- Phone Number
  
  Area CodePhone Number
- Relationship
- Informed Consent & Acknowledgement
- I, Parent/Guardians Full Legal Name*, grant permission for my child(ren) to attend Academic and Enrichment Campus. I also hereby release Academic and Enrichment Campus from any and all liability or responsibility due to any injury that he/she/I may incur as the result of participating in activities at or under the direction of Academic and Enrichment Campus. I am fully aware and consent to accept these risks and voluntarily agree to allow his/her participation in activities.
- Health Information
- Contagious Diseases
  
  We are a small campus, if your child(ren) contracts a contagious diseases such as chicken pox, measles, mumps, head lice, etc., please notify Academic and Enrichment Campus immediately so we can let our community know there has been a potential exposure.
  
  ALL notifications will be anonymous. The identity of all children and families affected will be withheld from the community and staff.
  
  These requirements are legally protected.
  
  Please notify Academic and Enrichment Campus if child(ren) is/are ill and unable to attend.
  
  Covid-19
  
  All students, staff, and instructors will be required to attest they do not have a temperature of over 100.4 degrees to be on campus. At sign in each day, all students and staff attest they (and their live-in family members) are symptom free.
  
  If a student, staff member, or instructor develops a temperature of 100.4 or higher or shows signs of illness they will immediately be sent home.
  
  Students, staff, and volunteers who have any of the following symptoms (Covid or non-Covid) should stay home: fever, cough, shortness of breath, muscle or body aches, loss of taste or smell, sore throat, congestion, nausea, diarrhea, or vomiting.
  
  *Please do not give your child medicine to subdue symptoms to attend classes.
  
  If you or someone in your home tests positive for Covid-19, please defer to the CDC guidelines for schools at CDC Guidance for Schools for Covid-19 and notify one of our campus Directors.
  
  All students, staff, and instructors will also comply with guidelines for quarantine and for when they may return to campus if they test positive for Covid-19.
  
  All student-contacted items will be disinfected throughout the day and all students and staff will use hand sanitizer upon entering the classroom.
  
  Hand washing will be strongly encouraged both before and after lunch.
  
  *All policies are subject to change in the event that the State and Public Health requirements and/or Charter requirements change.
  
  General Illness
  
  Please keep you child home if they exibit any of the following symptoms.
  
  Fever of 100.4 or above
  Nasal discharge
  Cough
  Cold
  Sore throat
  Stomach ache
  Unexplained malaise
  Eye issues (discharge, itchy redness)
  Diarrhea or vomiting
  Unexplained rash
  Parasitic infection (i.e. lice) *if your child has lice, please provide proof that your child is lice free before returning to campus
  please keep your child home until they are symptom free for 24 hours.
  Your child must be symptom free WITHOUT the aid of ANY medication, to include (but not limited to): Aspirin, Tylenol, Advil, any prescription and/or over the counter medications continaing acetaminophen).
  
  Medical Staff
  
  Academic and Enrichment Campus does not have a nurse on staff or facilities for sick children. If your child becomes ill, he/she will be isolated as much as possible and must be picked up WITHIN ONE HOUR.
  
  On site first aid is limited to cleaning the injury with soap and water, band aids, and ice packs.
  
  Medications on Site
  
  Medicine will not be dispensed by faculty or volunteers unless they are deemed necessary for life threatening situations, such as Epi-pens, with clearance from parents (provided by the family).
  
  Make sure to include the need of emergency medications in the student information section.
  
  Please notify Academic and Enrichment Campus if child(ren) is/are ill and unable to attend.
- Yes
- Medical Release and Authorization
- Contagious Diseases
  
  We are a small campus, if your child(ren) contracts a contagious diseases such as chicken pox, measles, mumps, head lice, etc., please notify Academic and Enrichment Campus immediately so we can let our community know there has been a potential exposure.
  
  ALL notifications will be anonymous. The identity of all children and families affected will be withheld from the community and staff.
  
  These requirements are legally protected.
  
  Please notify Academic and Enrichment Campus if child(ren) is/are ill and unable to attend.
  
  Covid-19
  
  All students, staff, and instructors will be required to attest they do not have a temperature of over 100.4 degrees to be on campus. At sign in each day, all students and staff attest they (and their live-in family members) are symptom free.
  
  If a student, staff member, or instructor develops a temperature of 100.4 or higher or shows signs of illness they will immediately be sent home.
  
  Students, staff, and volunteers who have any of the following symptoms (Covid or non-Covid) should stay home: fever, cough, shortness of breath, muscle or body aches, loss of taste or smell, sore throat, congestion, nausea, diarrhea, or vomiting.
  
  *Please do not give your child medicine to subdue symptoms to attend classes.
  
  If you or someone in your home tests positive for Covid-19, please defer to the CDC guidelines for schools at CDC Guidance for Schools for Covid-19 and notify one of our campus Directors.
  
  All students, staff, and instructors will also comply with guidelines for quarantine and for when they may return to campus if they test positive for Covid-19.
  
  All student-contacted items will be disinfected throughout the day and all students and staff will use hand sanitizer upon entering the classroom.
  
  Hand washing will be strongly encouraged both before and after lunch.
  
  *All policies are subject to change in the event that the State and Public Health requirements and/or Charter requirements change.
  
  General Illness
  
  Please keep you child home if they exibit any of the following symptoms.
  
  Fever of 100.4 or above
  Nasal discharge
  Cough
  Cold
  Sore throat
  Stomach ache
  Unexplained malaise
  Eye issues (discharge, itchy redness)
  Diarrhea or vomiting
  Unexplained rash
  Parasitic infection (i.e. lice) *if your child has lice, please provide proof that your child is lice free before returning to campus
  please keep your child home until they are symptom free for 24 hours.
  Your child must be symptom free WITHOUT the aid of ANY medication, to include (but not limited to): Aspirin, Tylenol, Advil, any prescription and/or over the counter medications continaing acetaminophen).
  
  Medical Staff
  
  Academic and Enrichment Campus does not have a nurse on staff or facilities for sick children. If your child becomes ill, he/she will be isolated as much as possible and must be picked up WITHIN ONE HOUR.
  
  On site first aid is limited to cleaning the injury with soap and water, band aids, and ice packs.
  
  Medications on Site
  
  Medicine will not be dispensed by faculty or volunteers unless they are deemed necessary for life threatening situations, such as Epi-pens, with clearance from parents (provided by the family).
  
  Make sure to include the need of emergency medications in the student information section.
  
  Please notify Academic and Enrichment Campus if child(ren) is/are ill and unable to attend.
- Yes
- Media Release
- Academic and Enrichment Campus often takes photos and videos of students throughout the day during classes, recess or activities. I hereby grant Academic and Enrichment Campus permission to use these photographs or videos to be used to promote our facility without compensation. I understand that Academic and Enrichment Campus will NOT not identify my child(ren) or myself by name nor will we release any other personal information without additional written permission from me.
  
  I understand that I will not receive monetary compensation for any publication herein authorized.
- Yes
- Basic Rules and Expectations
- Bullying
  
  It is our intention to cultivate a cooperative learning environment that is safe and welcoming. Bullying of any type will not be tolerated. This includes physical, verbal, emotional and cyber bullying. An attempt will be made to assist in getting to the core of the matter, however if the behavior continues, your student will be asked to leave the program.
  
  Cell Phones/Two Way Devices
  
  We are a cell phone free facility. If cell phones or tablets are brought to campus they must remain in the students backpacks until the student leaves for the day.
  
  We ask that you leave the devices that are not absolutely necessary at home.
  
  Use of devices during the day to talk, text, take pictures, play games, or record is strictly prohibited. If a student violates the device policy, the device will be confiscated and turned into administration to keep for the duration of the day. Devices can be claimed at the end of the day.
  
  Academic and Enrichment Campus is not responsible for lost, damaged or stolen devices. Bringing them on campus is at your own risk.
  
  Conduct While on Campus
  
  Students are expected to keep their hands, feet, and bodily fluids to themselves and show respect to adults and staff, other students, and self.
  - Disruptive children may be removed from group situations to regain self-control. If the behavior(s) continue, parents will be notified.
  While in the presence of children and/or Academic and Enrichment Campus teachers, aides, staff and volunteers, parents are expected to:
  - Maintain a professional demeanor.
  - Direct all behavioral or disciplinary concerns to a staff member (aside from thier own child)
  - Be courteous and respectful to all teachers, aides, staff members or volunteers, especially in the presence of other school personnel or children.
  Dress Code
  
  Clothing on campus should be reflective of being in a learning environment and students are expected to maintain some level of modesty and professionalism in their dress. While we are sensitive to personal style, we ask that these guidelines are followed:
  - Skirts, dress, and shorts should reach the tip of your fingers when arms are held to the side of the legs.
  - Overly ripped jeans remain at home. If they are worn, legging must be worn under them (and not removed once on campus).
  - Shirts must not be shorter than the bellybutton.
  - Pajamas are not to be worn unless there is a special day allowing for it.
  Nut Free Facility
  
  Academic and Enrichment Campus is 100% tree nut free. This includes:
  - Almond
  - Brazil nut
  - Cashew
  - Chestnut
  - Hazelnut (Nutella)
  - Hickory nut
  - Macadamia nut
  - Peanuts
  - Pecan
  - Pistachio
  - Walnut
  These must not come on campus in any form to include trail mixes, nut butters, nut milks and/or spreads. Please avoid nut oils as well on the skin and/or food (i.e. almond oil).
  
  Profanity
  
  Profanity is not allowed on campus. Keeping our language clean, courteous and respectful is expected. Our campus is K-8 and we share space with a church, therefore we expect everyone on campus to act accordingly.
  
  Property
  
  As with all individuals on campus, we expect that all property on campus will be used as it is intended and treated with respect. Intentional damage to property will be the responsibility of the student's parents to fix or replace. Graphity, destruction or defacement of property inside the classroom or outside is strictly prohibited.
  
  Sexual Harassment
  
  No sexual harassment of employees/vendors, parents, or students will be tolerated. To include body objectification, vulgar and lewd comments/suggestions and/or body/hand gestures.
  
  Such interactions are prohibited in all forms of communication, including telephone conversations, voice mail messages, face-to-face conversations, written communications, and email messages.
  
  In the event that these expectations cannot be met and/or continue to be broken after attempts have been made to solve the issue(s) at hand, it could result in the removal of your child(ren) from the program without a refund.
- Yes
- Drop/Withdrawal Policy
- All academic classes are signed up by the term. Upon enrollment, you have 30 days to finalize your decision. If after the first 30 days, you decide to stay in the program, you are financially responsible for the entire term. A credit card will be required to be kept on file.
  
  Refunds for enrichment classes are on a case by case basis. Once the student has taken two or more classes no refunds will be given.
- Yes
- Notes or Comments for any above policies:
- BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
- Enter the message as it's shown*
- Signature
  
  Clear
- Should be Empty:

Informed Consent & Acknowledgement

Health Information

Medical Release and Authorization

Media Release

Basic Rules and Expectations

Drop/Withdrawal Policy