After School Program Enrollment Form

SUMMER ACADEMY

2024
PROGRAM DETAILS

The students will be expected to engage in collaborative learning where they are able to work independently as well as in groups. We believe that leadership is not only about what you know but who you are and the characteristics that you display in how you learn and how you lead. Our students will learn the importance of Integrity, Expectancy, Ingenuity, Community, and Tenacity as they expand their knowledge of what it is to be a leader.
Application Process - The referring school support staff will complete an online application by following the prompted steps

Complete your applicationAttend In-Person or Virtual Interview. The selection process includes a student empathy interview. Student will receive a link to schedule.View your decision letter. The referring person and student will be notified of acceptance status. If selected, you will receive an acceptance letter with onboarding instructions.Complete Onboarding - Student and parent/guardian are required to attend the Onboarding Orientation. Documents provided include: Family Participation Agreement, Program Curriculum/Activities, Parent/Guardian Involvement Plan, Program Expectations
PROGRAM CRITERIA

Rising 9th, 10th, 11th and 12th graders will be recommended to the program by school and community leaders. No students that have a history of ongoing disciplinary issues will be accepted into the program. Parents and students admitted into the program must agree to the program continuation plan. In order to be eligible for the program benefits, the student must complete the required continuing education and activities. The students must agree to return to the Summer Academy for a period of one week each year after their inaugural year to receive refresher training and ongoing leadership training.
Must be a rising 9th, 10th, 11th, or 12thQualify based on Low to Moderate IncomeMust be enrolled in school (charter, public, virtual, or home school)Must have a minimum G.P.A. of 2.00Must provide an unofficial copy of school transcriptMust not have more than 10 unexcused absencesMust not have more than one disciplinary infraction. (Please note: Type of infraction may impact final acceptance)Must be available on the scheduled days for the entire duration of the programMust be interested in learning new skills for growth in leadership
STUDENT INFORMATION
Student's Name*

First NameLast Name
Student's DOB

MonthDayYear
Date
Student's Gender

MaleFemaleNon BinaryTransgenderI do not wish to disclose.
Student's Phone Number

Area CodePhone Number
Student's Email
example@example.com
Student's Address ( Leave blank if same as Parents/Guardian)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Attending
Grade in fall (2023-2024)*

Rising 9th GraderRising 10th GraderRising 11th GraderRising 12th Grader
PARENT/GUARDIAN INFORMATION
Parent's Name (1)*

First NameLast Name
Parent's Email (1)*
Parent's Phone Number (1)*

Area CodePhone Number
Parent's Work Phone Number

Area CodePhone Number
Parent's Home Phone Number

Area CodePhone Number
Parent/Guardian Address (1)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Name (2)*

First NameLast Name
Parent's Email (2)*
example@example.com
Parent's Phone Number (2)*

Area CodePhone Number
Parent's Work Phone Number

Area CodePhone Number
Parent's Home Phone Number

Area CodePhone Number
Parent/Guardian Address (2)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which parent has approved/is overseeing your participation?

Parent 1Parent 2Both parent 1 and 2
EMERGENCY CONTACT INFORMATION
Emergency Contact Name (1)

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
What relationship is this person to you?
Emergency Contact Name (2)

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
What relationship is this person to you?
TRANSPORTATION/ PICK-UP INFORMATION
If a parent/guardian will be handling your transportation to and from Vanguard, please list authorized individuals. ID's will be checked daily and students will only be released to the listed individuals whose identification has been verified:
Does your child need transportation?

YesNo
Primary Pickup/Release 1:

First NameLast Name
Phone Number 1:

Area CodePhone Number
Alternate Pickup/Release 2:

First NameLast Name
Phone Number 2:

Area CodePhone Number
MEDICAL INFORMATION
Does your child have a disability/difference?

IntellectualPhysicalEmotionalLearningOther
If so, please describe the disability/difference :
Please note any known medical conditions :
Please list current medications, prescribed or supplements :
Please note any known allergies :
*To food, medicine and/or environmental
Is there any other health or medical information that you want us to know about?
In the event of an emergency please list ;
Hospital Preference
Phone Number

Area CodePhone Number
Insurance Information
Primary Physician
Phone Number

Area CodePhone Number
Height
Weight
REFERRALS
Referring School Contact Email Helper Text: Please enter the email address of the referring School Counselor or Social Worker*
For all other referring persons, please provide the following:
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Referring Student*

First NameLast Name
Describe the student you are referring ?*
What are 3 strengths ?*
What are 3 areas of improvement ?*
Why do you feel that this student is a good fit for the program?*
Does this student have any disciplinary infractions? If so, Are you aware of any details that explain the behavioral or disciplinary issues with this student?*
Does this student have a history of disciplinary issues?*
Does this student have more than 10 unexcused absences?*
What qualities do you see in this student that have not been recognized or nurtured by others?*
Why does this student stand out to you as a student that would benefit from this program?*
Does this student have leadership potential? If so, what potential do you see in this student?*
How can VLA help this student come out of the shadows and maximize their potential?*
What support do you feel this student needs to maximize their potential?*
Is there anything more you’d like to share about this student that was not asked?*
STATEMENT OF POLICY
A complete application and referral is required for all students applying to participate in the Summer Academy.

At the Vanguard Leadership Academy, we are dedicated to fostering a stimulating and safe learning environment that empowers young minds to explore, discover, and grow. Our policies reflect our commitment to providing an enriching experience for all participants while maintaining a culture of respect, inclusivity, and responsibility.

1. Equal Opportunity and Inclusion:

We firmly believe that diversity enriches the learning experience. Our academy is open to participants of all backgrounds, irrespective of race, ethnicity, gender, sexual orientation, religion, or socioeconomic status. We actively promote inclusivity and ensure that every participant feels valued, heard, and respected.

2. Safety and Well-being:

The safety and well-being of our participants are paramount. We implement stringent safety protocols, including carefully maintained staff-to-participant ratios, well-defined emergency procedures, and adherence to relevant health and safety guidelines. Our staff members undergo training to address any physical or emotional concerns promptly and effectively.

3. Code of Conduct:

We uphold a high standard of behavior that reflects mutual respect and responsibility. Participants are expected to treat others with kindness and consideration, refraining from any form of bullying, harassment, or discrimination. Any behavior that disrupts the learning environment or compromises the safety and well-being of others will not be tolerated. Our disciplinary measures are designed to be fair, consistent, and proportionate to the violation.

4. Academic Integrity:

Academic honesty is the foundation of our learning community. Plagiarism, cheating, and any form of academic dishonesty are strictly prohibited. Participants are encouraged to engage in independent thinking, creative expression, and the pursuit of knowledge with integrity. Any violations of academic integrity will be addressed through appropriate measures.

5. Attendance and Punctuality:

Consistent attendance and punctuality contribute to a successful and rewarding experience for everyone. Participants are expected to attend all scheduled sessions, lectures, workshops, and activities. In cases of unavoidable absences, participants or their guardians are requested to inform the academy in advance.

6. Technology Usage:

We acknowledge the role of technology in education but emphasize responsible usage. Participants are encouraged to utilize electronic devices for educational purposes while maintaining respect for others and the academy's guidelines. Disruptive or inappropriate use of technology will be addressed, and we foster an environment that balances virtual engagement with real-world interactions.

7. Confidentiality and Privacy:

Respect for each individual's privacy is fundamental. Participants and staff members are expected to maintain the confidentiality of personal information shared within the academy community. Sharing personal information or images without explicit consent is strictly prohibited. Breaches of privacy will be dealt with seriously.

8. Health and Wellness:

Promoting physical and emotional well-being is an integral part of our academy's mission. Any medical conditions, allergies, or dietary restrictions should be communicated to the academy in advance to ensure the well-being of all participants.

9. Parental Communication:

We recognize the vital role that parents and guardians play in the success of our participants. Regular communication will keep families informed about the academy's schedule, activities, and participant progress. Parents are encouraged to reach out to the academy staff with questions, concerns, or suggestions to ensure the best possible experience for their child.

10. Loss/Damage to Students' Items:

While participating in the academy, participants are responsible for their personal belongings and items. The academy cannot be held liable for the loss, damage, or theft of personal items. We recommend that participants label their belongings and exercise caution when bringing valuable items to the academy. Staff members will assist in creating a safe and organized environment, but participants are ultimately responsible for their possessions.

11. Photo Release:

The academy occasionally captures photographs and videos of participants engaged in various activities. By participating, participants and their guardians grant the academy permission to use these images for promotional and educational purposes. If participants or their guardians do not wish to have images of themselves used, they must communicate this in writing to the academy's administration.

12. Lunch and Dietary Considerations:

As part of our commitment to providing a well-rounded experience, lunch will be provided to all participants during the academy's activities. We understand the importance of dietary preferences, restrictions, and allergies. Participants or their guardians are encouraged to communicate any specific dietary needs or allergies to the academy's administration in advance. We strive to accommodate a variety of dietary requirements and will provide vegetarian options for every meal.

13. COVID-19 Considerations:

The safety and well-being of our participants are especially crucial during the ongoing COVID-19 pandemic. We are committed to following recommended health guidelines to mitigate the spread of the virus. This may include measures such as mask-wearing, social distancing, enhanced sanitation, and adherence to quarantine or isolation protocols if necessary. The academy will communicate any specific COVID-19-related policies and procedures to participants and their families in a timely manner.

We understand that the situation surrounding the pandemic is fluid, and our policies may need to adapt accordingly. The academy reserves the right to make changes to programming, scheduling, or other aspects to ensure the safety and health of all participants.

14. Emergency Notification:

In the event that a child becomes ill or is injured while participating in the Vanguard Leadership Academy, the staff will attempt to notify the parent/guardian by telephone. If we are unable to contact a parent/guardian, we will call the emergency contacts listed on the registration form in order. Parents/Emergency contacts are expected to respond to notification by arriving for pick up as swiftly as possible. Vanguard Leadership Academy staff will monitor the child until a parent/guardian or emergency contact arrives to pick up the child, but please note that academy staff are not medically trained,

and cannot provide medical care or assessment. If the need seems dire, staff may call for emergency transport to the nearest medical facility, and all costs resulting from that transport request and subsequent treatment will be the responsibility of the parent/guardians. The parent/guardian agrees and acknowledges that the Vanguard Leadership Academy staff has permission to administer first aid or to obtain emergency medical treatment in the child's best interest at the discretion of academy staff. Parents/guardians agree to be financially liable for all medical transport and treatment deemed necessary by Vanguard Leadership Academy staff.

15. Feedback and Improvement:

We value the input of participants and their families in our continuous efforts to enhance the academy. Constructive feedback, concerns, and suggestions are welcomed and actively encouraged. We commit to carefully reviewing and considering all input as we strive to improve our programs, activities, and policies.

By participating in the Vanguard Leadership Academy, all individuals commit to upholding these policies and contributing to a positive and enriching learning environment. These policies reflect our shared values and aspirations for personal growth, academic excellence, and a brighter future for each participant.
I have read and understand the Statement of Policy contained here.*

Agree
I give Vanguard Leadership Academy permission to ................*

Agree
Vanguard Leadership Academy's vision is to:
- Propel graduates of the summer leadership program to the top of their class, and gain admittance to desirable institutions of higher learning.
- Support and Guide students in gaining admittance to desirable institutions of higher learning.
- Develop outstanding leaders in society.
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SUMMER ACADEMY

PROGRAM DETAILS

PROGRAM CRITERIA

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

TRANSPORTATION/ PICK-UP INFORMATION

MEDICAL INFORMATION

REFERRALS

STATEMENT OF POLICY