"The Afterschool Boost" by Operation Refuge

Operation Refuge "The Afterschool Boost"

Afterschool Program
Operation Refuge “The Afterschool Boost” is a safe afterschool program that provides students with educational enrichment with a "Boost" of fun and structured activities after school.

“The Afterschool Boost” recognizes students who regularly attend after-school programs are more likely to have higher grades and test scores than those who do not.

Enroll your child today to give them that extra "Boost" with homework help, math, science, and reading enrichment along with dance and art.

Program Details

Location: Operation Refuge Headquarters 27807 Carlysle St. Inkster, MI

Days& Times: Monday- Friday 3:30-6:00 pm

Grades 1-4th

Afternoon Snack

Homework Help and more...

Contact Information: Phone: (313) 380-0408‬

Email: afterschoolboost@yahoo.com

Weekly Boost of math, science, reading, dance, art, behavior management, and conflict resolution in a safe environment.

- "The Boost" after-school program is a great way for parents to know their children are learning, staying active, and engaged outside of school hours.
- "The Boost" after-school program is a great way for children to explore their interests and learn new skills in a fun and engaging environment.
- "The Boost" after-school program is a great place to come for homework help and "Boost" those critical thinking skills.
- So why not give your student "The Boost" the fun and enchantment of after-school programs and give your child a chance to explore new passions and make new friends?
Student's Information

First NameMiddle Name
Last NameNickname
Student Address*

Street Address

Street Address Line 2

CityState

Zip Code
Student's Birth Date

MonthDayYear
School Information

Name of SchoolCurrent Grade
Student Email
example@example.com
Parent/Guardian Information
Name:*

First NameLast Name
Relationship to Student*
Home (Living Address)

Street Address

Street Address Line 2

CityState

Zip Code
If your mailing address is different from your living address, please provide the mailing address
Can we text your cell phone?
Primary Phone:
Home/Work Phone:
E-mail:
example@example.com
Secondary Contact
Name

First NameLast Name
Relationship to Student*
Street Address

Street Address Line 2

CityState

Zip Code
Can we text your cell phone?
Primary Phone:
Phone:
E-mail:
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Emergency Contact Phone*
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Student's Birth Date

MonthDayYear
Additional Student Information
YesNo
If yes, please describe
YesNo
If yes, please describe (food allergies, seasonal allergies, other
Ex: Asthma, Peanut allergies
YesNo
If yes, please describe
Health & WellnessExcelLiteracySTEAM ActivitiesField ExperiencesGirls MentoringBoys Mentoring
Operation Refuge "The Afterschool Boost" COVID-19 Health & Wellness Policies
Operation Refuge's top priority is the safety of those in our care including your students, our staff and volunteers, and the community. While there is no 100% effective way to prevent illnesses, we’re taking ongoing steps to make our program as safe a learning environment as possible.

If your child is sick, please keep them at home. Our building spaces will be thoroughly cleaned and sanitized daily. Masking is optional, and students will be required to wash their hands frequently throughout the day.

Operation Refuge will continue to monitor COVID-19 transmission in Wayne County, and we will meet or exceed guidelines provided by the CDC, and state and local health departments.
For reporting purposes, please complete: (Optional)
Race
Number of members in household:
Highest level of parent/guardian education:
SingleTwo Family IncomeWish not to disclose
YesNoNot sureDo Not Wish to Disclose
Primary Language spoken in your home:
YesNo
YesNo
YesNo
YesNo
YesNo
Confirmation

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.
Digital Signature:
Type your name
Operation Refuge “The Afterschool Boost” program is excited about the opportunity to provide afterschool enrichment for your child!! To ensure that each and every student has an amazing experience we want all of our students and parents to understand and be familiar with the expectations for participants.
Student Expectations: (Please check the box next to each)
I will cooperate with staff, counselors and volunteers as well as fellow students in all activities.I will be responsible for my actions and behavior so that it doesn’t interfere with somebody else’s opportunity to enjoy "The Boost."I will follow all rules established and follow the rules on the Do’s & Don’t listI will act and speak positively and kindly to everyone (i.e. no swearing, inappropriate remarks, etc).I will have FUN, make FRIENDS, and LEARN new things!I understand students who choose not to follow the behavior expectations will be given “two strikes” and then dismissed from the program.First strike: Separated from activity temporarily. Incident is discussed with student and documented. Warning issued.Second strike: Separated from activity and escorted to office. Incident is discussed with student and documented. 2nd and final warning issued. Parent/guardian notified by phone immediately. Arrangements are made with parent/guardian to pick up student immediately.No tolerance: Operation Refuge reserves the right to immediately dismiss any student whose actions or behaviors endanger themselves, other students, or staff, including, but not limited to, the possession of tobacco, drugs, or alcohol of any kind while at the program.
I will submit my students progress reports, report cards within one week of receiving the above from the schoolI will submit test scores (NWEA, MSTEP, PSAT etc) within one week of receiving themI understand that attendance is important and will make sure my child is at program Monday- Friday by 4:15I will drop off and pick up my student between 3:30-6:00 pmI will notify the staff of my Childs absence in a timely mannerNo tolerance: Operation Refuge reserves the right to immediately dismiss any student whose actions or behaviors endanger themselves, other students, or staff, including, but not limited to, the possession of tobacco, drugs, or alcohol of any kind while at the program.
Parent Expectations: (Please check the box next to each)
Parent's Digital Signature:
Type your Name
Students Signature:
Type your Name
Date

Operation Refuge "The Afterschool Boost"

Additional Student Information

Operation Refuge "The Afterschool Boost" COVID-19 Health & Wellness Policies

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