K-8 After-School 2024-2025 Registration

K-8 STEAM After-School Program Application 2024-2025

Thank you for applying to the K-5 and Middle School STEAM After-School Program! This application will allow you to apply for three children; any additional children will require a separate form. You will receive a confirmation email that your registration has been completed.
The K-5 and Middle School STEAM After-School Program begins on Tuesday, September 3, 2024 and operates Monday-Friday 3 pm-6 pm (hours subject to change for half days and program closures)

Please read and agree to the following:
- your child(ren) must attend the program at least 3 days a week for 60 minutes or more.
- all required documentation must be submitted promptly
- you and the child(ren) must adhere to the program's health and safety regulations
With my signature, I agree to adhere to the attendance, documentation and healthy safety regulations of program:

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Non-Discrimination Clause

The K-8 Program at Honickman Learning Center Comcast technology Labs will not discriminate against any participant based on factors like race, color, religion, sex (including gender identity and expression), national origin, disability, age or any other protected characteristic in its admissions, program services, or employment practices. This ensures equal access to participate in all aspects of program and fair treatment for all children in the program. We provide reasonable accommodation for children with disabilities to ensure equal participation.
I understand and agree to the non-discrimination clause
FERPA

Under FERPA (Family Educational Rights and Privacy Act), afterschool programs can access student data from a school if they are considered a "school official" with a "legitimate educational interest," meaning they need the information to fulfill their educational responsibilities in supporting students. The program adheres to privacy guidelines when handling this information. Our K-8 program maintains the confidentiality of student data they receive from the school and follow our organization's data security practices to protect personal information.
If documentation is needed from the school for the collection of required data, do you give us consent to contact the school to receive the documentation on your behalf?*

Yes, I consent to the collection of data from my child(ren)'s school.No, I do not agree to the school sharing my child(ren)'s data
Parent/Guardian Information
Parent/Guardian Name (Please place full legal name, we can not accept abbreviations, letters or nicknames) *

First NameLast Name
Relationship to Child*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
How many children will you be enrolling in the after-school program that are not already enrolled?*
If you are eligible for ELRC (formerly CCIS), where are you in the process of applying?*

Yes, I have started but did not complete the applicationNo, I have not started the application yetI have completed the application and am waiting for determinationI am not eligible for ELRC (CCIS)
You can apply for the Early Learning Resource Center (ELRC) (formerly CCIS) in Philadelphia, Pennsylvania by:
- Calling the ELRC at (888) 461-KIDS (5437)
- Applying online at compass.state.pa.us
- Mailing, faxing, or dropping off a printed application at your local ELRC office
You will need to provide documents to verify your information. What you need to apply:
- Proof of your income
- Proof of your child's citizenship or legal residency
- Proof of your child's need for care
- Proof of your employment or school attendance
- Proof of identification for each parent or caretaker

Honickman Learning Center & Comcast Technology Labs After-School 2022-2023 Parent/Guardian Consent Form

Please list the name(s) of the children you are enrolling into program.
Child 1 Name*

First NameLast Name
Child 2 Name

First NameLast Name
Child 3 Name

First NameLast Name
Parent Name*

First NameLast Name
Emergency Consent

Please read carefully and initial to indicate your consent.
In case of a medical emergency, I understand that my child will be transported to the hospital as the local emergency resource (police, EMS, fire, etc.) deem necessary.
In hereby assume full financial responsibility for any medical attention or treatment provided, as well as transport.
It is understood that in some medical emergencies, staff will need to contact the local emergency resource before contacting the parent, child's physician, and/or other adults acting on the parent's behalf.
Field Trips/Swimming

In order for your child to attend trips and go swimming, you must sign a permission slip. We will only swim in pools that certified lifeguards on staff/duty.
I hereby authorize HLCCTL K-8 Program to transport my child to and from the HLCCCTL for field trips.
I release HLCCTL, K-8 Program, Project HOME and/or any of their agents or employees from all claims, demands, judgements, for all personal injuries known and unknown which my child has or may incur by participating in the described activity.
Sanitizer & Topical Ointments
I understand that my child will utilize hand sanitizer in their classroom and other areas of the building and/or while on trips.
I understand that my child will utilize sun screen and/or insect repellant while engaging in outdoor play, water play, and/or on trips.
Parent/Guardian Responsibilities
I understand that HLCCTL reserves the right to refuse participation program or its activities for reasons that include but are not limited to the following: poor behavior/excessive redirection, risk of health/safety to themselves or others, acts of violence, theft, profane language, lack of attendance or lack of reasonable accommodations, etc.
I have read this release, acknowledge, and understand all of its terms.
Signature

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Date

MonthDayYear
Date

Project HOME Image Release Form
Project HOME Image Release Form

Definition of “Personal Image”
In this form, “Personal Image” means any:
• photograph, film, video, sound recording, or drawing that depicts the image, likeness or voice of my child; or
• any edited or modified version of the above; or
• my child’s name

Grant Project HOME Right to Use Personal Image
I, on behalf of my minor children, grant to Project HOME the right and license to use, copy, modify and display the Personal Image in any medium (example- written or electronic) for its promotional or operational efforts.

Types of Uses by Project HOME
This right includes the right to use my child’s Personal Image in Project HOME’s:
• newsletter, mailings, promotional and fundraising materials, paper or electronic publications, web pages, social media and networking sites, films, videos, and other similar works.

No Compensation
I understand that neither I, nor my minor children, will receive any money or other compensation for use of any Personal Image.

No Right to Approve use or Personal Image
I understand that neither I, nor my minor children, will have the right to inspect or approve any Personal Image or any edited or modified version of any Personal Image.

Waiver and Release of Any Liability
I, on behalf of my minor children, hereby release and hold harmless Project HOME and its agents and employees from and against any claims related to the use of any Personal Image, such as any editing, blurring, or alteration, either intentionally or otherwise, that may occur in its publication or distribution.

Right in Perpetuity
I understand that this right continues unless I change my permissions in writing to the Program Manager, or Building Direcor, or the Development at Project HOME.
I have read this form, and I fully understand its meaning and effect, and I:
Your Signature

Clear
Date

MonthDayYear
Date

Emergency Contact/Parental Consent Form

Please hit the button to complete the Emergency Contact/Parental Consent form.
Should be Empty:

K-8 STEAM After-School Program Application 2024-2025

Non-Discrimination Clause

FERPA

Parent/Guardian Information

Student Information

Student Information

Student Information

Honickman Learning Center & Comcast Technology Labs After-School 2022-2023 Parent/Guardian Consent Form

Emergency Consent

Field Trips/Swimming

Sanitizer & Topical Ointments

Parent/Guardian Responsibilities

I have read this release, acknowledge, and understand all of its terms.

Project HOME Image Release Form

Emergency Contact/Parental Consent Form