YWCA Phyllis Wheatley Center

 After School Enrichment Program (ASEP)

2024-2025 Registration Packet

For Boys and Girls (ages 11-18)

August 8th, 2024 - May 23nd 2025

3:30 p.m. - 6:30 p.m.

For Office Use Only: Check completed items. Staff title, date and signature required.

_______Registration Packet

_______Permission/Liability

_______Permission/Release Form (Field Trip/Photo/Movie/Computer)

_______Permission/Release Form (Transportation)

_______Release Auth. Form 

_______ASEP Policies & Parent Info

_______Code of Conduct

_______Intake Sheet*

Field Trip permission

 

_____  I give my child permission to travel on: Knoxville city transportation, trolleys, YWCA staff vehicles, school buses, and other partnering agencies-provided transportation. I am aware that my child may be required to walk short distances in the downtown and East Knoxville area for field trips under the supervision of YWCA staff.

Media Release and Video Form

 _____ I agree that the YWCA Knoxville & the Tennessee Valley has my permission to utilize photographs of my children to assist in the publicity of the YWCA and its programs and partnering agencies

_____ I agree that my child/ren may be videotaped for purposes of TV coverage or promotion of the YWCA Knoxville & the Tennessee Valleys programs and partnering agencies.

Movie / Documentary Videos/ Gaming Systems (PS4)

I understand that YWCA Knoxville & the Tennessee Valley Staff will be making use of educational materials that may include my child/ren watching 1-2 movies/documentaries per week.

 

 _____ I give permission for my child/ren to watch appropriate educational movies.

_____ I give permission for my child/ren to watch to watch: G-rated Movies.

_____ I give permission for my child/ren to watch to watch: PG-rated Movies 

_____ I give permission for my child/ren to watch to play the gaming system using non-violent games.

Computer/ Internet Usage

.

_____ I understand students will have access to the Computer Lab and online educational materials, resources, and programs to support and increase student learning and engagement.

_____ I give permission for my child/ren to utilize the computer lab/internet during program hours.

 

Please read carefully and initial the following statements:

Transportation Plan:

_____ | give permission for my child to walk to the YWCA Phyllis Wheatley Center from Vine Middle Magnet School.

_____ I understand that my child must consistently attend the after-school program to keep their spot.

_____ | understand that my child/ren will be required to sign in and out of the YWCA Phyllis Wheatley Center.

_____ I understand that if my child signs-out or leaves without signing-out for any reason on any given day, he or she will not be allowed to re-enter for that day.

_____ I give permission for my child/ren to sign-out and leave the YWCA Phyllis Wheatley Center when he or she chooses.

______I understand that if my child leaves for any reason on any given day without parental consent or without notifying the YWCA Phyllis Wheatley Center staff, the parent/guardian will be notified via phone call, voice message, and/or by contacting the emergency contacts listed for the student.

_____ | understand that it is the parent's responsibility to notify the YWCA Phyllis Wheatley Center of any changes in contact information, status and/or transportation plan.

In the event that I am unable to pick up my child/ren, he or she may be released to the following people:

NOTE: Anyone other than a parent/guardian will be required to show a photo ID to pick-up a student. NO ONE other than those listed above will be allowed to pick up your child/ren without prior notification. Should we be notified of someone else, we will require a photo ID.

_____ I have discussed a transportation plan with my child to get to and from the YWCA Phyllis Wheatley Center. 

 

Please provide any other specific details about your child's transportation plan below:

As part of the YWCA Phyllis Wheatley Center's After-School Enrichment Program, for the 2024-2025 school year, we will need a copy of your child's :

• Four-and-a-half-week progress reports
• Attendance reports
• Parent, teacher, or student surveys
• In-school behavior reports

 This information is important for the assessment of our program. Our afterschool extended learning program is funded by 21st Century

Community Learning Center (CCLC) and Lottery for Education (LEAPs); by signing below you are consenting for the YWCA staff to obtain and share student information within the guidelines of state and federal requirements.

Your child's records are confidential and will only be reviewed by YWCA Knoxville staff. Please print and sign your name below giving your child's school authorization to release their records.

Release Information

I acknowledge receipt of the YWCA's After School Enrichment Program (ASEP) Parent Handbook. I have read, understand, and will adhere to the policies and procedures set forth in the handbook. I understand these policies will be adhered to without exception. 

 VOLUNTEERS

The YWCA Phyllis Wheatley Center invites and encourages parent involvement in our After-School Enrichment Program (ASEP

We feel this would be a wonderful opportunity for you to spend valuable time with your child/ren and see what he/she is learning and actively participating in during the After School Enrichment hours.

YWCA Knoxville 2024-2025 After-School Enrichment Program (ASEP)

Parent Information

• Inclement Weather Policy
• Emergency Plan Policy:
• Received A Copy of 0520-12-01 (Standards for School Administered Childcare Programs)
  • http://publications.tnsosfiles.com/rules/0520/0520-12/0520-12-01.20131128.pdf
• Pick-up Procedures
• Meal Service Policy
• Child Abuse Reporting
• Abuse Prevention Awareness Program will be offered once a year
• If your child is enrolled in school, immunization records will not need to be provided

 

Please sign if you received and read the parent packet with the information listed above:

In order to establish the YWCA Phyllis Wheatley Center as an enriching, positive and safe place, the following expectations are to be adhered to at all times:

1. Respect your fellow students and staff members.

2. No fighting.

3. Positive language only. (No yelling or cursing on-premises)

4. All areas outside of the gym are "Walk-Only" zones. (No running or horse playing)

5. No throwing objects at each other or staff.

6. Respect the personal boundaries of students and staff. Do not hit or touch each other and staff inappropriately.

7. No food or drink allowed in the gym.

8. No willful destruction of property.

9. Clean up after yourself.

10. KCS dress code applies while on premises.

11. Stay with staff member at all times while on premises.

 

Consequences for not adhering to the code of conduct will be administered as follows at the discretion of staff members:

• First Infraction - Verbal Warning
• Second Infraction- Revoke Privilege(s)
• Third Infraction- A consequence chosen by the participant, but must be in agreement with the counselor
• Forth Infraction - Written Warning
• Fifth Infraction - Parent Phone Call
• Sixth Infraction- See the Director or Assistant Director with counselor

 

Any of the following actions will result in immediate removal from the ASEP. A mandatory meeting will occur parent and program directors:

• Physically harming or threatening to harm another person
• Bringing any type of weapon onto the premises
• Possession or use of illegal drugs or alcohol
• Destroying PWC Property
• Stealing

 

We are a drug and weapons-free facility. Firearms (or any other forms of weapons) are not allowed on our premises. All personal items can and will be randomly searched.

A violation of this rule will result in an automatic suspension etc.

2024 YWCA Intake Information Sheet - INDIVIDUAL (Knox County)

Confidential

This form is completely confidential. All information gathered from this form is used anonymously to provide the most accurate demographic information to our funders.

For Office Use Only: