SPARK Afterschool Form

SPARK Afterschool Program Student Registration Form

SPARK Afterschool Program 2025/26 School Year
CONTACT INFORMATION

Cassia School District 151 -- 21st Century Community Learning Centers -- Tiffany Kahalioumi, Program Director -- kahtiffa@cassiaschools.org 208.647.8522 -- Chyna Kahalioumi, Program Assistant -- kahchyna@cassiaschools.org 208.647.1733
IMPORTANT INFORMATION

READ THE FOLLOWING CAREFULLY AS THE SPARK SCHEDULE AND THIS REGISTRATION FORM HAVE CHANGED.
1. Please include each child from the same household you want to be considered for the SPARK Program.
2. If POWERSCHOOL does not have all the current information you will be required to complete the entire registration packet.
3. FILLING OUT AN APPLICATION DOES NOT GUARANTEE ENROLLMENT IN THE SPARK AFTERSCHOOL PROGRAM. YOUR CHILD WILL AUTOMATICALLY BE PUT ON THE WAITLIST AND YOU WILL BE CONTACTED VIA PHONE CALL, TEXT, OR THE REMIND APP WHEN HE/SHE HAS BEEN ENROLLED.
4. SPARK uses the Cassia SD APP, REMIND, Facebook, Instagram, the Cassia School District website, and Flyers to communicate important information about SPARK.
5. SPARK Afterschool Program serves students K-8 enrolled in White Pine, Mountain View, Burley Jr. High, Dworshak, John V. Evans, Homeschool/Private School/Charter School students that live within the boundary of one of the schools above.
6. SPARK has a webpage under the Cassia School District website. Information and photos will be posted there for your convenience.
7. SPARK will not be in session if there is no school due to cancelations, holidays, and weather-related closers.
8. It is highly recommended that a parent attends the Student/Parent Orientation night.
9. PLEASE, consider applying for the FREE & REDUCED BREAKFAST AND LUNCH, even if you don't believe you will qualify or use the benefit. MANY grant-funded programs such as SPARK Afterschool/Summer Camp rely on free & reduced percentages to receive funding. If the requirement is not met programs like SPARK will no longer be funded, and therefore, unavailable to our community.
SCHEDULE: THIS YEAR THE JUNIOR HIGH WILL HOLD PROGRAMMING AFTER SCHOOL FOR 2.5 HOURS. ELEMENTARY WILL CONTINUE TO HOLD PROGRAMMING FOR 3 HOURS AFTER SCHOOL.

SPARK's Start Date: September 15, 2025

Days: Monday-Thursday after school

Elementary Schools: Parent pick-up by 6:30 pm

Burley Jr High: Parent pick-up by 6 pm

SPARK Programs

White Pine, Mountain View, Dworshak, John V. Evans and Burley Jr High

This Page is Required to be Completed by All Applicants
CURRENT DATE AND TIME
Student Name/Grade/School*

First and Last NameGrade/School
Student Name/Grade/School

First and Last NameGrade/School
Student Name/Grade/School

First and Last NameGrade/School
Student Name/Grade/School

First and Last NameGrade/School
Student Name/Grade/School

First and Last NameGrade/School
All student, parent/guardian, emergency contacts, and no contact orders information have been updated and current in PowerSchool?*

YesNo
All student allergies, medical needs, 504, and IEP have been updated and current in PowerSchool?*

YesNo
PHOTOGRAPHY:

Pictures/videos/stories may be used in newsletters, websites, presentations, and social media sites for the advancement of community awareness and of SPARK Afterschool. SPARK Afterschool will follow all policies as established by Cassia School District 151 and the State Department of Education.

I do release SPARK Afterschool and Cassia School District 151 from any claims whatsoever which may arise in said regards.
PARENT/GUARDIAN CONSENT TO BE PHOTOGRAPHED AND/OR VIDEO*

YesNo
MOVIES:

The SPARK Afterschool may schedule movie nights during programming. The movie will be PG and appropriate for students. If a movie is scheduled you should be able to view the title on the monthly calendar sent home.
PARENT/GUARDIAN CONSENT TO WATCH PG MOVIES*

YesNo
MEDICAL & EMERGENCY PROCEDURES:

Parents will be notified as soon as possible if there is an emergency.

SPARK will treat minor scrapes and bruises with ice packs and bandages. SPARK will not administer any medication. If the situation requires it, 911 will be called. Parents will be notified as soon as possible if there are any injuries.

The SPARK staff does not have access to the secretary and/or nurse's offices. Therefore, the parent/guardian is responsible for providing any additional needed medical treatments (i.e., inhaler, epinephrine auto-injector (EpiPen), medication, blood sugar check, etc.) that my child may need.
RELEASE OF CLAIM FORM
Student and Parent/Guardian- Please read the Release of Claims. By placing your initials you indicate that you have read and agree with the RELEASE OF CLAIM FORM.*
ATTENDANCE POLICY

1. Parents/Guardians will notify SPARK Afterschool if student(s) will be absent from the program.

2. SPARK Afterschool will notify you when your child is at school and not attending SPARK Afterschool if the parent/guardian has not previously notified SPARK of absence.

3. Students will attend a minimum of two (2) out of the four (4) days per week and no less than eight (8) days in a month, unless extended absence from school (i.e. sickness). Failure to maintain the required attendance may result in your child’s dismissal from the program.
Please check the days your child(ren) will be regularly attending SPARK. (Your child must attend at least two (2) days a week)*

MondaysTuesdaysWednesdaysThursdays
Students and Parent/Guardian- Please read the Attendance Policy carefully and completely. By placing your initials you indicate that you have read and agree with SPARK's Attendance Policy and you will follow all School and SPARK procedures, policies, and rules.*
PARENT PICK-UP POLICY:

1. SPARK Afterschool does not offer bus transportation home from SPARK.

2. Parents/Guardians are required to pick students up.

3. If SPARK Afterschool is unable to contact any of the child’s contacts (as posted on page 3) within 45 minutes of the latest pickup time, then the police may be notified. Four (4) late pickups of 20 minutes or later may result in your child’s dismissal from the program.

4. Only the name(s) you have approved in PowerSchool and/or this form can pick up your child(ren) from SPARK Afterschool. To add/remove someone from the approved list please speak directly with the Site Coordinator.

5. Students that are walking home:
Students may only walk home if,
a. They live within 2 blocks of the school.
b. It is NOT dark when the program ends.
c. The weather is suitable for walking.
d. Parent/Guardian has filled out the permission form and it is on file with SPARK. BELOW IS THE PERMISSION TO WALK HOME FORM. PRINT AND RETURN TO SPARK AFTERSCHOOL.
HOW WILL YOUR CHILD(REN) GET HOME FROM THE SPARK PROGRAM?*

Parent Pick upMy child will walk home
Student and Parent/Guardian- Please read the Parent Pick-up Policy carefully and completely. By placing your initials you indicate that you have read and agree with the Parent Pick-up Policy and if your child will be walking home, you agree to complete the Walk Home Permission Form and return it to the Site Coordinator.*
STUDENT DISCIPLINE AGREEMENT: Please read the parent/Student Handbook for SPARK's discipline policy.

The staff of SPARK Afterschool is expected to respect the dignity of the children and conduct themselves as role models and mentors. SPARK follows the Cassia School District's discipline policies and the PBIS Behavior Matrix. SPARK does not use any strategy that hurts, shames, belittles, threatens, or intimidates a child. Physical contact in disciplining a child is never permitted and is avoided unless it is necessary to restrain a child from harming him/herself or another. The program does not permit the use or restriction of food and the provided snack as a reward or punishment.

SPARK uses a 3-strike policy. Parents will be required to sign each strike and discuss the behavior. If parents and staff are unable to resolve ongoing or serious behavior issues (i.e. aggressive, abusive, disturbing, or destructive behavior) and if the child’s behavior does not change in a reasonable length of time, the Site Coordinator will give the parents/guardians notice of dismissal from the program.
Students and Parent/Guardian- Please read the disciplinary procedures carefully and completely. By placing your initials you indicate that you have read and agree with SPARK's Discipline Agreement and you will follow all School and SPARK procedures, policies, and rules.*
HOMEWORK POLICY

SPARK Afterschool provides opportunities to help develop the whole child academically, emotionally, physically, socially, etc... In the past 9 years of successful programming, we have data that supports that students' grades, school attendance, and behaviors improved by providing a daily schedule that includes adequate homework time of 45-60 minutes and quality staff capable of helping your child.

However, it is not the responsibility of afterschool staff to withhold your child from other enrichment activities to complete homework. Please encourage your student to utilize the offered homework time and help available every day of programming.

Homework may need to be completed at home if a field trip or special event has been scheduled and does not allow adequate homework time.
Student and Parent/Guardian- Please read the section above carefully and completely. By placing your initials you indicate that you have read and agree with the Homework Policy and you will follow all school and SPARK procedures, policies, and rules.*
STUDENT AND PARENT/GUARDIAN PARTICIPATION AGREEMENT:

I understand that as the parent/guardian, I have a responsibility to maintain my child’s participation in the SPARK Program; therefore, I understand and agree to the following:

Part of the SPARK Afterschool Program objective is to benefit the entire family and incorporate families in the learning process. Therefore, I will attend at least one (1) Family Event that is offered. I will also attend special events and activities that support my child’s development.

I will notify SPARK of my child’s absence from the program.

I expect SPARK to respect my needs, opinions, and concerns and work together to provide the safest learning environment for my child. I will participate in program surveys, evaluations, and discussions as needed to help improve program quality and operations.

My child will attend a minimum of (2) days a week of the Spark Program unless extended sickness. Failure to maintain the required attendance may result in my child’s dismissal from the program.

My child will be picked up according to the SPARK Site schedule. If SPARK is unable to contact any of my child’s contacts within 45 minutes of the latest pickup time, then the police may be notified. Four (4) late pickups of 20 minutes or later may result in my child’s dismissal from the program.

Only the name(s) I have approved- parent/guardians & emergency contacts listed on this registration or in PowerSchool will be allowed to pick up my child from SPARK. If I would like to add/remove someone from the approved list then I will talk directly with the Program Director or your site Coordinator.
Parent/Guardian- Please read the section above carefully and completely. By placing your initials you indicate that you have read and agree with SPARK's Participation Agreement and you will follow all School and SPARK procedures, policies, and rules.*
Statement of Child’s Ability to Participate: I certify that to the best of my knowledge my child is in good mental and physical health and is able to participate in SPARK Afterschool.*

YesNo
If you answered YES to PowerSchool being current and no changes need to be made to your information, then you may SUBMIT now.
If you answered NO to PowerSchool being current and accurate then you are must click NEXT and complete the entire form.

The following Pages are Required If PowerSchool Does NOT have Current Information.
PARENT/GUARDIAN

First NameLast Name
ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
RELATIONSHIP TO STUDENT(S)
HOME NUMBER
Please enter a valid phone number.
CELL NUMBER
Please enter a valid phone number.
CAN SPARK ADD YOUR CELL NUMBER TO REMIND? THIS IS HOW WE WILL TEXT YOU IMPORTANT INFORMATION.

YesNo
WORK NUMBER
Please enter a valid phone number.
PARENT/GUARDIAN

First NameLast Name
ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
RELATIONSHIP TO STUDENT(S)
HOME NUMBER
Please enter a valid phone number.
CELL NUMBER
Please enter a valid phone number.
CAN SPARK ADD THIS NUMBER TO REMIND? THIS IS HOW WE WILL TEXT YOU IMPORTANT INFORMATION.

YesNo
WORK NUMBER
Please enter a valid phone number.
EMERGENCY CONTACT

First NameLast Name
PHONE NUMBER
Please enter a valid phone number.
EMERGENCY CONTACT

First NameLast Name
PHONE NUMBER
Please enter a valid phone number.
If there is a person(s) who may NOT HAVE ACCESS to the student, please enter First and Last name, Relationship to Family, and if there is a Court Order of Protection.

First NameLast Name
RELATIONSHIP TO STUDENT(S)
IS THERE A COURT ORDER OF PROTECTION?

YesNo
DOES YOUR CHILD(REN) HAVE

DiabetesAllergiesAsthma
IF YES, PLEASE DESCRIBE THE CONDITION AND THE PLAN FOR CARE DURING THE SPARK PROGRAM. PLEASE INCLUDE THE STUDENT'S NAME IF MORE THAN 1 CHILD REGISTERED.
IS THERE ANY INFORMATION YOU WOULD LIKE US TO KNOW ABOUT YOUR CHILD(REN)? IEP, 504, OR ANY SOCIAL/EMOTIONAL NEEDS.
Should be Empty:

SPARK Afterschool Program Student Registration Form

CONTACT INFORMATION

This Page is Required to be Completed by All Applicants

If you answered YES to PowerSchool being current and no changes need to be made to your information, then you may SUBMIT now.

If you answered NO to PowerSchool being current and accurate then you are must click NEXT and complete the entire form.

The following Pages are Required If PowerSchool Does NOT have Current Information.