After School Program Enrollment Form

Area of Concern

All information provided in this section should reflect student's performance from last school year.
EOG Scores: Reading Level? Math Level?
Grade Average: Reading? Math?
School Attendance: Can you provide the number of days your child was Absent and how many days they were Tardy this past school year?
Suspensions/ISS: Can you provide the number of times your child was suspended or sent to ISS? What was the reason for suspension/ISS?
IEP:

YesNo
504 Plan:

YesNo
Copy on File: If so please upload documents below.

YesNo
Upload Documents

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Parent/Guardian Information
Parent/Guardian Email*
Parent/Guardian Name 1*

First NameLast Name
Education Level:
Please select one
Parent/Guardian Home Phone #*

Area CodePhone Number
Parent/Guardian Cell Phone #*

Area CodePhone Number
Parent/Guardian Work Phone #*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name 2

First NameLast Name
Education Level:
Please select one
Parent/Guardian Home Phone #

Area CodePhone Number
Parent/Guardian Cell Phone #

Area CodePhone Number
Parent/Guardian Work Phone #

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about New Foundations Management: Life Sycle 21st Century Learning Center?

Medical Consent Form

* Please read the following and sign for confirmation.
In consideration of the agreement by NEW FOUNDATION MANAGEMENT to admit your child as a NEW FOUNDATION MANAGEMENT student, the undersigned parent(s)/guardian(s) hereby authorize(s) LIFE SYCLE PROGRAM, its agent, and employees to secure for the above named student any medical, mental health, or dental treatment which they, in their sole judgment, may deem necessary and proper for said student. We further specifically authorize LIFE SYCLE PROGRAM, its agents, and employees to execute administration of any medical, mental health, or dental treatment or procedure whatsoever to the said student. We also authorize (or any successor company) to pay directly to NEW FOUNDATION MANAGEMENT all benefits that become payable.

We hereby release and waive any claims for damages which we, or the said student, might have against LIFE SYCLE PROGRAM, its agents, or employees in any manner arising from or in the course of medical, mental health, dental treatment, or procedure administered to said student.

We, individually and on behalf of the student, do herby release, acquit, and forever waive and discharge the said LIFE SYCLE PROGRAM, (or any successor company) , their agents, and employees from any and all action claims for compensation on account of personal injuries accruing while the students is enrolled at LIFE SYCLE PROGRAM.

We understand that we, the parents/guardians, are responsible for any and all off-campus or emergency medical expenses incurred by the above-named child, including all prescribed medications.

This form also authorizes the release of information pertinent to the treatment of this child.

* Please sign below to confirm.
Signature*

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21st Century After School Program Application

Area of Concern

Parent/Guardian Information

Medical Consent Form

Health History

Leave Authorization Form