2025-2026 Enrollment Form

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

PARENT/GUARDIAN 1 (REQUIRED)

PARENT/GUARDIAN 2

SIBLINGS IN THE ARC PROGRAM

For informational purposes only. A separate enrollment form is required for each student.

EMERGENCY CONTACTS/EMERGENCY RELEASE AUTHORIZATION

I understand that my child must be signed out of program every day by an authorized adult (18 years or older with picture ID). I authorize the following individuals to pick up my child, including in case of an emergency.

EMERGENCY CONTACT 1 (REQUIRED)

EMERGENCY CONTACT 2

EMERGENCY CONTACT 3

ANY PERSON TO WHOM THE STUDENT MAY NOT BE LEGALLY RELEASED?

EARLY RELEASE FORM

FOR ELEMENTARY/MIDDLE SCHOOL STUDENTS

California state legislation governing after school programs for elementary and middle schools funded by After School Education and Safety Program and/or 21st Century Community Learning Centers mandates that we operate from the close of every school day until 6:00 p.m. It is expected that elementary and middle school students attend 5 days a week and stay for the duration of the program. If a program has a waiting list of students, preference for enrollment is given to students who can attend the program until 6:00 p.m.

While programming will be available to all students every day, we will be flexible within the guidelines of the grants to allow for early release. If your student needs to leave the program early (prior to 6pm), please fill out this form. The parent/guardian or authorized person (18 years or older who is on the student's emergency contact list) may pick up their child under one of the following conditions.

1. Parallel Program
2. Family Emergencies
3. Family Needs
4. Medical Appointments
5. Weather Conditions
6. Medical Emergencies
7. Other Conditions

In signing below, I request that my child be excused from the program at the specified time(s) and day(s) mentioned above. In addition to the reasons listed above, I request that my child be excused early on any dates where there are no transportation options that allow my child to remain for the full duration.

I understand neither the program provider nor the school district is liable for incidents involving my child occurring after they are signed out of the program. I understand that my child is expected to attend every day and stay for the duration of the program. I am aware services will be terminated if the program has a waiting list of students who can participate 5 days a week and remain for the duration of the program.

PARTICIPATION AGREEMENT

ASES/21CCLC: Eligibility & Applications: Students are eligible to participate in Arc as long as they are enrolled at a partnering school during the regular school day. Enrollment in the Arc program is "first come, first serve," with priority given as follows: first priority goes to homeless and foster youth (EC § 8483[c][1][A] and § 8483.1[d][1][A]) as defined by McKinney-Vento (42 U.S.C. Sec. 11434a); second priority goes to students who attend daily (EC § 8483[c][B]); however, if the program is already at full capacity, enrolled students do not need to be removed to make room for high priority students (EC § 8483[c][3] The intention of the program is for pupils to attend the full length of the program daily, except as allowed by an early release policy (EC § 8483[a][2] Enrollment in the program is for the duration of one school year. Students are required to fill out a new application and re-enroll each academic year. Attendance: In accordance with California Education Code, students are expected to attend the program every day for the full range of hours offered (a minimum of 3 hours per day Students who do not attend regularly may be subject to disenrollment. Students must maintain an average attendance rate of at least 85% in order to avoid possible disenrollment.

ALL PROGRAMS: Participation Agreement: I agree to have my child participate in the Arc program. I understand that participation in Arc is a privilege, and that my child's failure to comply with the program's rules, regulations, and policies may result in disciplinary action, including but not limited to suspension or dismissal from the program. I understand that my child may risk bodily injury and or other loss, including damage to property, by virtue of participation. I knowingly and freely assume all such risk for myself and my child. I release and hold harmless Arc, its officers, agents, contractors, subcontractors, and employees with respect to any and all such injury and or loss, except when the injury or loss results from willful misconduct of Arc, its employees, or agents. My child's participation in this activity is purely voluntary and I elect to have my child participate, with acknowledgement of all known and unknown risks. I understand that Arc and the school district in which my child is enrolled, is NOT responsible for my child while they are not signed in to the program. I understand that the submission of this form does not guarantee my child placement in the Arc program.I further agree to reimburse Arc for all attorney's fees and costs should I bring legal action against Arc and lose. Information Release Agreement: I understand that the school and/or school district may share personally identifiable information with Arc to enable Arc to understand student needs, progress, and promote program participation. In addition, Arc may administer surveys and assessments to evaluate student progress. Medical Treatment Authorization: In the event my child suffers an illness or accident, I authorize Arc to seek medical help by contacting 911 emergency services or otherwise securing treatment at a medical facility. I acknowledge that Arc does not provide medical coverage for participants. Media/Product Release: I give my permission for my child to be filmed or photographed. Arc may use/publish work my child produces during arc activities. I understand that all film and photos are the sole property of Arc. Photos/videos/student work may be used in public displays, for marketing, or for printed materials published by and/or for Arc without compensation to the child or parent/guardian. I am the parent/guardian with legal custody of the above-named child, OR I am the above-named participant aged 18 years or older. The information on this application is accurate and complete to the best of my knowledge. I understand that this is the entire agreement between myself and Arc, its agents or employees, and it cannot be modified or changed in any way by the representatives or statements of any employees of Arc or by me. My signature below indicates that I have read this entire document and understand it completely and agree to be bound by its terms.

ENTIRE AGREEMENT: I understand that this is the entire Agreement between myself and Arc, its agents or employees, and that it cannot be modified or changed in any way by the representatives or statements of any employees of Arc or by me. My signature below indicates that I have read this entire document and understand it completely and agree to be bound by its terms.