HHYD Application for Membership 2020-2021

  • HHYD Application for Urban Learning Center Membership 2025-2026

    Please fill the form out if you are interested in ULC After School, Teen Programming, Athletics, or Kids Club.

  • Youth Applicants

    • Child 1 
    • Child 1 Gender*

    • What after school program do you want to enroll your child in? Please select all that apply.*
    • For students in grades 6th-12th grade we offer teen programming. Please select all that you would like your child to participate in.*
    • Teens, 9th grade and older, are released after activities at various times during the week. Does your child have permission to walk home unless parent has given a specific direction?
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    • Child 2 
    • Child 2 Gender*

    • What after school program do you want to enroll your child in? Please select all that apply.*
    • For students in grades 6th-12th grade we offer teen programming. Please select all that you would like your child to participate in.*
    • Teens, 9th grade and older, are released after activities at various times during the week. Does your child have permission to walk home unless parent has given a specific direction?
    •  
    • Child 3 
    • Child 3 Gender*

    • What after school program do you want to enroll your child in? Please select all that apply.*
    • For students in grades 6th-12th grade we offer teen programming. Please select all that you would like your child to participate in.*
    • Teens, 9th grade and older, are released after activities at various times during the week. Does your child have permission to walk home unless parent has given a specific direction?
    •  
    • Child 4 
    • Child 4 Gender*

    • What after school program do you want to enroll your child in? Please select all that apply.*
    • For students in grades 6th-12th grade we offer teen programming. Please select all that you would like your child to participate in.*
    • Teens, 9th grade and older, are released after activities at various times during the week. Does your child have permission to walk home unless parent has given a specific direction?
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  • I, (Full Name of Parent or Guardian), am the parent or legal guardian of (child(ren)).

  • Parent/Guardian Information

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  • Parent/Guardian #1 Gender*

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  • Parent/Guardian #2 Gender

  • Authorized to Pick Up

  • Does your child(ren) have permission to walk home?*
  • Are others authorized to pick up your child(ren) from HHYD?*
  • How many people are authorized to pickup your child(ren) from HHYD?

    • Authorized Pick Up #1 
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    • Authorized Pick Up #2 
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  • Emergency Information

    In case of a serious illness or accident and you cannot be reached, who should be contacted?
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  • Hospitality House Youth Development is dependent on outside funding. Answering the following questions is necessary to receive the funding that will provide program income for HHYD to better serve our families.

  • What is the employment status of the "Head of Household?"*

  • Please select your household income*
  • Please select your household type:*

  • Does your child(ren) qualify for free/reduced lunch?*

  • Hospitality House Goals and Expectations

    Please read the below expectations of parents and students and select yes or no if you agree to abide by those expectations.

  • Parent/Guardians' Expectations

    Guardians are expected to attend all activities as scheduled (i.e. orientation, parent conferences, family fun events, and other planned activities). HHYD will provide homework assistance from 2-3 pm Monday-Thursday. 

    Attendance: 

      To receive the full benefits of the program, guardians are to encourage their children to attend the after-school program daily. In the event your child is going to absent for a period of time, please let us know within 24 hours. In the case of an emergency, please let us know as soon as possible.  Call 612-522-4485. Leave a message with Mrs. Glenda including the student's name, guardian's name, and current phone number. 

     Daily Pick-up: 

    All students must be picked up by 6:00 pm.

    A late fee will be applied beginning at 6:05 pm. Late fees are accrued $1.00 per minute.  Parents MUST call if you are going to be late for any reason!

     

  • I have read and understand the above expectations for parents/guardians.*

  • Expectations for Students: 

    Our goal is to establish a nurturing and healthy environment for all of our students to grow and learn. We will achieve this goal by encouraging positive behavior and addressing other behaviors with reflection and growth, rather than punishment. 

    All students are expected to...

    • Participate in all program activities
    • Be respectful
    • Be on task
    • Be responsible
    • Be positive
    • Understand that all behavior has consequences 

    Unacceptable and inappropriate behaviors include but are not limited to: 

    • No profanity, no swearing, and no put downs
    • No possession or use of tobacco, alcohol or other drugs on HHYD property
    • No firearms or weapons on HHYD property
    • No inappropriate touch to others (fighting, kissing, grooming others, pulling of others clothing/hair)
    • No threatening or engaging in any other forms of violence or other behavior that will be disruptive to the safety, activities participation or learning of self and others
    • No use of electronic devices unless during allowed times. These include, but not limited to games and cell phones. 

     For a more thourough look at our discpline policy, please read the following document: HHYD Discipline Policy

  • I have read and understand the above expectations for students in HHYD.*

  • Consent and Release Form

    Please read carefully, check off each item, and have at least one parent/legal guardian sign at the bottom.
  • As parent(s)/legal guardian(s) of the children identified above, I/we give my permission for his/her involvement in the activities and transportation, on and off site, including field trips and athletics activities, of Hospitality House Youth Development ("Hospitality House"). I/we have reviewed the stated expectations (stated above) for participants, will make sure my child understands them and agree that my child will abide by them. I/we understand that should my child fail to abide by the stated expectations, he/she may be subject to dismissal, suspension, or expulsion.*
  • I/we understand that Hospitality House expects all children to be picked up in person each day by an approved adult authorized in the Application for Membership unless Hospitality House transportation arrangements are made in advance. I/we understand that if my child is being picked up by anyone not authorized int he Application for Membership, I/we will notify the Hospitality House in writing in advance. I/we further understand that if it is not possible for my child to be picked up in person each day, Hospitality House will allow my child to walk home before dark if I/we authorize in the Application for Membership or provide Hospitality House with written permission.*
  • In the case of an emergency, medical or otherwise, I/we authorize Hospitality House to seek appropriate medical, dental and/or professional assistance and services. I/we understand that I/we will be responsible for all costs and expenses of such treatment or services.*
  • I/we authorize my child's school, identified above, to release copies of my Child's Individual Learning Plan ("ILP"), also known as Continuous Learning Plan ("CLP") to Hospitality House. I/we further authorize my child's school to release the results of his/her standardized testing, grades or any other education information necessary for Hospitality House staff to meet the academic needs of my child.*
  • Hospitality House staff and authorized volunteers may on occasion, take photographs, audio, or videos of participants involved in Hospitality House programs. These photographs, audio, or videos are used only to document Hospitality Houses' activities or to bring publicity to the general public about Hospitality House's programs. Such media may be used in Hospitality House's newsletters, website, annual reports, newspapers, social media, and other similar venues, or by partnering organizations with permission. I/we understand that, on occasion, family members may also be photographed when picking up my child or participating in picnics, programs, or other Hospitality House events. I/We hereby authorize Hospitality House to take photographs, videos, and audio of your Child and/or other family members to use my child's and/or other family member's image in any photographs or videos for the purposes expressed above. I/we further authorize the use of my child's and/or family member's first name for any photographs, audio, or video used in Hospitality House's newsletters, website, annual reports, newspapers, social media, and other similar venues.*
  • I/we understand that Hospitality House may assemble a yearbook for the participants of the program. I/we hereby authorize the use of my child's first and last name for the purposes of Hospitality House's Yearbook.*
  • I/we understand that my child should not bring to Hospitality House any valuable personal items, including but not limited to, bikes, toys, electronics, electronic games, and cell phones. I/we understand that Hospitality House will not be responsible for any lost, stolen, broken, damaged items and/or clothing.*

  • Release and Indemnification: 

    In consideration for my child to be permitted to participate in Hospitality House programs, I/we, on behalf of myself/ourselves, my child, and my respective agent, assign beneficiaries, heirs, personal representatives, successors, trustees, and other representatives herbey assume the risk and agree to release, hold harmless, discharge, indemnify, and defend the Hospitality House, its directs, officers, employees, agents, and volunteers from and against any and all liability, including all causes of action, claims, damages, participation in Hospitality House activities, including, without limitation, my child's attending, being at, being involved with, and/or participating in Hospitality House activities, including, without limitation, any claims arising in connection with any of the affirmations, authorizations, commitment, permissions, releases or undertakings I/we have made in or through this Consent and Release. These indemnification, hold harmless, and defence terms shall apply and be fully enforceable even if such injury, illness, or disease, or damage arises in whole or in part from the negligence of Hospitality House, its directors, officiers, employees, agents, and volunteers and shall include, without limitation, the reasonable attorneys' fees of Hospitality House, its directors, officers, employees, agents, and volunteers associated therewith.

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  • Minor Electronic Communications Consent and Release Form, and Data Sharing.

    This form provides your permission, along with your consent and release, for your child to participate in electronically based programs, activities and data sharing with NAZ (Northside Achievement Zone).

  • I, * (Full Name of Parent or Guardian), am the parent or legal guardian of * (child(ren)).

  • I authorize and consent to staff or other leaders of Hospitality House Youth Development (“Hospitality House”) to electronically communicate with my Child. I understand that such communications are for Hospitality House purposes only and may involve group communications relating to Hospitality House
    programs and activities. I understand that communications may be accessible or viewable by others. Further, I understand that such electronic communications may be made via text, email, telephone and cell phone, social media, video conferencing, and other electronic means (referred to as “Electronic Communications”). Examples of Electronic Communications include, but are not limited to, Zoom Video Communications, Facebook, Skype, FaceTime, and Video Calling on Facebook. I understand that these Electronic Communications are web-based platforms operated by third-parties, its own privacy terms and conditions to which members must adhere and which parish or diocese cannot control or assume
    responsibility.

    I understand that if any staff or other leaders knowingly communicate privately with my child as a part of his or her duties for or on behalf of Hospitality House, reasonable steps will be taken to inform me of the communication content, though not necessarily via the same technology.

    I acknowledge that to review or receive public communications shared via social media with my Child, I may need to become a fan or follower of the same social media.

    I understand that communications or posts may be accessible or viewable by others who are also fans or followers of the same social media. I understand that without this consent, my child will not be able to participate in Hospitality House programs and activities available through Electronic Communications.

    Hospitality House Youth Development is partnering with the Northside Achievement Zone (NAZ) to provide additional supports for Northside scholars. I/we give consent for program information and data about or on my child/ren to be shared between Hospitality House and the Northside Achievement Zone (e.g., enrollment/registration information, program attendance data, etc.). I/we understand the purpose for sharing this information and data is for program evaluation purposes and data tracking purposes. Data will be kept confidential and reporting will occur at the group and not the individual level.
     
    If you do not want your scholar's data to be shared with NAZ for data tracking and/or evaluation purposes, please let Stacey Jones or Melinda Brown know. 

    If I choose to rescind my authorization and consent provided in this Electronic Consent and Release Form, I agree that I will inform the Hospitality House in writing and that my rescission will not take effect until it is acknowledged by Hospitality House.

    I understand, however, that it may not be possible to recall any work, photos or videos that have been published as part of the program(s) prior to receipt of my written rescission.

    I have read this Consent and Release Form and have had the opportunity to consider its terms and understand them. I verify that I have read and voluntarily agree to the terms and conditions of the Hospitality House Youth Development Minor Electronic Communications Consent and Release Form.

    I further hereby hold harmless, release and forever discharge the Hospitality House Youth Development and its employees, volunteers, agents, and legal representatives from, and shall indemnify them against, all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators or
    any other person(s) acting on my behalf or on behalf of my estate have or may have because of my Child’s participation in the program(s) and through my authorization, consent and release herein.

    I have read this Hospitality House Youth Development Minor Electronic Communications Consent and Release Form, I fully understand it, and I voluntarily agree to be bound by its terms. I represent and certify that I am the parent or legal guardian of the minor.

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