K-8 After School 2025-2026 Application

K-8 STEAM After School Program Application 2025-2026

Thank you for applying to the K-5 and Middle School STEAM After School Program! This application will allow you to apply for three children; any additional children will require a separate form. You will receive a confirmation email that your registration has been completed.
The K-5 and Middle School STEAM After-School Program begins on Tuesday, September 2, 2025 and operates Monday-Friday 3 pm-6 pm (hours subject to change for half days; program closed on SDP days off).

Our Services: Daily hot meal, snack, academic enrichment, STEAM activities, literacy support, social emotional learning, club offerings, snack, and transportation from partner schools.

Please read and agree to the following:
- Your child(ren) must attend the program at least 3 days a week for 90 minutes or more;
- Students who do not meet the attendance standards will receive warning and then be removed from the roster;
- All required documentation must be submitted before children are permitted to begin program;
- You and the child(ren) must adhere to the program's health and safety regulations;
- There is no fee to attend program, but all families must submit an ELRC application;
- Arrival time is between 3 - 4 pm; pick up time is from 5:30 - 6 pm;
- Late pick ups will be charged $1 per every late minute after 6 pm.
I, the parent/guardian have:*

received complete written program information at the time of enrollment.
I, the parent/guardian:*

agree to update the emergency contact/parental consent form information whenever changes occur or every 6 months at a minimum.
With my signature, I agree to adhere to the terms above: *

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Parent/Guardian Information
Parent/Guardian 1 Name (Please place full legal name, we can not accept abbreviations, letters or nicknames) *

First NameLast Name
Relationship to Child*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Email*
example@example.com
Parent/Guardian 2 Name (Please place full legal name, we can not accept abbreviations, letters or nicknames)

First NameLast Name
Parent/Guardian 2 Relationship to Child
Parent/Guardian 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 Phone Number
Please enter a valid phone number.
Parent/Guardian 2 Work Phone Number
Please enter a valid phone number.
Parent/Guardian 2 Email
example@example.com
How many children will you be enrolling in the after school program?*
Everyone must apply for ELRC (formerly CCIS) and provide proof of application before being enrolled in program. Where are you in the process of applying?*

I have started but did not complete the application. I will email proof of application to k8program@projecthome.org.I have not started the application yet. I will email proof of application to k8program@projecthome.org.I have completed the application, uploaded proof of application below, and am waiting for determination.
Proof of ELRC Application

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You can apply for the Early Learning Resource Center (ELRC) (formerly CCIS) in Philadelphia, Pennsylvania by:
- Calling the ELRC at (888) 461-KIDS (5437)
- Applying online at compass.state.pa.us
- Mailing, faxing, or dropping off a printed application at your local ELRC office
You will need to provide documents to verify your information. What you need to apply:
- Proof of your income
- Proof of your child's citizenship or legal residency
- Proof of your child's need for care
- Proof of your employment or school attendance
- Proof of identification for each parent or caretaker

Emergency Contact / Parental Consent Form

This portion of the form must be updated every 6 months, or earlier if the information changes.
Emergency Contact Persons

Please provide at least two emergency contacts that are NOT a parent/legal guardian.
Emergency Contact 1 (not a Parent/Guardian)*

First NameLast Name
Emergency Contact 1 Phone Number*
Please enter a valid phone number.
Emergency Contact 2 (not a Parent/Guardian)*

First NameLast Name
Emergency Contact 2 Phone Number*
Please enter a valid phone number.
Emergency Contact 3 (not a Parent/Guardian)

First NameLast Name
Emergency Contact 3 Phone Number
Please enter a valid phone number.
Authorized Release

Please provide at least two people to whom your child can be released from program, other than a parent/guardian. If your child is an authorized release person to themselves or a sibling in program, you are required to include their information.
Authorized Release 1*

First NameLast Name
Authorized Release 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Authorized Release 1 Phone Number*
Please enter a valid phone number.
Authorized Release 2*

First NameLast Name
Authorized Release 2 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Authorized Release 2 Phone Number*
Please enter a valid phone number.
Authorized Release 3

First NameLast Name
Authorized Release 3 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Authorized Release 3 Phone Number
Please enter a valid phone number.
Medical Information
Name of Physician/Medical Provider*

First NameLast Name
Physician/Medical Provider Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Physician/Medical Provider Phone Number*
Please enter a valid phone number.
Health Insurance Provider*
Policy Number*
Emergency Consent

Parent/Guardian signature required for each item below to indicate parental consent.
Consent for the facility to obtain emergency medical care.

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Consent for the facility to administer minor first aid.

Clear
In case of a medical emergency, I understand that my child will be transported to the hospital as the local emergency resource (police, EMS, fire, etc.) deem necessary.*
In hereby assume full financial responsibility for any medical attention or treatment provided, as well as transport.*
It is understood that in some medical emergencies, staff will need to contact the local emergency resource before contacting the parent, child's physician, and/or other adults acting on the parent's behalf.*
Field Trips

In order for your child to attend trips, you must sign a permission slip that staff will distribute in advance.
Consent for children to participate in field trips if, and only if, a permission slip is signed in advance.

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Sanitizer & Topical Ointments
I understand that my child will utilize hand sanitizer in their classroom and other areas of the building and/or while on trips.
I understand that my child will utilize sun screen and/or insect repellant while engaging in outdoor play and/or on trips.
Parent/Guardian Responsibilities
I understand that HLCCTL reserves the right to refuse participation program or its activities for reasons that include but are not limited to the following: poor behavior/excessive redirection, risk of health/safety to themselves or others, acts of violence, theft, profane language, lack of attendance or lack of ability to provide accommodations, etc.
I have read this release, acknowledge, and understand all of its terms.
Signature

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Date

MonthDayYear
Date
Project HOME Image Release Form
Project HOME Image Release Form

Definition of “Personal Image”
In this form, “Personal Image” means any:
• photograph, film, video, sound recording, or drawing that depicts the image, likeness or voice of my child; or
• any edited or modified version of the above; or
• my child’s name

Grant Project HOME Right to Use Personal Image
I, on behalf of my minor children, grant to Project HOME the right and license to use, copy, modify and display the Personal Image in any medium (example- written or electronic) for its promotional or operational efforts.

Types of Uses by Project HOME
This right includes the right to use my child’s Personal Image in Project HOME’s:
• newsletter, mailings, promotional and fundraising materials, paper or electronic publications, web pages, social media and networking sites, films, videos, and other similar works.

No Compensation
I understand that neither I, nor my minor children, will receive any money or other compensation for use of any Personal Image.

No Right to Approve use or Personal Image
I understand that neither I, nor my minor children, will have the right to inspect or approve any Personal Image or any edited or modified version of any Personal Image.

Waiver and Release of Any Liability
I, on behalf of my minor children, hereby release and hold harmless Project HOME and its agents and employees from and against any claims related to the use of any Personal Image, such as any editing, blurring, or alteration, either intentionally or otherwise, that may occur in its publication or distribution.

Right in Perpetuity
I understand that this right continues unless I change my permissions in writing to the Program Manager, or Building Director, or the Development at Project HOME.
I have read this form, and I fully understand its meaning and effect, and I:
Your Signature

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Date

MonthDayYear
Date
Biometrics / Security Camera Consent

This Security Camera Consent (this “Consent”) is by and between Project HOME and its affiliates (collectively “Project HOME”) and the undersigned.By signing this Consent, I understand and agree that Project HOME utilizes a cloud-based security system with facial recognition software provided by a third-party vendor for purposes of verifying identity and securing and controlling access to our buildings (the “Security Cameras”). The Security Cameras leverage algorithmic systems that may collect, capture, or otherwise acquire certain information about facial geometry, or other bodily features, that constitute biometric data or identifiers under some laws or regulations.I expressly agree that the Security Cameras may collect and process your information, including any facial geometry or other biometric data, so that Project HOME may secure and control access to its buildings; ensure the safety of its inhabitants and personnel; prevent and deter theft; investigate any incidents, unauthorized access, or other issues; and as otherwise necessary and appropriate. I further agree that the vendor of the Security Cameras may use your information to train the algorithms and software used to power the Security Camera. I further agree to the terms of Project HOME’s Privacy Policy.
I,First & Last Name (full name of parent/legal guardian ), have legal custody of the child(ren) listed below and consent to the collection, processing, storage, and disclosure their data in accordance with the terms set out above.
Child 1 Name*

First NameLast Name
Child 2 Name

First NameLast Name
Child 3 Name

First NameLast Name
I have read this form, and I fully understand its meaning and effect, and I:
Your Signature

Clear
Date

MonthDayYear
Date
Non-Discrimination Clause

The K-8 Program at Honickman Learning Center Comcast Technology Labs will not discriminate against any participant based on factors like race, color, religion, sex (including gender identity and expression), national origin, disability, age or any other protected characteristic in its admissions, program services, or employment practices. This ensures equal access to participate in all aspects of program and fair treatment for all children in the program. We provide reasonable accommodation for children with disabilities to ensure equal participation.
I understand and agree to the non-discrimination clause
FERPA

Under FERPA (Family Educational Rights and Privacy Act), after school programs can access student data from a school if they are considered a "school official" with a "legitimate educational interest," meaning they need the information to fulfill their educational responsibilities in supporting students. The program adheres to privacy guidelines when handling this information. Our K-8 program maintains the confidentiality of student data they receive from the school and follow our organization's data security practices to protect personal information.
If documentation is needed from the school for the collection of required data, do you give us consent to contact the school to receive the documentation on your behalf?*

Yes, I consent to the collection of data from my child(ren)'s school.No, I do not agree to the school sharing my child(ren)'s data

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