Transformation Life Center Youth Enrollment Form Summer Discovery & OST (Out of School Time)Programs

Transformation Life Center Youth Enrollment Form Summer Discovery & OST (Out of School Time)Programs

Transformation Life Center (TLC) is committed to providing a safe, enriching, and engaging environment for youth and families in our community.This form is required to enroll your child in TLC programming. Please complete all sections to ensure we have accurate information to support your child’s safety and success.
- Which program are you enrolling your child in?*
- Parent/Guardian Full Name
  
  First NameLast Name
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Email*
  example@example.com
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Name
  
  First NameLast Name
- Relationship
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Student Full Name*
  
  First NameLast Name
- Date of Birth*
  
  MonthDayYear
  Date
- Current Age*
- Current School*
- Current Grade*
- Shirt Size*
- Health, Medical & Dietary Information
- Medical Conditions
- YesNo
- If yes, please describe medications and instructions
- Dietary Restrictions (if any)
- I certify that my child is in good health and able to participate in program activities unless otherwise noted. I agree to inform TLC of any changes to my child’s medical information.
- Learning & Support Needs (IEP/504)
- YesNo
- Please describe any learning, behavioral, or support needs we should be aware of
- Upload IEP/504 document
  
  Cancelof
- YesNo
- Attendance Commitment
- I understand that my child is expected to attend at least 80% of program days. I agree to support consistent attendance and communicate any absences in advance. I understand that failure to meet attendance expectations may result in removal from the program.
- I agree to communicate with TLC staff regarding absences, schedule changes, or concerns that may impact my child’s participation.
- Behavior & Program Expectations
- I acknowledge that I have reviewed and understand TLC’s Code of Conduct. I agree to support my child in following all program expectations, including behavior, safety, and respect for staff and peers. I understand that serious or repeated violations may result in suspension or removal from the program.
- I agree to partner with TLC staff to support my child’s behavior, growth, and overall success in the program.
- Parent Handbook & Program Policies
- The TLC Parent & Student Handbook outlines important program policies, expectations, and procedures. Please review the handbook prior to the start of programming.
  
  A copy of the handbook will be provided upon enrollment and available upon request.
- I acknowledge that I have received access to the TLC Parent & Student Handbook and agree to review and follow all program policies outlined.
- Pick-Up & Dismissal Authorization
- Name - Authorized Pick Up #1*
  
  First NameLast Name
- Relationship
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Name - Authorized Pick #2*
  
  First NameLast Name
- Relationship
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Name - Authorized #3
  
  First NameLast Name
- Relationship
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Picked up by authorized adultEnrolled in aftercareAllowed to self-dismiss (if age appropriate)
- YesNo
- I understand that my child will only be released to authorized individuals listed above. I agree to pick up my child on time and follow all TLC dismissal and aftercare policies.
- Emergency Medical Authorization
- I give permission for Transformation Life Center staff to seek emergency medical treatment for my child if I cannot be reached. I understand that reasonable efforts will be made to contact me.
- Liability Waiver & Release
- I understand that participation in TLC programs involves physical activity and group engagement. I release and hold harmless Transformation Life Center, its staff, volunteers, and partners from liability for any injury or loss that may occur during participation, except in cases of gross negligence.
- Media Consent
- YesNo
- Final Agreement & Signature
- By signing below, I confirm that all information provided is accurate and complete. I understand and agree to all policies, expectations, and terms outlined in this form, including attendance, behavior, safety, and participation requirements for Transformation Life Center programs.
- Parent/Guardian Full Name*
  
  First NameLast Name
- Parent/Guardian Signature*
- Student Demographics & School Information (Required for Program Reporting)
- The following questions help us meet program requirements and improve services for students and families. All responses are kept confidential and used for reporting purposes only.
- Please share the ZIP code of the school your child attends. If multiple, please write the ZIP code where they ended the year.*
- American Indian, Indigenous, Native American, or Alaskan NativeBlack or African-AmericanAsian or Asian-AmericanHispanic or Latinx and any raceWhite or CaucasianNative Hawaiian or Pacific IslanderMultiracialPrefer not to answerOther
- FemaleMalePrefer Not to answer
- YesNoNot SurePrefer Not to answer
- YesNoNot Sure
- YesNoNot sure
- Please note: Along with assessments, your child may be asked to complete a post-survey after the program to help us evaluate successes and improve services. No further action is required to provide consent for participation.
  
  If you prefer that your child not participate in surveys, please notify TLC staff to opt out.
- By submitting this enrollment application, I consent to be contacted by Transformation Life Center and/or Summer Discovery program staff regarding my child’s participation.
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Transformation Life Center Youth Enrollment Form Summer Discovery & OST (Out of School Time)Programs

Health, Medical & Dietary Information

Learning & Support Needs (IEP/504)

Attendance Commitment

Behavior & Program Expectations

Parent Handbook & Program Policies

Pick-Up & Dismissal Authorization

Emergency Medical Authorization

Liability Waiver & Release

Media Consent

Final Agreement & Signature

Student Demographics & School Information (Required for Program Reporting)