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
- Is your child currently taking any medication?
- If yes, please describe medications and instructions
- Dietary Restrictions (if any)
- Health Acknowledgement
- Learning & Support Needs (IEP/504)
- Does your child have an IEP or 504 plan?
- Please describe any learning, behavioral, or support needs we should be aware of
- Upload IEP/504 document
  
  Cancelof
- Does your child require any accommodations to safely participate?
- Attendance Commitment
- Attendance Agreement
- Communication Agreement
- Behavior & Program Expectations
- Behavior Agreement
- Parent Partnership
- 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.
- Handbook Acknowledgment
- 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.
- How will your child be dismissed daily?
- Will your child participate in aftercare?
- Dismissal Agreement
- Emergency Medical Authorization
- Emergency Authorization
- Liability Waiver & Release
- Liability Agreement
- Media Consent
- Do you give permission for your child to be photographed or recorded?
- 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.
- What is your child's racial and/or ethnic identity?
  
  Other
- Gender
- Is your child an English learner or English as a second language student?
- At school, is your family eligible to receive free lunch?
- Did your child attend a Summer Discovery program last year (2025)?
- 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.
- Communication Consent
Should be Empty:

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)