After School Registration

Student Name

First NameMiddle InitialLast Name

Date of Birth

Date

Address

City

ZIP Code

Gender

Race/Ethnicity

This information is required to obtain grants and is not used by us for any other reason. This allows us to keep our program free of charge.

Student Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

School

Grade

Qualifies for Free or Reduced Lunch

Parent/Guardian 1 Full Name

First NameMiddle NameLast Name

Cell Phone

Please enter a valid phone number.Format: (000) 000-0000.

Relationship to Student

Street Address

City

State

ZIP Code

Email Address

example@example.com

Lives with Student?

Parent/Guardian 2 Full Name

First NameMiddle NameLast Name

Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Emergency Contact Name - if parent is not available (21+)

Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Relationship to Student

Medical Conditions

Prescriptions

Allergies

Student Name (Printed)

Student Signature

Student Signature Date

Date

Parent Name (Printed)

Parent Signature

Parent Signature Date

Date

Dress Code: Students should wear appropriate clothing. Students should refrain from wearing tank tops, midriff/crop tops, visible undergarments, revealing garments, t-shirts, or clothing that display inappropriate graphics, pictural or written expression. All skirts and/or shorts and dresses should be no shorter than 2 inches above the knee. Students are prohibited from wearing gang-affiliated clothing, accessories, and symbols, including colors, numbers, or phrases associated with an affiliation. Violation of the dress code may result in students being sent home. Repeated violations of this dress code policy may result in disciplinary action.

Our Expectations: Be responsible… Clean up after yourself before going home. Everyone must participate in planned activities. Be respectful…No cursing, no perverted jokes. Always treat fellow youth, visitors, leaders, staff, and any guest speakers and musicians with dignity and respect. Student-to-student harassment is prohibited. Verbal and physical harassment of any kind will not be tolerated. This includes physical, verbal or written harassment. Examples of additional harassment include, but are not limited to... Stalking, making obscene gestures, making sexual comments, remarks or insults, or pressure for unlawful activity. Do not physically or verbally abuse others. This means that under no circumstances should you bully, hit, gossip about, throw something at, or make fun of another person. Words matter... “Death and life are in the power of the tongue...”(Proverbs 18:21). Use your words to bring life, not death.

Consequences for Misbehavior: The consequences for misbehavior outlined below aim to exemplify graceand forgiveness. It is our goal that any student who receives any offense learns from it and returns to The Link 4 Youth with a clean slate. We desire to have all students participating in all activities and will not hold prior offenses against students who have already completed the consequences for such (assuming that a pattern does not emerge)- students are held accountable for their behavior but not condemned. Consequences for Offenses Include: The student will receive a verbal warning. The student will be pulled aside by a staff member to discuss the offense. Or the student will be asked to call his/her parents, explain why they are calling (i.e., what actions got them in trouble) and ask to be picked up immediately. At this time, the student will receive advance warning that the next offense will result in suspension from The Link 4 Youth. Leaders/Staff reserve the right to determine the severity of the misbehavior and may choose to skip or modify any of the above stated consequences. All cell phones will be placed in the cell phone safe. If phones are seen out, they will be taken by a leader and given back at the end of the night. Several violations will lead to consequences. Be safe: At no time should a student wander off or leave The Link without talking to a leader and getting permission. At no time shall a student enter any rooms without supervision by a leader. At no time shall a student be unsupervised in the building alone. Drugs, alcohol, weapons, fireworks, vapes, knives, etc... are never permitted on property. Be respectful to staff/leaders... Students are expected to fully recognize the authority and responsibility of all leaders/staff by obeying instructions and following rules. Anyone who breaks the guidelines may be dismissed early from the program and or the special event. ~ I understand that my regular attendance is a key to spiritual and community growth. ~ I understand that violence, disruptive behavior, and abusive language are unacceptable and will not be tolerated.

Media Release Agreement - I give permission for The Link 4 Youth, and those acting under its authority, to use my child's image for use in media publications including video, email blasts, recruiting brochures, newsletters, magazines, general publications, websites and/or affiliations. I waive the right to inspect or approve the finished photograph or electronic material that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties other compensation arising from or related to the use of the image.

Activity Participation Agreement - Students who attend The Link 4 Youth participate in many different activities, including athletics, sleigh riding and rock wall climbing. For their safety, students must wear appropriate closed toe footwear and clothing that is conducive to being active. I acknowledge that participation in activities at The Link 4 Youth involve risk to the participant, and may result in various types of injury, including, but not limited to: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage and financial damage. The participant, and/or parent/guardian, accepts personal financial responsibility for any injury or loss sustained during the activity, or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, volunteers, or other representatives from The Link 4 Youth.

Transportation Agreement - I give permission for my child to be transported in a motor vehicle driven by staff or volunteers of The Link 4 Youth for sponsored events, programs, specific pickup locations, and other special activities. I understand that my child is expected to follow all applicable laws regarding riding in a motor vehicle and is expected to follow the directions provided by the drivers and/or other adult volunteers. My child and I understand that all passengers are required to: *wear a seatbelt *remain seated and not disrupt the driver *be respectful of all individuals inside the vehicle. I understand the risks involved with riding in a motor vehicle, including, but not limited to, personal injury, property damage, death and trauma which can come from accidents caused by objects in the road, other drivers or passengers.

Student Behavior Agreement - At The Link 4 Youth, students are expected to: *Treat one another respectfully regardless of racial, ethnic or religious background * Use appropriate language as to not offend others *Help one another by being kind, loving and lending a hand *Actively provide a welcoming experience for all people who enter The Link 4 Youth *Listen and be respectful of individuals presenting or speaking in a group setting *Settle all disagreements using calm words, never resorting to physical altercation *Follow all check in/check out procedures for programs and events *Never remove any property of The Link 4 Youth from the building or grounds without prior approval *Care for the building and grounds and people on the property as if it were their personal home and family. The entire Student Behavior and Rules Book can be obtained upon request and is subject to change over time.

Student Printed Name – Policy & Consent Acknowledgements

Student Signature – Policy & Consent Acknowledgements

Student Date – Policy & Consent Acknowledgements

Date

Parent/Guardian Printed Name – Policy & Consent Acknowledgements

Parent/Guardian Signature – Policy & Consent Acknowledgements

Parent/Guardian Date – Policy & Consent Acknowledgements

Date

First time attending Afterschool Program

Household Type

Is anyone living in the home a U.S. military veteran?

Number of People Living in Household

Race of Head of Household

Household Status

Total Yearly Household Income Range (by household size)

After School Registration

Student Information

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Emergency Contact Information

Health Information

Membership Application Signatures

Agreements and Acknowledgements:

Required Data Report and Household Demographics