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Event registration - Hoquiam Middle School "After Hours - Cub Club!"
Event Timing: December 17- June 16 Monday - Friday  3:00 PM - 6:00 PM
Event Address: Hoquiam Middle School
Contact us at (646) 765-7670 or jcooper@hoquiam.net

*PLEASE NOTE: each day Dinner & Snacks will be provided and if your scholar lives 1 mile away from the school and requires bus transportation that will be provided.

(Click here).  --------------->. Cub Clubs - After Hours ---> "SUMMARY" INFORMATION PACK

(Click here)   ---------------> Cub Clubs - After Hours ----> "COMPREHENSIVE" INFORMATION PACK

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Student Information: Name of Student? *
Prefered name or Nickname? 
Cell number for student?  
School Email Address? @hoquiam.net
Grade? *
Age?
Date of birth? *
Guardians Contact Information:  1st guardian *
Address?  *
Relationship? *
Phone Number? *
Email address? *
Guardians Contact Information:  2nd guardian? *
Relationship? *
Phone Number? *
Email address? *
Emergency Contact - Name? *
Relationship? *
Emergency phone number? *
Email address? *
MEDICAL CONDITIONS & ALLERGIES - Allergies (check all that apply) *
Required
Does your scholar take allergy medication? Will they require medication to be available on site for emergency or non-emergency reasons?
 *
Medical Conditions (check all that apply) *
Required

Daily Medication: ___________________________________________

 *

Emergency Medication: ___________________________________________

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PROGRAMS / SERVICES (Check all that apply) *
Required
FAMILY & COMMUNITY VOLUNTEER INTEREST

We welcome families and community members to share cultural traditions, cooking, arts, crafts, heritage, and real‑world skills.
Indigenous, Latin, and international‑heritage individuals are strongly encouraged to volunteer.

Would you, a family member, or a friend like to provide a one‑time lesson or activity?

 *

Additional Notes:


DRAMA CLUB PARTICIPATION

Is your student able to participate in the upcoming production?  We are tentatively scheduled to perform in May.        

*
Required
What days will your scholar attend? *
Required

Is your student in sports, and due to scheduled practice can attend only the 3:00–4:30 PM or 4:30–6:00 PM schedule? If so what time and what is the sport? (These are also ideal for homework and tutoring.)


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Students home address?
If your student requires transportation and is eligable Please note the bus dispatch will arrange a general bus stop for scholars.  *
Dietary restrictions *
Required
Would your scholar require a bus ride? (Your student would be eligible if they live one mile from the school.) *
Required
POLICIES & PERMISSIONS

Personal Belongings Disclaimer

The HCC / Altera / 21st Century Program and Hoquiam School District are not responsible for lost, stolen, or damaged items.

 *
Photo & Video Permission
Photos may be used for public display to the school community, for updates, for newsletters, or for program documentation.

Teacher-Assessed Lessons: The program director may record short teaching segments for self-reflection, coaching, or required training. These recordings are not publicly shared and follow district privacy rules.
 *
Technology Use Permission. We will use computers and cell phones to program tools that will assist our scholars with their projects. This would include ChatGPT and other AI-generated tools, online research, coding, robotics, tutoring, and academic programming.  Is this alright with you? *
Emergency Dismissal Plan

If your child requires bus transportation, we can provide this service as long as they meet the eligibility requirements. Please refer to the Family Policy and After Hours - Cub Club Program Description booklet for more information. You must complete the attached form to ensure your scholar is scheduled and assigned to a designated bus for transportation home.


 *
Required
PICK‑UP AUTHORIZATION: The following people are authorized to pick up the scholar.




 *
Required
Please let us know if your scholar has any learning or support needs. We want to support each student in the way that works best for them, so any information you can share is helpful.

Are there any student interests that would help us design programs to engage your scholars in our clubs better? We welcome any ideas or suggestions that help us support what your student enjoys most.
 *
LANGUAGE PREFERENCE?

 *
Dinner & Snacks

The Hoquiam Middle School Cafeteria will provide daily dinners and snacks.

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Please have your student read the following agreement as a member of our clubs. Please have them check each box to signify that they understand the expectation as an After Hours - Cub Club member.
 *
Required
E-Signature
E-Signature *
Submit
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