STEAM Works @ Mulberry Lofts Registration Form
Please complete the following to help us collect information about people who attend our programs so we can use this for grants and donors.
Name of Parent(s) *
Your answer
Name of child(ren) *
Your answer
Mailing Address: *
Your answer
Email address: *
Your answer
Telephone number: *
Your answer
Emergency Contact: *
Your answer
Age of parent with child attending *
Age of child(ren) *
Household Annual Income *
Do you have health insurance coverage? *
Does your household receive any state or federal assistance for housing? *
Does your household receive and state or federal assistance for food? *
Does your household receive state or federal assistance for childcare? *
What is your race? *
What is(are) your child(ren's) race? *
Terms of Service
Terms of Service

BEACON House, Inc. STEAM Works Family Center Program“Policies, Rules, and Procedures”

While attending the STEAM Works Family Center at Mulberry Lofts, all children and adults are asked to comply with the already existing rules of their school, as well as, the Family Center rules. In order to maintain a safe environment, we ask that you please review them with your child.
1.Be respectful to other students, our college mentors, parents, teachers and staff members.
2. Follow all the directions the first time they are given.
3.Stay in assigned area.
4.You are only allowed to leave assigned area with a parent, mentor or staff member escort.
5.Keep hands, feet, inappropriate comments, and objects to yourself.
6.Walk appropriately on while in/on the Mulberry Lofts property.
7.Use respectful language at all times, using ‘inside voices’.

“After School Discipline Policy” The Family Center Program is a means of providing additional educational support and opportunities to students and families beyond the formal school day. Therefore, it must be recognized that inappropriate behavior by the students, especially in the form of threats against other students and/or staff, does not promote a favorable learning environment, and will not be tolerated. As with any other zero-tolerance policy, there will be consequences for the following types of misconduct:
1.Failure to follow rules, policies and procedure of the Family Center Program.
2.General misconduct, including loud or boisterous behavior that tends to disturb other students, and includes running in the classroom/halls, minor defacement of property, and pushing or shoving others.
3.A student’s persistent refusal to follow the instructions of program staff, program administrators, or any volunteer/employee. This shall also include a student’s refusal or failure to properly identify oneself on request.
4.Use of obscene vulgar, profane, disrespectful, demeaning or threatening words and/or actions or gesture directed to or in the presence of any student, parent, volunteer or employee.
5. Mutual physical confrontations between students (fighting).
6.Possession and/or use of any tobacco or drug related items or ‘look a like’ items – this may include cigarettes, chewing tobacco and other tobacco-related products, lighters, alcoholic substances, drug-consumption devices, and any substance suspected of being a ‘drug’.
7.A behavior that may result in physical or mental abuse to one’s self.8.Committing an act of indecent exposure in the presence of any other student, member of the staff, or school employee.

.“Disciplinary Actions”
1. Verbal reprimand 2.Special assignments or removal from classroom 3.Program staff/student behavioral contract
4. Parent Contact 5. Suspension from Family Center:
a.First Offense – 1 day suspension.
b. Second Offense – 3 days suspension
c.Third Offense – Parent/Staff conference to determine continued enrollment in the program 6.Permanent withdrawal of Family Center privileges – includes non-academic activities taking place during and beyond the normal After School hours (i.e. games, gym activities, computer lab, field trips, etc.)
7.Immediate notification of authorities if appropriate*Note: The program staff is responsible for utilizing different intervention techniques before a student is referred to the school administration.

“Inclement Weather Policy”
*In the event of inclement weather, the Family Center Program follows your Washington County Public school district’s lead for school delays and cancellations.
*If your school is delayed, the Family Center Program will be in session.
*If your school is cancelled, the Family Center Program will be cancelled.
*In the event that the Family Program is in session, and the weather becomes dangerous, the parents are encouraged to take children home early from the program.
Please be sure to call ahead and make arrangements for someone to meet you at the door.

“Child Policy”
All parents or a responsible adult must accompany their child(ren) while at the BEACON House, Inc. STEAM Works Family Center at Mulberry Lofts. This is not a daycare or child care program. It is meant as a place that families can learn together and grow.

“Payment Policy”
The starting of this agreement with first payment and submitting the form signs the parents to a contract of one full year of the Family Center Program. This means the Fall, Spring, and Summer sessions for a total of 12 months at $25/month/child. If you need to cancel your membership you will be charged the balance of the year for each child.I have read and reviewed the contents of the BEACON House, Inc.’s STEAM Works Family Center’s at Mulberry Lofts Parent’s Manual, and I agree to accurately carryout the policies and procedures of the BEACON House, Inc.’s STEAM Works Family Center at Mulberry Lofts by clicking yes and submitting the form.

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