2017-18 Democracy Prep Congress Heights Online Registration Form
Greetings Democracy Prep Families:

2017-18 school year, Democracy Prep Congress Heights PCS will be collecting All contact information electronically, for our operations team, school nurse and teaching staff members to have a more efficient way of getting in contact with you for emergencies and family engagement only. This form is NOT OPTIONAL and must be filled out during enrollment. This form must be filled out for each scholar. This directory will be available only to the Democracy Prep Congress heights staff. Contact information we collect is to be used exclusively for school related purposes and emergencies and not for commercial, charitable or political activities of any sort.
Thanks you

Email address *
The following information pertains to the REGISTERING SCHOLAR.
Scholars Last Name *
Your answer
Scholars First Name *
Your answer
Scholars Date of Birth *
Scholars Grade ( Enrolling Grade) *
IEP and other Services * Please indicate whether your scholar has an IEP or receives related services at school. Be sure to bring a copy of the IEP, 504 plan and any evaluations with you to your enrollment meeting. *
Primary Guardian Informaiton
The following information pertains to the primary guardian the scholar lives with
Primary Guardian Information (Relationship to Scholar) *
Last Name *
Your answer
Parents First Name *
Your answer
Street Address ( must be a DC Resident, All addresses will be verified by proving proof of residency at enrollment) *
Your answer
Apartment number
Your answer
City *
Your answer
State *
Your answer
Zipcode *
Your answer
Ward you live in *
Your answer
Home Phone Number *
Your answer
Work Phone Number *
Your answer
Cell Phone Number *
Your answer
Email Address *
Your answer
Please choose all that apply to the person above: *
Secondary Guardian and Emergency Contact information
Please use this section to add a secondary or emergency contact
Secondary Guardian /Alternate/Emergency Contact Information (Relationship to Scholar) *
Phone Number *
Your answer
Email Address
Your answer
Please choose all that apply to the person above: *
Residency Questionnaire:
This questionnaire is intended to address the McKinney-Vento Act 42 U.S.C.11435. THE INFORMATION YOU PROVIDE IS CONFIDENTIAL. Your child will not be discriminated against based upon the information required.
Please check the box if you understand this statement. *
Is this scholar in the physical custody of the parent or guardian? *
Is this scholar considered an unaccompanied youth? *
Please provide the scholars current living arrangements. *
Please type in your name if you have completed the residency questionnaire. *
Your answer
Accepted Students Instructional Placement Disclaimer:
Our goal at Democracy Prep is to prepare each of our students for the path to college. To fulfill this goal, it is necessary for us to appropriately and realistically evaluate where our students are academically when they enroll at Democracy Prep.

We are committed to recruiting and serving all children, including those students with special needs and English Language Learners. Democracy Prep accepts new scholars at all grade levels (K-12) at the beginning of each new academic year by random lottery when space is available. Acceptance guarantees the accepted student a seat in the grade that is most appropriate for the student’s level of academic ability but does not guarantee a student’s acceptance to a particular grade regardless of age or prior grade completion.

As such, after a student is accepted to one of our schools based on our random lottery, the student takes an academic assessment which serves to let us know the appropriate grade level in which to place the student based on our rigorous college preparatory curriculum. Even if a student initially is placed in an upper grade, a scholar can be retained at any time if the student does not meet the DPPS promotion criteria. We do provide extra support to scholars in the form of after school tutoring, Saturday school and summer school to ensure that our scholars succeed at Democracy Prep, in college, in civic life and beyond.

Democracy Prep’s ability to appropriately evaluate and serve each scholar is highly dependent on any Individualized Education Programs (IEPs) and special learning needs. In any instance in which Democracy Prep is unable to serve a student in an appropriate manner, a discussion will occur with each family to find at the most appropriate match for the student’s needs. We will try our best to serve each student and their needs to the best of our ability with the resources available to us.

While it may take some scholars longer than others, at Democracy Prep we are committed to preparing all scholars for success in the college of their choice and a life of active citizenship and we ask that our parents partner with us in this extraordinary endeavor.

I have read the above Accepted Students Instructional Placement Disclaimer and accepted its terms and conditions *
Seat Accepted Form
As a DPPS Scholar, I pledge that I will:

★ Attend Prep Academy in August 2015.
★ Attend school from August to June without exceptions or excuses.
★ Arrive promptly to school, Monday through Friday, five minutes before the agreed upon start time in the appropriate uniform, prepared, rested, enthusiastic and ready to learn until dismissal.
★ Attend Saturday and/or Summer Academy from 8:30AM to 1:00PM, as required.
★ Always give my best effort in every class and keep trying in everything until I succeed.
★ Do all my homework, study for all tests and never let failure stop me from moving forward.
★ Always strive to attain the DREAM Values of Democracy Prep (Discipline, Respect, Enthusiasm, Accountability & Maturity).
★ Always be open and honest with my teachers, family, peers and myself.
★ Always accept responsibility for my actions and learn from my mistakes.
★ Always treat my teachers, peers and myself with respect.
★ Use my gifts, talents and dedication to serve others and become an engaged citizen in my community.

As a DPPS Family, we pledge that we will:

★ Help register at least two individuals in our family or community to vote.
★ Attend family conferences and important school events.
★ Be active in our scholar’s life and help our scholar achieve their goals as they work hard, go to college and change the world!

Parents Name *
Your answer
Field Trip Consent, Waiver, and Release Form
Democracy Prep offers its students many opportunities to participate in field trips for the purpose of educational enrichment. To that end, each student’s parent or guardian must authorize Democracy Prep to take his/her child outside the confines of the school facilities. When you execute this permission slip, you will authorize your child to participate in all Democracy Prep field trips during each school year.

Participation of students on most Democracy Prep field trips is voluntary; parents who have specific questions about any part of a field trip activity are encouraged to contact their child’s Campus Director. Teachers and often parent volunteers accompany students on these trips. We expect students to maintain the same behavior on field trips as that expected in school and throughout the school year. Please note that behavior infractions prior to the field trip could jeopardize the student’s opportunity to participate.

If the destination of the trip is too far to walk, students and their chaperones usually take public transportation. Offsite trips begin at the child’s school; students must leave for their trip from their Democracy Prep school and cannot meet the school group at the designated location from another site (e.g., home). Furthermore, Democracy Prep requires that all students participating on field trips return to their school before they are dismissed for the day, unless a student’s parent provides Democracy Prep with specific written permission to allow the student to embark for another destination upon the conclusion of the trip. Such permission must be provided to the school no later than 24 hours prior to the start of the trip.

Waiver and Release
I understand that these events will take place away from the school grounds and that my child will be under the supervision of the designated school employees. I understand that my child is expected to follow all applicable rules, standards, instructions and laws, including, but not limited to, those that pertain to riding in a motor vehicle and any other mode of transportation. I further understand that my child is to behave responsibly and to follow the school’s discipline code and policies and to follow the directions provided by the school trip leaders and chaperones.

As a parent or guardian, I understand that the school staff will do everything possible to prevent any accidents. However, I fully understand that some activities on field trips involve inherent risks to students regardless of all feasible safety measures that may be taken by Democracy Prep including the risks associated with traveling to and from the location of the trip by walking, public transportation or other means and the possibility of bodily injury, emotional distress, and even death, incurred while transporting to or participating in the trip.

I agree that I am solely responsible for any loss, damage, or injury to my child that occurs during my child’s participation in a field trip even that is caused by the negligence of Democracy Prep, Democracy Prep Public Schools or any charter school it operates or manages, their officers, trustees, directors, volunteers, agents, chaperones, or other affiliates (together, “Democracy Prep”) not including any loss, damage, or injury that is the result of gross negligence or willful misconduct of Democracy Prep.

In consideration of my child being allowed to participate in field trips, I for myself, my child, my child’s other parent/guardian(s) if any, and any of my or our executors and assigns hereby agree to release, discharge, indemnify and hold harmless Democracy Prep from any and all claims of liability, injury, or damage that we may have or that we could each bring on our own, or on my or our child’s behalf, from or relating to or in connection with my child’s participation in field trips. I further agree to release and discharge Democracy Prep from any claim that we may have or that we could each bring on our own, or on my or our child’s behalf, with regard to any damages, demands, or actions whatsoever, including those based in negligence, in any manner arising out of my scholar’s participation in the field trips. This release and indemnification does not apply to claims for intentional misconduct or gross negligence.

Consent to Medical Treatment
I agree that in the event of an emergency injury or illness and in the event that I cannot be contacted, the staff member(s) in charge of the trip may act on my behalf and at my expense in obtaining medical treatment for my child. I further agree that I release Democracy Prep from any claim whatsoever that might arise on account of any such medical treatment. I have read this entire Consent, Waiver and Release Form, fully understand it, and agree to be legally bound by its terms. I authorize my son/daughter to attend any and all Democracy Prep field trips. I understand that I may, from time to time, receive additional information from my child’s school setting forth specific details, including return time and costs not borne by Democracy Prep, in advance of particular field trip.

I have read this entire Consent, Wavier, and Release Form, Fully understand it, and agree to be legally bound by its terms. *
Parent /Guardian Signature *
Your answer
Media Release Form
This form will allow your child’s name, photograph and video to be used by any media or school personnel that might take photographs or video at a Democracy Prep public school or any field or function of Democracy Prep.

I hereby authorize Democracy Prep Public Schools, school personnel, or media to photograph my child, take video footage of my child, and/or make electronic sound recordings of my child. I authorize the use of my child’s name, or any such photographic or electronic reproductions of my child for any purpose, including, but not limited to educational and other media as may be deemed appropriate by Democracy Prep Public Schools (I understand that my child may be identifiable from such photographic or electronic reproduction). I understand Democracy Prep Public Schools will not use my child’s last name in conjunction with any photographic or electronic reproductions. I understand that there will be no financial or other remuneration for recording my child, either for initial or subsequent transmission or playback. On behalf of my child and myself, I waive any rights, claims, or interest I may have to control the use of my child’s identity or likeness in whatever media used.

Please choose one statement below: * *
Parent/Guardian Name *
Your answer
Ethnic Identification Form
All students between the age of 5 and 21 years of age have the right to a free public education. Children may not be refused admission to a public school because of race, color, creed, national origin, gender identity, pregnancy, immigration/citizenship status, disability, sexual orientation, religion, or ethnicity.

Is the scholar Hispanic, Latino, or of Spanish origin? *
Select one or more races from the following five racial groups. *
Parent/Guardian Name *
Your answer
Transport Information
Please answer the following questions about your scholar. If the question does not pertain to the scholar, please state "Not Applicable".
What mode of transportation are you using to get your child from school *
If aftercare what is the name of the aftercare provider?
Your answer
Who will be picking up your scholar
Does your scholar need a DC One Card>
My scholar will be attending aftercare with Champions, DPCH in-house aftercare program. *
Medical Information
Please answer the following questions about your scholar. If the question does not pertain to the scholar, please state "Not Applicable".
Does your scholar have any dietary restrictions? Please list or explain *
Your answer
Does your scholar have any of the following allergies? Check all that apply. *
Does your scholar have any medical conditions we need to know about? *
Does your scholar have any medications that we will need to administer here at Democracy Prep? If so, please remember to give the school the Medical Administration Form ( MAF) filled out by your scholars physician. *
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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