After-school Sign-up & Permission Form 2021-22

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Email *
Student Last Name *
Student First Name *
Student Grade *
What activity would your student like to participate in on Mondays from 3:15 PM - 4:00 PM? *
What activity would your student like to participate in on Mondays from 4:05 PM - 4:45 PM?
What activity would your student like to participate in on Tuesdays from 3:15 PM - 4:00 PM?
What activity would your student like to participate in on Tuesdays from 4:05 PM - 4:45 PM?
What activity would your student like to participate in on Wednesdays from 3:15 PM - 4:00 PM?
What activity would your student like to participate in on Wednesdays from 4:05 PM - 4:45 PM?
What activity would your student like to participate in on Thursdays from 3:15 PM - 4:00 PM?
What activity would your student like to participate in on Thursdays from 4:05 PM - 4:45 PM?
What activity would your student like to participate in on Fridays from 2:45 PM - 3:30 PM?
What activity would your student like to participate in on Fridays from 3:35 PM - 4:15 PM?
After-school Expectations and Disclosure
Students must check-in for their after-school activity by 3:05 PM in the Cafeteria (Northeast doors). On Fridays this time is 2:35. One of the program administrators will be there to check-in and supervise the students.

A healthy snack will be served in the cafeteria. Students must clean-up after themselves and be in their selected activity no later than 3:15 PM.

WJMS closes at 3PM. Any students in the building after 3:10 PM must be in a supervised activity at all times. Students may not wander the halls or loiter outside the building.

If students leave the building during after-school activities, they cannot come back in the building for safety reasons. They must be in or out.

Students who are not participating may be asked to leave.

All students participating in after-school activities MUST be out of the building by 4:55 PM.

If students are involved in an incident or repeatedly fail to meet these expectations during after-school activities, they may not be allowed to participate for the rest of the quarter.
How will your student get home from after-school activities? *
Required
Guardian Phone Number in Case of Emergency: *
My student and I understand and agree to follow all after-school expectations and staff requests. *
PHOTO RELEASE
During the school year, we take photographs of WJMS after school activities involving students to share with our grant partners, 21st CCLC, and on school social media accounts. Incidentally, some photographs may capture your child's participation, directly or indirectly.
These photos may be published through our website, social media pages, news bulletins, and grant reports. With this, we seek your consent in allowing us to publish photos which may involve your child to these platforms. Please provide your response by selecting your choice below:
Photo Release *
DATA RELEASE
The WJMS After-school program is funded through a grant through the 21st Century Community Learning Center. Four times a year we are required to share data with the funders our programs. This will include attendance, efficacy, and success in a grant report. The report includes information such as student gender, ethnicity, school performance, and test results. None of this information will be attached to any individual student names. Student names and privacy will maintained.
Data Release *
Parent name and permission. Please enter your first and last name as the guardian to agree to your student participating in the WJMS after-school program. *
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