VIRTUAL/IN-PERSON TEXAS ACE AFTER SCHOOL PROGRAM 2020-21: STUDENT APPLICATION
***SUBMISSION OF THIS FORM IS NOT A GUARANTEE OF ENROLLMENT***

Free Virtual and/or In-Person After School Program for 3rd and 4th Grade students from Burnet, Parker, Oppe, and LA Morgan Elementaries, and also for all students from Crenshaw and Ball High School.
Our virtual program will be a mixture of live and recorded classes, and tech-free kit-based classes will also be available. Virtual Tutoring will be through Canvas.
Virtual program will start on or after August 24th.
In-person program will start from September 28th (to be confirmed), following school opening dates. In-person program will follow all the same safety procedures as the school day.
Supplies will be provided for virtual and in-person attendees.

Once you enroll, you will receive more information about the program.
*Funded by the 21st CCLC Program administered by the U.S. Department of Education*
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Email *
Student Last Name *
Student First Name *
Student ID Number (Lunch Number) - if known
Student Email Address (provided by the school) - if known
2020-21 Campus *
2020-2021 Grade *
Will student be attending our program virtually or in-person (must be enrolled for on campus school day activities to attend in person)? *
What is the primary reason your students will be enrolling for the after school program? *
Will your student have a younger sibling/s enrolled in the TOR after school program (K-2)? (Burnet, Parker, LA Morgan, Oppe) *
If your student attends program in-person, would they need bus transportation? (Bus transportation availability after program not yet known) *
Does the student have any Medical Issues/Learning Challenges/Allergies? *
Parent/Guardian #1 First and Last Name *
Parent/Guardian #1 Phone Number *
Parent/Guardian #1 Relationship to Student *
Parent/Guardian #1 Email Address *
Parent/Guardian #2 First and Last Name
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Relationship to Student
Parent/Guardian #2 Email Address
Parent/Student Home Address (including city and zip code) *
What does your family have access to (for virtual program)? Please check all that apply: *
Required
How would you prefer to receive supplies if student is virtual? *
Texas ACE will take all reasonable measures to ensure that supplies are sanitized before distribution per district guidelines. However, we are unable to guarantee they are 100% free from contamination. Do you agree to accept the supplies on these terms and agree that we shall not be held liable in any way should illness occur? (Please check I agree) *
I hereby give Galveston ISD permission to use my child’s image and/or work on the district’s TV channel, website and social media, for media purposes and in district publications. *Please note: Submission of a photo or video will be viewed as permission to share that photo or video. (Please check I agree) *
Parent/Guardians are responsible for notifying Galveston ISD/Texas ACE of all medical information pertaining to the student on this form. The parent/guardian at home remains responsible for the student's health and safety during virtual activities. (Please check 'Agree') *
Parent/Guardians are responsible for notifying Site Coordinator of any potential exposure to COVID-19 including but not limited to positive diagnoses of student, family member, or any other source. (This information will be used for contact tracing and for program safety. Personal health information will not be shared with the public.) *
I give permission for Texas ACE to share student data with our partners, including but not limited to demographic data and pertinent medical information. (Please check 'Agree') *
Typing my name and the date below certifies my understanding of all paragraphs above, and gives my permission for my child to participate in the Galveston ISD Texas ACE/21st Century After School Program. Please write your name and the date: *
A copy of your responses will be emailed to the address you provided.
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