2025-2026 21st CCLC Registration Form 
Welcome to Glen Meadow's 21st Century Community Learning Center. The 21st CCLC is an after school program grant-funded by the New Jersey Department of Education. Our after school program affords students the opportunity to complete homework, enhance study skills, collaborate with their peers, and engage in new learning opportunities. We have a strong STEM focus, but also have activities such as Culinary Arts, Theater, Media Creations, Team Building, Physical Activity, and much more. 

Please note that ALL Glen Meadow Middle School After School Clubs/Activities require a 21st Century Community Learning Center registration. Students will report to the 21st CCLC program after the last period of the day  and at the conclusion of their club or activity. ALL students must be picked up and signed out by a parent/guardian through the 21st CCLC staff no later than 6pm. As you may know, after-school bussing is back. There will be an attached form explaining the bus stops. 

Please fill out the registration form below for the 2025-2026 school year. 

If you have any questions, please do not hesitate to reach out to Mrs. Kait Ramirez, Program Director, at kramirez@vtsd.com or Mrs. Marianne Amato, Site Coordinator, at mamato@vtsd.com. 


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Student Last Name *
Student First Name *
Student Grade Level *
Parent/Guardian Last Name *
Parent/Guardian First Name *
Parent/Guardian Email *
Confirm Parent/Guardian Email *
2025-2026 Late Bus Information—PLEASE READ CAREFULLY!
What is your child's late bus letter AND cross street? (For example: Bus B, Canistear and Ames Road)  *
Confirm late bus letter AND cross street?  *
I understand that if my child does NOT take the late bus, I must pick my student(s) up from Glen Meadow Middle School no later than 6:00 pm on days they attend CCLC. 

Please type the parent/guardian's first and last name as a signature. 
 *
Approved Guardians for Pick-Up
Please list the first and last names of individuals who are ALLOWED to pick up your student(s). 
Approved Guardian(s) First and Last Names

*Please type the first and last names and use a comma in between. (i.e. John Smith, Joe Smith, Amy Smith)
 *
Permission and Acknowledgements
Please read the following statements carefully.
I grant permission to the Glen Meadow 21st CCLC staff to access my child's Genesis account to get important information such as contact information, medical information, etc. 

Please type the parent/guardian's first and last name as a signature. 
 *
MEDIA CONSENT: I hereby consent to the participation in program-related interviews, the use of quotes, and the taking of photographs or videos of the student named above by the staff in Glen Meadow Middle School’s 21st Century Community Learning Center. I also grant to the Glen Meadow Middle School’s 21st Century Community Learning Center the right to edit, use, and reuse products for non-profit purposes including use in print, on the internet, and all other forms of media. I also hereby release Glen Meadow Middle School’s 21st Century Community Learning Center and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above. *
As a parent/guardian, would you be interested in participating in the Advisory Board? This group meets quarterly throughout the school year and focuses on growing and continuously improving our 21st CCLC program.
*
My child is interested in registering for the following clubs/activities. 

For more information on the listed clubs and activities, please click here. 
 *
Required
What is your child's t-shirt size? (adult sizing) *
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This form was created inside of Vernon Township Board of Education.