2018-2019 CCLC Enrollment
BY SUBMITTING THIS FORM YOU ARE AGREEING TO THE FOLLOWING:
> I give my permission for my child to be enrolled in CCLC for the 2018-2019 school year. > I give my permission for CCLC staff to transport my child or children for the purpose of medical care or to attend club activities, field trips, or other activities. > I understand that CCLC does not carry health and accident insurance for my child or children and that I, as a guardian, will be primarily responsible in case of injury where bills are incurred (this is the same policy for Crete Public Schools). > CCLC follows the Crete Public Schools Medication Policy. Copies of the CPS Medication Policy are found in the office of all school locations and the CPS administration building. > I understand the CCLC staff may use any photographs, writings, artwork, etc. for the purposes of presentations, documentation, or promotional materials. > I understand that my child may be dismissed from CCLC for failure to follow rules, failure to follow general operation procedures, and/or failure to participate. As the parent/guardian, I will work as a partner with the CCLC staff to ensure my child is successful in the program. > I understand as the parent/guardian, that I am responsible for picking up my student by or before 6pm each day. The authorities will be notified if students are left on school premises after the site closes (6pm for Elementary, Intermediate, and Middle Schools; 8:30pm for High School) > I understand that CCLC policies and procedures are found in the CCLC Parent/Student Handbook and are available on the CPS website, in each office, or upon request. > I understand that if any changes occur to the students’ information, it is my responsibility to notify the correct CCLC program to update those changes.
Student Name (first and last) *
Your answer
2018-2019 Grade *
Please list any allergies or medical conditions.
Your answer
Please list any emergency contacts not listed in Infinite Campus.
Your answer
How will your student get home from CCLC on most days? *
Please list any restrictions you have for how your student will get home. *
Your answer
Electronic Signature:
Please write your first and last name to approve this form.
Your answer
Would you like to volunteer in the after school program? *
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