NY Gear Up After School Registration Form 24-25
Dear Schenectady School District Families,

We are excited to announce that the NY Gear Up Team will be offering academic support and social activities for 9th Graders. Our afterschool program will commence on October 15th and will run daily from 3:30 pm to 5:30 pm at SHS. Transportation is not guaranteed. Snack and dinner will be provided daily. 

To ensure we can communicate any program updates effectively, please make sure all contact information is current. Should you have any questions or need further information, please feel free to reach out to Ms. Leah Hall, NY Gear Up Coordinator, at 518-918-6613.

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Student Preferred Name:
Student Name: *
Parent/Guardian Name *
Student ID # 
Telephone Number: *
Student Address: *
Which school does your student attend? *
Email address: *
Which service(s) are you interested in having your student participate in? (check all that apply) *
Required
Method of transportation upon dismissal:  *
Is there anyone that your child should not be released to? (example: custody issues) *
Does your student have any special needs? (Health/Medical, Behavioral, Dietary, etc.) Please specify below *
Briefly explain any additional concerns or goals that you have for your student: *
Do you give your student consent to have their photo(s), videos taken and used for the district website? *
NYS often requires surveys to be completed by NY Gear Up participants to evaluate the effectiveness of services. Surveys are typically anonymous, do you consent to your student participating in the survey? *
I understand that this program is voluntary and my student's continuous enrollment is contingent upon behavior, attendance and active participation in the activities. Final decisions are determined based upon the capacity and discretion of the leaders. *
I understand that Transportation may not be available for my student. (Please contact the Gear Up coordinator for extenuating circumstances). *
There is a 4:30 late bus for qualifying students. These buses have designated corner stops around the city. Your student will have to get off at the stop closest to their home. More information can be provided upon request. Will your student need to take the 4:30 bus? *
Gear Up is dedicated to your student's success. We are tracking and monitoring their progression towards their academic success. Other than student names and grades, no other information is shared to the NYS database. By answering this question, you acknowledge your understanding of how your student's information is used. *
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