Albany High School 21st Century Community Learning Centers After School Program Registration Form
The Albany High School 21st Century Community Learning Centers After School Program is run in collaboration with district staff and various diverse community partners to provide your student with access to high quality, engaging academic support and enrichment programs driven by student needs and interests.

The program will be held Monday through Thursday at no cost and hours will vary depending on the activity. The program provides:
- Tutoring in Math, Science, English and Social Studies
- Enrichment programs include Anime, Culinary, Cosmetology, Barbering, Falcon Council, Gay Straight Alliance, Music Composition and Sound Recording, Health Sciences, Girls in STEM, Chess, Photography, College and Career Readiness, BGC Lyricism, Artists as Activists.

Please complete this form with your student if they would like to sign up to participate in the Albany High School 21st Century Community Learning Centers After School program.


Email address *
Student's Full Name *
Student's School ID Number *
Student's Academy *
Parent/Guardian's Name *
By completing this form and checking the box below, you are giving permission for your student to participate in 21st Century Community Learning Centers After School in-person or virtual programs. *
Required
Parent/Guardian's Email Address *
Parent/Guardian's Phone Number *
Emergency Contact's Name *
Emergency Contact's Phone Number *
Data Collection – Parent/Guardian Permission - Students may be asked to participate in a voluntary and confidential survey to assess student opinions of the after school program. We are required by law to report any information concerning suicide, homicide, child abuse or neglect. Data such as report card grades, state test scores and demographic information are required for an Annual Performance Report. This information is used to measure program success. I understand the above description for the survey and data collection and agree to allow the use of my child’s information for data collection purposes. *
My child has special needs and I have listed them below. *
My student would like to sign up for the following 21CCLC after school ACADEMIC programs and I agree that the instructor or site coordinator may contact them.
Virtual Credit Recovery (Online Learning)
Tutoring
My student would like to sign up for the following 21CCLC after school ENRICHMENT programs and I agree that the instructor or site coordinator may contact them.
Enrichment
Enrichment
Enrichment
Enrichment
Enrichment
Enrichment
Enrichment
Enrichment
Enrichment
Enrichment
Enrichment
Enrichment
Enrichment
Enrichment
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