Sharks Until Dark Enrollment Form 2018-19
Enrollment: This program is open to Sherman Elementary students in Kindergarten to 5th grade. Enrollment priority is granted first to incoming kindergarteners and families who are new to the school. Next, we will re-enroll current after-school participants. Finally, we hold open enrollment based on teacher recommendation and then first come, first serve.

Program Components: Every semester, Sharks Until Dark provides high quality enrichment developed by our program staff. Classes usually include Healthy Cooking, Fine Arts, Drama, Dance, Physical Education, Literacy or Digital Arts, Music, and Gardening. Each student will have a chance to take all of our enrichment classes throughout the year and will also have the chance to choose into other exciting courses on Fridays. Additionally, we focus on academic success by providing Homework Support, Math games, and more! And most importantly, we provide our students a safe space to make friends, become leaders, and have fun!

Hours of Operation: The Sherman After School – Sharks Until Dark (SUD) program will begin the first day of school and will end on the last day of school. The program operates everyday school is in session. The Board of Education has approved the instructional calendar for the 18-19 school year. As part of the calendar, schools will be CLOSED the week of Nov 19th (Thanksgiving week). Depending on need, after school program services may be offered for two days. Additionally, SUD will be CLOSED for two days out of the school-year for staff professional development. These dates are TBD and will be communicated with families a month in advance. SUD begins immediately at the end of the school day and ends at 6:00 pm. After 6:05pm SUD charges a dollar a minute for late pick-up. All staff leave the building by 6:30pm, 7 at the latest. After 7pm, if a child is still at school, the police will be contacted.

Fees: All fees, including scholarship fund, will help ensure that Sharks Until Dark provides adequate supplies, enrichment materials, staff appreciations, professional development opportunities, and other valuable resources to support our high quality after school program. This fee will be collected at the time of registration. We accept cash or check for the registration fee payment. No student will be denied from program due to inability to pay. If you have questions about fees, please contact the site coordinator.

Fees Due & Due Dates:
A Registration Fee of $125 per application will be collected with Enrollment of all new families not on scholarship.
All monthly fees will be due on the first of the month and the first monthly fee will be due September 1st
All payments and fees are non-refundable

Please make checks payable to: Sharks Until Dark Under the memo line write: SUD & child name(s)
Any checks should be mailed to 171 Carlos Drive, San Rafael 94903 attn: Leah O'Neil
Fees can also be paid through paypal, directions will be sent along with confirmation email

Waitlist: If you fall on a waitlist, you will be notified and applications will be accepted without fee until a space becomes available. You will be immediately informed once space becomes available via your preferred method of communication at which which point a registration fee and monthly payment will need to be submitted.

You will receive confirmation of enrollment by or before late June.

Please let us know if you have any further questions by emailing Program Coordinator, Bel Olivar, at bolivar@bacr.org or by calling 209-914-7164

Student and Family Information
Is your child *
Student Full Name *
Your answer
Student Grade in 2017-18 *
Your answer
Date Of Birth *
Your answer
Age *
Your answer
Gender *
Your answer
Race / Ethnicity *
Required
Home Language *
Required
Does your child have a sibling(s) that will attend the after school program? *
Please name them.
Your answer
What is the level of English fluency for your child? *
Parent / Guardian 1 Name *
Your answer
Address *
Address/City/Zipcode
Your answer
Phone Number *
HOME
Your answer
Phone Number *
CELL
Your answer
Email Address *
Your answer
Parent / Guardian 2 Name *
Your answer
Address *
Address/City/Zipcode
Your answer
Phone Number *
HOME
Your answer
Phone Number *
CELL
Your answer
Email Address *
Your answer
In the case of separation or divorce, does the non-custodial parent have permission to pick up the child?
Does your family qualify for fee reduction based on your documented free and reduced lunch from the school? *
Emergency Information
It is important that you list 3 emergency contacts other than parent's/guardians in the event that we can not contact you during an emergency with your child.
Emergency Contact and Authorized Pick-up (other than guardian) 1 *
name/relationship/phone
Your answer
Emergency Contact and Authorized Pick-up (other than guardian) 2 *
name/relationship/phone - REQUIRED
Your answer
Emergency Contact and Authorized Pick-up (other than guardian) 3 *
name/relationship/phone - REQUIRED
Your answer
Medical Information: Health Insurance Provider *
Name / Policy Number / Physician / Phone number
Your answer
Does your child have any medical condition? (allergies, asthma, heart condition, seizures, diabetes, hearing or sight loss, etc) *
please explain
Your answer
Does your child take any medication during the day? *
Services are provided to students of all abilities. Should your child need reasonable accommodations, please notify the program coordinator at least 30 business days in advance of program start. Does your child need reasonable accommodations? *
Please Explain
Your answer
Does your child have a 504 or IEP *
Is there anything else you would like us to know about your child? *
Please Explain
Your answer
Program Fees
Program Monthly Fees (Please select one) *
Note - Program Fees have increased in order to improve the quality of program. Families on free and reduced lunch can qualify for a scholarship. We are asking scholarship families to contribute the equivalent of $1/day to support program quality. Please contact the site coordinator with any questions.
New student registration fee $125 *
Authorizations
Upon acceptance, I give my child permission to participate in BACR’s After School Programs. I also give permission for my child to leave campus with his/her teacher to walk within a 1 mile radius of the school without an additional field trip form Upon acceptance, I give my child permission to participate in SUD's After-School Programs. I also give my child permission to attend field trips in SUD's After-School Programs. I also give permission for my child to leave campus with his/her teacher to walk within a 6 block radius of the school with-out an additional field trip form. *
Please initial below if you give permission.
Your answer
I give BACR permission for my child to be photographed, videotaped, and/or audio taped for the purposes of students’ learning and/or publicity for the program. I give permission to BACR to use materials, including, but not limited to, brochures, fliers, and press releases to the media *
Please initial below if you give permission.
Your answer
I authorize BACR and the SFUSD or any third party it has approved to photograph or videotape my child during After School Program activities and to edit or use any photographs or recordings at the sole discretion of BACR and SFUSD. I understand that I and my child shall have no legal right or interest arising from the recording, including economic interest. I also agree to release and hold harmless BACR and the SFUSD and any third party it has approved from and against all claims, demands, damages, and liabilities arising out of or use of the recording. *
Please initial below if you give permission.
Your answer
I understand the nature of the After School Program and that participation is voluntary. I understand that BACR and the San Francisco Unified School District are not responsible for loss, damage, illness, or injury to person or property as a result of participation in the After School Program. I hereby release and discharge BACR and the San Francisco Unified School District and its officers, employees, agents, and volunteers from any and all claims for injury, illness, death, loss or damage as a result of After School Program activities. *
Please initial below if you give permission.
Your answer
Electronic Signature
I hereby certify that, to the best of my knowledge, the above statements in this form are true and correct. I understand this information is subject to verification only by authorized officials *
Please initial below if you do.
Your answer
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