Murphy Creek 22/23- After School Tutoring Enrollment Form
APS received extra Federal funding to support our students. Partnering with Results Learning,  Murphy Creek is excited to offer after school tutoring for our students. The program will run from 2:30-4:15pm, on Tuesdays and Thursdays, starting on September 6th.  If you are interested in this impactful and free opportunity, please completed this form.  
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Student Name (Last name, First name) *
Grade *
Known Food allergies or Dietary restrictions - Please List
Homeroom teacher *
What is your preferred language? *
Parent/Guardian First and Last Name *
The best way to contact me is by *
Required
Phone number *
Email address *
My student will be...
Person(s) allowed to pick up my student - Name and Phone number
Emergency Contact - Name and Phone number *
I authorize my child's school to provide Results Learning with copies of any academic records.
 *
For the safety and well-being of my child, I will arrange transportation for my student to be picked up after the tutoring sessions.  Any individual(s) allowed to pick up my child are listed above
 *
I agree to call the Results Learning site coordinator in the event my child will miss a tutoring session.
Clear selection
If my child misses more than five sessions for any reason, they may be withdrawn from the program.
Clear selection
My child will be picked up on time to avoid a LATE PICK-UP FEE.  Beginning 10 minutes after the end of the daily session, $1.00 PER MINUTE will be charged for each minute past that time
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Results Learning Policy Agreement

The inability to abide by these policies may cause an individual to be suspended or terminated from the program.

Behavior Policy
All students are held to a standard of being respectful and safe to themselves, others, and their environment. Results Learning supports students and staff by maintaining a high standard of safety and respect for property, staff, and students.
Unsafe and disrespectful behavior to themselves, other students/staff, or their environment will not be tolerated. Students may be removed Immediately from the program if they cannot be safe and respectful.
Site Coordinators are required to document behaviors and actions taken with families as needed. Communication of these behaviors must always include the student’s parents/guardians.  

Bullying Prevention
Results Learning is a bully-free program and does not tolerate bullying in any form. Bullying is defined as repeated behaviors where the balance of power is uneven. This can include the use of physical strength, making threats, or distributing embarrassing information. Cyber bullying of students or any employee via any social media platform will also not be tolerated. Students should report any bullying behavior to a teacher, principal, or another staff member immediately.

Inappropriate/Disruptive Behavior
Inappropriate and disruptive behavior disrupts the learning process. This is why Results Learning does not allow such behavior. Swearing, using racial slurs, or using vulgar and obscene gestures are examples of foul language. Disruptive behavior, such as rough play, making loud unnecessary noises, throwing items, or other behavior that interferes with the learning process is also prohibited.

Sexual Harassment
Sexual harassment is defined as unwelcome sexual advances, requests for favors of a sexual nature, or any other physical or verbal sexual communication that is not welcome, hostile, and intimidating. Sexual harassment is taken seriously and will be interpreted in the context of federal and state law. Procedures for investigation will be left to the proper authorities.

Nondiscriminatory Statement
Results Learning does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. These activities include, but are not limited to, hiring and firing of staff, selection of volunteers and vendors, and provision of services. We are committed to providing an inclusive and welcoming environment for all members of our staff, clients, volunteers, subcontractors, vendors, and clients.

Results Learning is an equal opportunity employer. We will not discriminate and will take affirmative action measures to ensure against discrimination in employment, recruitment, advertisements for employment, compensation, termination, upgrading, promotions, and other conditions of employment against any employee or job applicant on the bases of race, color, gender, national origin, age, religion, creed, disability, veteran's status, sexual orientation, gender identity or gender expression. 

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