Aaces Student Registration

 
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 Aaces Student Registration 

 
  *If registering for Double AAces/Empowering Teens, please ensure that your child will be attending the program for 30 or more days throughout the school year. 21CCLC funding is dependent upon continuous engagement of students. Items denoted with a red asterisk * are required.
   
  Student(s) Information
   
1.
*
  Select Date
mm/dd/yyyy
   
2.
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5.
*
Please Check all that apply.
 
  
  
  
  
   
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  Parent/Guardian Information:
   
  Name
   
16.
*
 

 

 

 
   
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18.
*
If same as Cell please fill number in both areas. (XXX)-XXX-XXXX
 
   
19.
(XXX)-XXX-XXXX
 
   
20.
(XXX)-XXX-XXXX
 
   
21.
(XXX)-XXX-XXXX
 
   
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(XXX)-XXX-XXXX
 
   
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(XXX)-XXX-XXXX
 
   
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  Other Information
   
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26.
*
I give my consent for WCSD#1 to share needed information about my child with Double AAces program staff. This includes: speaking to my child’s teacher, obtaining information from the school nurse, obtaining helpful information about my child/ren from the school counselor, special education teacher(s), IEPs, Title teacher(s) and classroom aides.
 
*
I give my consent for WCSD#1 to share needed information about my child with Double AAces program staff. This includes: speaking to my child’s teacher, obtaining information from the school nurse, obtaining helpful information about my child/ren from the school counselor, special education teacher(s), IEPs, Title teacher(s) and classroom aides.


   
27.
*
I give my consent to the Double AAces program to obtain reporting information on my child that relates to academic and behavioral success. This information is utilized by the Department of Education to ensure continued funding and programming options for the 21st Century Community Learning Centers. All names remain confidential and information is ONLY used to meet quality program objectives and retain funding.
 
*
I give my consent to the Double AAces program to obtain reporting information on my child that relates to academic and behavioral success. This information is utilized by the Department of Education to ensure continued funding and programming options for the 21st Century Community Learning Centers. All names remain confidential and information is ONLY used to meet quality program objectives and retain funding.


   
28.
*
I give permission for my child to be photographed/digital recorded during activities by program staff for publication.
 
*
I give permission for my child to be photographed/digital recorded during activities by program staff for publication.


   
  Transporation Aggreement:
   
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*
 
  
  
  
   
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34.
*
(student name) has permission to participate in the 21st Century Community Learning Center, Double AAces program. My child is given permission to participate in all areas of the Double AAces program. We agree to abide by the rules of WCSD#1 and realize that participation in the program is voluntary and a privilege.
 
   
35.
 
   
36.
*
By checking this, I agree that all the above information is correct and that I am the legal parent/guardian for this child. My child has permission to participate in the 21st Century Community Learning Center, Double AAces program. My child is given permission to participate in all areas of the Double AAces program. We agree to abide by the rules of WCSD#1 and realize that participation in the program is voluntary and a privilege.
 
  
   
37.
*
  Select Date
mm/dd/yyyy
   
 
 
 
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