Charter-After School Academic Activities
Registration For- (K-8th) Whitmore Charter
2018-2019 School Year
Please submit a separate form for every student you wish to enroll
Please use a blue or black ink pen when completing this form
Student’s Name Grade School d
Address City Zip Code d
Parent/Guardian’s Name Home Phone Work Phone d
Parent/Guardian’s Name Home Phone Work Phone d
The following are adults whom I authorize to pick up my child or be called in an emergency. Photo identification
will be required
Emergency Contact’s Name Phone Relationship d
Emergency Contact’s Name Phone Relationship d
d(Infinite Campus contacts will be used- photo I.D. will be required-for additional space please use other side of form)
Please note any medical conditions that your child may have:
Is there a current court order on file? ⎸ No ⎸ Yes If yes, please provide a copy for the C-ASAA program. If there are
changes, please provide copies to the C-ASAA site supervisor.
⍅ My child will be picked up ⍅ My child will be allowed to walk home
The C-ASAA program starts immediately after school and ends
at 6 p.m.
C-ASAA Rules and Discipline Policy
Expectations All steps are documented and Parent will be notified
Follow all regular-day school Step 1 = Verbal Warning
rules and procedures at all Step 2 = Written Warning
locations (bathroom, cafeteria, Step 3 = Student suspended from program for 1-5
classroom, playground.) days
Follow directions the first time Step 4 = Student suspended from program for 1-5
given from staff. days
Keep hands, feet, and objects Step 5 = Student suspended from program for the
remainder of the session
to self.
Speak respectfully to others
Session schedule: August to December & January to June
and staff. **If student is removed from program during first session, they
will return in Jan. on 3rd step.
Note: We reserve the right to skip disciplinary steps depending on the
severity of the action.
I have read the information and give my student permission to participate in the program. I have read and agree to
comply to the standards and procedures described above.
Required: Parent/Guardian Signature: Date: