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After School Registration Form

After School Registration Form
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R.E.A.C.H.

Thompson Falls School District #2

After School Program

Student's First Name
required
Student's Last Name
required
Student's Full Name
Parent/Guardian
required
Mailing Address
required
Physical Address
required
Phone
required
Email
required
Local Emergency Contact OTHER than Parent
required
Relationship to Student
required
Emergency Contact Phone
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REACH ends at 5:00pm. No bus transportation is available. My child will:
required

If this plan changes, contact the office at (406)827-3592 x3.
Walk home.
Be picked up promptly at 5:00pm.
Persons Authorized to Pick Up Student:
Name
Phone

REACH

I understand the REACH program is an after school enrichment program that is federally funded and is offered free of charge to my child and to my family.  I also understand that my child must follow the rules listed below.

Program Rules

  1. Respect self and others.  Fighting will not be tolerated.

  2. Use positive language.  Foul language or other inappropriate language will not be tolerated.

  3. Follow all staff instructions.  Remain in activity area designate by staff.

  4. Students must remain with staff members until parents or authorized pick-up person arrives.  Any other arrangements for getting students home must be made in advance with the Program Coordinator.

  5. Students should take pride in themselves and their environment.  Strive to keep activity areas clean.  Take care of facilities and materials.  Students may be charged for damage to building and/or property.

NOTE:  THE PROGRAM COORDINATOR MAY, AT ANY TIME, WITHDRAW A STUDENT FROM THE PROGRAM FOR ANY OF THE FOLLOWING REASONS:     

  1. Failure to meet appropriate behavior standards.

  2. Refusal to follow program procedures and rules.

  3. Verbal abuse, physical abuse or sexual harassment of students or staff member by student or their parents.

  4. Being in the wrong place or unauthorized departure from a bus or activity site.

  5. Consistent late pick-up.  (Up to 3)

  6. Child's needs cannot be met by the program.

  7. Failure to provide required records

WE HAVE READ AND AGREE TO FOLLOW THE REACH AFTER-SCHOOL PROGRAM RULES.
required
WE HAVE READ AND AGREE TO FOLLOW THE REACH AFTER-SCHOOL PROGRAM RULES.
Parent/Guardian Signature
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Draw your signature in the area above, or use the saved signature button if available.
Date
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