Child's Legal Name(Required) Enter your child's legal name (example: Joseph Smith not Joe Smith)
First Name
Last Name
Preferred Name Enter your child's preferred first name (example: Joe)
Preferred First Name
Gender(Required) Address(Required)
Programs(Required) Check the program(s) you would like your child to attend.
First Parent or Legal Guardian First Parent or Legal Guardian(Required)
First Name
Last Name
Living Arrangements(Required) Address(Required)
Phone number to call while child is in our care(Required) Call First
Second Parent or Legal Guardian Second Parent or Legal Guardian Living Arrangements Second Parent or Legal Guardian(Required)
First Name
Last Name
Address(Required)
Phone number to call while child is in our care(Required) Call First
Authorizations Computer and Internet Authorization(Required) Choose yes below to authorize your child to use the computers while attending the Above and Beyond Students program. Students will use computers that are on the CMS and ABS network. Students will have access to the Worldwide Web and their usage will be supervised by the staff of Above and Beyond Students.
By choosing yes, I acknowledge that my child may participate in the activities listed below:
Students will use online learning tools such as I-Ready, A-Z Reading, Raz Kids, and other academic based learning programs as directed by the staff of Above and Beyond Students; Students will have the ability to conduct online research and use computers to prepare projects; Students will work with other students who are using the same network of computers; Students will work with tutors and volunteers to access learning tools, complete homework, work on projects, and use internet for personal enjoyment with adult supervision.
By choosing yes, I am acknowledging that if my child violates or abuses his or her Internet privileges, he or she may be prohibited from accessing the computer during participation in the Above and Beyond Students. If this is necessary, a parent or legal guardian will be notified.
Authorization for CMS to Release Data to ABS(Required) By choosing yes, I authorize Charlotte-Mecklenburg Schools to release the following data for my child to Above and Beyond Students for the purposes of evaluating my child's academic performance. The data will be used to evaluate my child’s academic progress as result of attending the afterschool tutorial program. The data will also be used to determine additional tutorial needs and program support to assist my child in achieving both academic and social success. ABS occasionally utilizes the services of an external evaluator. When an external evaluator is used, all data including name and students ID number will be kept private and remain unidentifiable. The program agrees to comply with all FERPA laws and will use this data internally. Above and Beyond Students will not share my child's data without my prior knowledge or consent. By checking yes, I authorize the release of the following data:
Demographic data (that is, gender, race/ethnicity, grade level, school name); Limited English Proficiency (LEP) Status; Exceptional Children (EC) and/or Gifted (AIG) Status; Course Grades; Standardized test scores, levels, proficiency (that is, beginning, middle and end of year district/state tests); Attendance data, behavior data (suspensions); Promotion/Retention; GPA (High School Students Only); Graduation Status (High School Students Only); Credits Earned and Credits Attempted (High School Students Only); 21st Century Community Learning Center End of Year Feeder School Teacher Survey.
Records Release Authorization(Required) By choosing yes, I authorize (i) Above and Beyond Students (the “Partner”), (ii) Read Charlotte, a component fund of Foundation For The Carolinas ("Read Charlotte"), and (iii) all employees, directors, agents, vendors, designees and contractors of the Partner and Read Charlotte ((i), (ii) and (iii) collectively referred to herein as the “Program”), to collect, test, monitor, assess and record data on my child. This data may include, but is not limited to: Surveys and/or interviews about his/her knowledge, attitudes, skills, and behaviors in regard to his/her academic development such as motivation to read; nonacademic development such as leadership and conflict resolution skills, as well as his/her satisfaction with the Program; Academic assessments managed by the Program; Charlotte Mecklenburg Schools (CMS) student data. By choosing yes, I authorize the Program to gather all information it finds necessary to assist in my child's educational growth and development. I understand that the purposes of obtaining this information is to document the impact of the Program on its participants and to identify areas for improvement. I also understand that this information will remain confidential and that only the Program will have access to his/her responses. I also understand that my child's responses will be automatically grouped together with the responses of other Program participants for any public presentations of their findings and that my child will not be individually linked to his/her responses.
By choosing yes, I authorize Charlotte-Mecklenburg Schools to release student data for my child to the Program. Such information may include, but is not limited to, the following: demographic data (name, gender, race, ethnicity, grade level, date of birth, school name), Limited English Proficiency (LEP) status, Exceptional Children (EC) and/or Gifted (AIG) status, course grades, standardized test scores, levels, proficiency (beginning, middle and end of year district and state tests), attendance data, behavior data (suspensions), promotion/retention, GPA, graduation status, teacher and school administrator assessments, credits earned and credits attempted.
Information Release Authorization(Required) Since the ABS 21st CCLC program is federally funded, it is necessary for ABS to give data to the NC DPI 21st CCLC Educational Consultant. This information includes attendance records, test scores, class grades, and other student data. Only group information will be reported and will not include your child's name. Children can attend the ABS 21st CCLC program even if you do not authorize us to release data. This data helps us to continue to receive funding and develop community partnerships.
Image Authorization(Required) By choosing yes, I grant Above and Beyond Students the unlimited right to use and to reproduce photographs, videos, likeness or the voice of my child in any legal manner, for the internal and external promotional website and informational activities of Above and Beyond Students 21st CCLC. I also agree to allow my child to be interviewed, photographed, and videoed by representatives of the external news media, and in relation to any and all coverage of Above and Beyond Students in which he or she is involved. I also agree to allow my child's work, photograph, and video to be published on the Above and Beyond Students News Board, brochures and website. I further understand that by checking yes, I waive any and all present or future compensation rights to the use of the above stated materials. I also agree to have testimonial statements of my child used and reprinted for promotional and informational purposes to promote Above and Beyond Students.
Medical Information Allergies(Required) If your child is at risk of serious allergic reactions, you will be asked to submit an Allergy and Anaphylaxis Emergency Plan completed by your child's physician.
Current Medications(Required)
Medication Authorization(Required) By choosing yes below, you agree and understand that In order to help protect your child's health, your consent and written authorization from a licensed healthcare provider are required when it is necessary for your child to receive either prescription or non-prescription medicines while attending the Above and Beyond Students programs. No medications will be given to your child at school until this authorization has been received. A separate form is required for each medicine. New authorization forms are required every year at the beginning of each program year, whenever the dose or directions change, or when a new medicine is prescribed. It is your responsibility to provide all medicines to be given while your child is attending the program. Each medicine must be in an appropriately labeled original container from the pharmacy or healthcare provider's office. Most pharmacies will provide an extra container for school use upon request. A completed authorization is also required for the administration of non-prescription medicines at school. A medication authorization form will be provided to me during my first in-person meeting with ABS staff, and it is my responsibility to complete and return it.
Emergency Medical Authorization(Required) Emergency medical authorization: I authorize the child care center to obtain medical care for my child in the event of a medical emergency. The center will provide transportation to an appropriate medical resource. Other children in the facility will be supervised by a responsible adult. The center will not administer any drug or any medication without specific instructions from the physician or the child's parent, guardian, or full-time custodian
I agree and consent to the Emergency Medical Authorization.
Special Needs(Required) Explain any special medical, physical limitations, allergies or school IEPs/504 plans that we should be aware of. This information will not disqualify your child from program, but will help us better serve your child.
Medical Action Plan(Required) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a Medical Action Plan shall be provided to the center. The medical action plan must be completed by the child's parent or health care professional. Does your child require a medical action plan?
Required Health Forms(Required) North Carolina 10A NCAC 09.3005 requires that you provide us with a Child's Medical Report and Immunization Record completed and signed by a licensed physician, his/her authorized agent currently approved by the North Carolina Board of Medical Examiners (or a comparable board from bordering states), a certified nurse practitioner, or a public health nurse meeting DEHNR standards for EPSDT program.
A separate dental screening must also be provided. The Dental Screening Form must be completed by your child's dentist.
If your child has diabetes, you will need to submit a Child Care Diabetes Medical Management Plan completed by your child's physician.
If your child has asthma, you will need to submit an Asthma Medical Action Plan completed by your child's physician. These forms will be provided by ABS staff during your first in-person meeting.
Student and Parent Contracts Behavior Contract(Required) We are very pleased that you have chosen to enroll in the Above and Beyond Students after school program. To fulfill the ABS mission, it is important that we have the full cooperation of students and parents. The following Behavior Contract will provide guidelines for your students as they participate in the after school program. Students who violate the contract are subject to discipline that may include suspension or dismissal of the program. It is our desire that all students have a successful and safe year. For this to happen, we ask students and parents to read the entire Conduct Agreement and sign the form. If you have any questions, please contact your site coordinator listed in the Parent Handbook. Your signature represents that you have read the Contract of Conduct, understand and accept the contents.
Attendance
I must attend afterschool each day to receive the maximum benefit from the program and participate in the weekly programs.
I must be on time each day for afterschool. I am expected to arrive within 5 minutes of the time I am dismissed from school. We are very pleased that you have chosen to enroll in the Above and Beyond Students after school program. To fulfil the ABS mission, it is important that we have the full cooperation of students and parents for the academic year 2020–2021. The following Behavior Contract will provide guidelines for your students as they participate in the after school program. Students who violate the contract are subject to discipline that may include suspension or dismissal of the program. It is our desire that all students have a successful and safe year. For this to happen, we ask students and parents to read the entire Conduct Agreement and sign the form. If you have any questions, please contact your site coordinator listed in the Parent Handbook. Your signature represents that you have read the Contract of Conduct, understand and accept the contents.
Attendance
I must attend afterschool each day to receive the maximum benefit from the program and participate in the weekly programs.
I must be on time each day for afterschool. I am expected to arrive within 5 minutes of the time I am dismissed from school.
Parental Partnership Agreement(Required) The ABS 21st CCLC program is a federally funded program designed to provide academic and cultural programming for students in an after school setting. Family involvement is key to our program and student success. Parent/Guardians must agree to support the total program by promoting academic, enrichment, and social components of the program.
Parents may support their students by participating in parent-teacher conferences, workshops, parent meetings, and other ABS 21st CCLC functions. Below outlines the commitment we ask each parent to make as a part of their child participating in the ABS 21st CCLC:
As a parent I agree to the following:
Require my child to obey all school and ABS 21st CLCC program rules
Insure that my child attends all ABS 21st CCLC programs on a regular basis
Attend Family Night programs offered by ABS
Participate in Family Literacy activities that ABS provides for my student
Review my child's homework and sign any forms sent home each week
Attend parent conferences as requested
Communicate with staff and other program related representatives in a timely and professional manner
Volunteer at least 1 hour per month (this can be in the form of donations to the program, soliciting employer, friends, and/or co-workers to support ABS)
Provide accurate contact information and update the information as it changes.
Transportation Transportation Preferences(Required) As an ABS 21st CCLC participant, your child has several options for transportation. Please choose the preferred option for your child.
Consents Handbook and Discipline Policy(Required) I will review and comply with the center's handbook and discipline policy that will be provided to me during my first in-person meeting with ABS staff..
Summary of the NC Child Care Law and Rules(Required) I will review the Summary of the North Carolina Child Care Law and Rules for Child Care Centers that will be provided to me during my first in-person meeting with ABS staff.
The information I provided is accurate(Required) I certify that the information I have provided is accurate to the best of my knowledge.
