After School Program Application Name(Required) First Last Date of Birth(Required) Month Day Year Phone(Required)Current Grade(Required)Parent/Guardian Name(Required) First Last CDIB Number(Required)Emergency Contact Name First Last Emergency Contact PhoneFood Allergies(Required)Please enter "no known allergies" if your child does not have any. Other Allergies(Required)Please enter "no known allergies" if your child does not have any. Behavior Plan All participants are expected to be respectful to each other and staff. 'Staff' includes the Anadarko Public School bus driver that brings them to the complex daily. Participants will keep their hands to themselves in order to provide a safe environment for all. No foul language or inappropriate talk. Participants will do what is asked by staff without argument or disrespect. If your child violates guidelines after being verbally redirected, they will be written up. Their write up will be a descriptive explanation of the behavior. You as the parent will be able to review and sign it. This will include when the bus driver has issues. If your child receives three write-ups, they will be asked to stay out of ofter school for five days. After three write-ups, and the five-day suspension, if they receive three more write-ups, they will be asked to stay out of after school indefinitely, and you will need to seek alternative after school care. If it comes to the point where your child is asked to stay out of after school, we would like the opportunity to get them behavioral health services started. This program can assist you with that as well.Signature(Required)
