ASPIRE Plus

 

The ASPIRE PLUS after school program is a fee-based program that runs in tandem at every ASPIRE school site and provides students with a snack, homework assistance, academic enrichment and KidsPlay recreation every school day.  The program is available every school day starting immediately after the school day ends and remains open until 6:00 PM.

ASPIRE Plus programming is also available as a stand along program at any interested school site. For more information about establishing an ASPIRE Plus program at your school site, please contact Leslie Laine at 562-945-0150 or leslie@learnla.org.

Fees for the ASPIRE Plus program are $5 per student per day for a 3-hour program. When your child is dismissed from school early (before 3:00 PM), you have the option to pay double the fee to extend their participation beyond 3 hours, but no later than 6:00 PM.

Payments are accepted (in full or in monthly installments) online below or mailed check or money order, payable to LEARN.


Pay Online
Make Payment

Pay by Check

Please make checks payable to LEARN.
Please mail your check to:

7200 Greenleaf Ave, Suite 300
Whittier, CA 90602

 

Program Sites
  • Cleminson, El Monte
  • Cherrylee, El Monte
  • Gidley, El Monte
  • Legore, El Monte
  • Rio Vista, El Monte
  • Shirpser, El Monte
  • Wright, El Monte
  • Rio Hondo, Arcadia
  • Columbia, El Monte
  • Cortada, El Monte
  • Durfee, El Monte
  • Greenwood, El Monte
  • New Lexington, El Monte
  • Potrero, El Monte
  • Wilkerson, El Monte
  • Greenwood, Montebello

ASPIRE Plus Registration Form


PROGRAM INFORMATION 

Program Guidlines 

• The first day of the program will be the first day of school in August, 2016 and will continue until the last day of school in June, 2016, as long as there are enough students enrolled to secure the required staff. • ASPIRE PLUS students are not held to any strict attendance or early release policy requirements. • The Student Code of Conduct enforced during the school day at your child’s school will also be enforced during the after school program and students may be dropped from the program for unacceptable behavior. • Students may travel in order to participate in off-site field trips and/or KidsPlay sports leagues and parents/guardians will receive sufficient advance notice and schedules of such off-site activities. • One of the parents/guardians is required to attend a Parent Orientation at the beginning of the school year. Failure to attend will result in your child’s dismissal from the program. The ASPIRE Site Coordinator will announce dates early in the school year for your child’s school.

Equal Opportunity

LEARN is an Equal Opportunity Non-profit Organization committed to providing all employees and program participants an environment free of discrimination and harassment regardless of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.

 

STUDENT INFORMATION

What school will your son/daughter attend during the 2017-18 school year?:   

Have you already enrolled your son/daughter for 2017-18 school year at th e school you selected above?:   

Student Name:   

Gender:   

Grade:   

Date of Birth:   

Age:  

Student Address:   

Home Phone Number:   

Mobile Phone Number:   

Student Email:   

 

PARENT/GUARDIAN INFORMATION

Parent/Guardian #1 Name:   

Parent/Guardian #1 Address:   

Parent/Guardian #1 Home Phone Number:   

Parent/Guardian #1 Mobile Phone Number:   

Parent/Guardian #1 Email:   

Parent/Guardian #2 Name:    

Parent/Guardian #2 Address:   

Parent/Guardian #2 Home Phone Number:   

Parent/Guardian #2 Mobile Phone Number:   

Parent/Guardian #2 Email:   

 

STUDENT HEALTH HISTORY & INFORMATION

Medications – If your son/daughter is required to be administered medication during program hours, an “Authorization to Medicate” form must be completed and submitted to LEARN. The form requires the physician’s signature. If you list any medications here, you will be emailed a printable copy of the form. A paper copy of this form can also be obtained from the Site Coordinator. Please follow the completion instructions on the form. : 

Medications:  

Medical Conditions:  

Allergies: 

Primary Care Physician’s Name:   

Primary Care Physician’s Phone Number:   

Health Insurance or Health Plan Provider:   

Health Policy/Plan Number of Member ID:   

 

EXPLANATION OF FEES

• Please note that fees and program regulations are reevaluated on an annual basis and may be subject to change. • The ASPIRE PLUS program is a fee-based program with a nominal, monthly fee of approximately $100 per student. The fee will vary month-to-month, based on the number of program days of operation. The program begins immediately at the time of your child’s dismissal from school. The cost for the first 3 hours of program is $5.00. An additional $5.00 extends the program beyond 3 hours, but no later than 6:00pm. Fees may be subject to change after July 1, 2016. • If your child joins the program in the middle of the month, we will prorate the fees for the first month of enrollment only. Fees may be subject to change after August 1, 2017 • Any pickup after 6:00pm is considered late and is subject to a $1.00 per minute late pick-up charge that accrues for every minute after 6:00pm until you pick-up your child. • NO REFUNDS will be given for any hours or days unattended within a service month.

 

INDICATE PREFERREDHOURS OF PARTICIPATION IN THE PROGRAM 

In order for us to best serve your son/daughter in the program, please indicate the hours you regularly want your child to participate in the ASPIRE PLUS program. Remember that any day your child stays beyond the standard 3 hours will be charged at double the daily rate, and that if you do not pick up your child before 6:00 PM, you will be charged a $1 per minute late fee for every minute after 6:00 PM until you pick-up your child.

Monday Start:   

Monday End:   

Tuesday Start:   

Tuesday End:   

Wednesday Start:   

Wednesday End:   

Thursday Start:   

Thursday End:   

Friday Start:   

Friday End:   

 

AUTHORIZATION FOR RELEASE OF STUDENT

Students in Grades TK – 5 will not be released to walk home at program-end and must be picked up by an Authorized Adult listed on this form. Students in Grades 6 – 8 may be released to walk home at program-end if a parent/guardian authorizes LEARN staff to do so. Such authorization must be provided on this form.

Initials of Parent/Guardian – My son/daughter is in Grade 6, 7 or 8 and therefore eligible to be released to walk home alone with my written authorization. My initials below authorize LEARN personnel to release my son/daughter when the program ends so he/she can walk home alone. If this field is left blank and/or my initials are not listed below, I understand that my son/daughter will NOT be released to walk home alone at program-end. : 

 

AUTHORIZED ADULTS 

LEARN will include the names of both parents/guardians listed on this Registration Form as Authorized Adults in the student information system. LEARN will only remove a parent from the student information system with a legal document that instructs that action, such as valid court documentation that restricts a birth parent’s access to a child. The parent or legal guardian of a student must authorize any other adults they will permit to take physical custody of their child when picking them up from the program. Such authorization must be provided on this form. All authorized adults will be entered into the student information system as being approved by the parent/legal guardian. Only the parent/legal guardian may request changes to the list of authorized adults in the student information system. Authorized adults must produce valid, unexpired, photo identification to LEARN staff. Adults who are not able to produce valid identification will not be allowed to pick-up a student from the program, regardless of whether the adult’s name appears on this form or in the LEARN student information system as an emergency contact or authorized person. It is the sole responsibility of the parent/legal guardian to ensure that LEARN has the correct information for Emergency Contacts and Authorized Adults.

 

EMERGENCY CONTACT 

Adults other than a parent/guardian must be listed as emergency contacts below.

Emergency Contact #1 – Name:   

Emergency Contact #1 – Home Phone Number:   

Emergency Contact #1 – Mobile Phone Number:   

Emergency Contact #1 – Relation to Student:   

Emergency Contact #2 – Name:   

Emergency Contact #2 – Home Phone Number:   

Emergency Contact #2 – Mobile Phone Number:   

Emergency Contact #2 – Relation to Student:   

 

ADULTS AUTHORIZED TO PICK-UP STUDENT 

Students in Grade TK – 5 will only be released to an authorized adult (over 18 years of age). The Authorized Adults must be listed below.

Authorized Person #1 – Name:   

Authorized Person #1 – Phone Number:   

Authorized Person #1 – Relation to Student:   

Authorized Person #2 – Name:   

Authorized Person #2 – Phone Number:   

Authorized Person #2 – Relation to Student:   

Authorized Person #3 – Name:   

Authorized Person #3 – Phone Number:   

Authorized Person #3 – Relation to Student:   

 

PROGRAM DESCRITION & GUDELINES

I understand that my child must attend the ASPIRE program EVERY DAY, Monday – Friday, for the entire duration of the program, from end of school day until 6PM.  I understand that my child may be dismissed from the program for excessive absences, tardiness or inappropriate behavior.  I am also aware that the program ends at 6:00 PM and if my child is picked-up after that time, my child will receive a “Late Pick-Up Warning Form.”  If a student receives three (3) Late Pick-Up Warning Forms, he/she may be asked to leave the program.

 

CONSENT TO USE OD VIDEO OR PHOTOGRAPHY 

I understand that LEARN personnel may photograph and/or film my child during the program and I hereby consent to use of these photographs/video in LEARN’s ASPIRE promotional material.

 

LIABILITY WAIVER

I hereby waive all claims against my child’s school district, LEARN and its employees for injury, accident or illness occurring by reason of participation in ASPIRE. In case of an emergency, I authorize and licensed physician or hospital to render such medical aid as may be deemed necessary and/or desirable. Any cost/liability incurred for such treatment shall be my sole responsibility.

 

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Signature Certificate
Document name: ASPIRE Plus Registration Form
Unique Document ID: abb08b70f4754da820e5805f495155ae61ab6a02
Timestamp Audit
2017-06-16 14:57:20 PDTASPIRE Plus Registration Form Uploaded by Brenda Carrillo - brenda@learnla.org IP 172.249.205.110
2017-06-20 11:38:22 PDT Document owner dallas@learnla.org has handed over this document to brenda@learnla.org 2017-06-20 11:38:22 - 172.249.205.110