TLC Spring 2025 Afterschool Clubs & Summer SOAR Application

TLC Spring 2025 Afterschool Clubs & Summer SOAR Application
Thank you for taking the time to complete this application and carefully read the updates within it.

Kinder-5th grade clubs will take place at CES, JES and MMES. With the exception of students from outlying schools, we will not mix students from different schools at any site. Therefore, students will remain at their school for all TLC afterschool clubs. Students from outlying schools are welcome to apply to clubs taking place at JES.

Through our partnership with TCSD, we will once again be able to provide an Activity Bus to bring students from MMES to CES after TLC clubs this spring. Please note if you are interested in your student(s) riding the Activity Bus on your application. Activity Bus spaces will be limited and will be filled according to lottery status. If a space is available for your student(s), we will reach out to invite you to take the space(s) and provide the next steps needed to do so. If your child is granted a space on the Activity Bus, you must notify instructors by 2:00pm day-of with any pickup related changes.

Important Updates for the Spring 2025 Club Session & Summer SOAR Program:

1. The application will close on Febuary 23rd. Any families who apply after Febuary 23rd will be automatically waitlisted.

2. We will notify families of enrollment or waitlist status on March 6th. All notifications will be sent via email. Families are required to respond to the email to accept their club space(s).

3. Club will run from Monday, April 7th until Thursday, May 29th. If your student is likely to miss two or more clubs due to scheduling conflicts, for example, other clubs, sports, etc., we ask that you do not apply for the spring session. This is in an effort to prioritize students who can attend the full duration of club.

4. Completing this application does not guarantee a space in our clubs on one or more days.

5. Please note that this application is for both our Spring Clubs and for our Summer SOAR Program.
- Summer 2025 programming will be 8 weeks and includes both TLC SOAR (6 weeks) and TCSD Summer Programming (2 weeks).
  - 8 weeks of free, full-day programming from 9:00am - 4:30pm
  - June 23rd - August 14th
- Please only apply to this summer programming if you can commit to all eight weeks of programming!
- Notifications for acceptance into our Summer SOAR & TCSD’s Summer Programming will be sent on Tuesday, March 18th.

Participant Information
Student Name*

First NameLast Name
Gender*

M-MaleF-FemaleO-Other
Race*
Ethnicity*
Birth Date (MM-DD-YYYY)*

MonthDayYear
Date
Grade 2024-2025*
School Attending 2024-2025*

Shared Information Consent
This authorizes Teton Literacy Center and Teton County School District #1 to share written or verbal information regarding my child’s academic performance, diagnosis, history, including medication, progress, psychological and educational testing, medical and legal information, social welfare and rehabilitation, reports and other materials that are relevant to my child's care. I give my permission for the staff of Teton Literacy Center, this 21st CCLC program with services located at Teton Literacy Center, Munger Elementary School, and Jackson Hole Middle School to review my child’s academic and behavior progress reports or their report card in order to document growth and progress in my child during his/her time in this before/after school or summer program. This includes attendance, academic performance, teacher surveys and information about whether my child has an identified exceptionality, an Individual Education Plan or Academic Improvement Plan, and suggestions from my child’s teacher(s) on how my child can best be helped in the program. TLC will send Wyoming Department of Education grade reports from your child’s teacher using WISERID numbers where data will be aggregated at the state level to protect your child’s identification. This data is collected to evaluate the effectiveness of TLC programs.

I understand that my records are protected under the laws regarding confidentiality, and cannot be disclosed without written consent, except in specific situations. This consent is valid throughout my child receiving services at Teton Literacy Center.
Signature*

Clear

Family Information
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Language Spoken at Home*

EnglishSpanishBothOther
In what language(s) would you prefer to receive communications from Teton Literacy Center? (These include newsletters, text messages, phone calls and letters home)*

EnglishSpanishEitherOther
1st Parent/Guardian Name*

First NameLast Name
Cell Phone*
Please enter a valid phone number.
Email*
example@example.com
Parent/Guardian Employment Status*
Parent/Guardian Work-Company Name
Relationship to Child*
Home Phone*
Please enter a valid phone number.
Work Phone*
Please enter a valid phone number.
2nd Parent/Guardian Name

First NameLast Name
Relationship to Child
Cell Phone
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
2nd Parent/Guardian Employment Status
2nd Parent/Guardian Work-Company Name
Sibling Names and Grades

TLC Student & Family Expectations

Teton Literacy Center's Afterschool Enrichment Clubs and Tutoring Programs are free programs for students that promote school success and student wellbeing in a safe environment. In all of our Programs, we aim to guide student behavior in a positive way through providing examples and modeling desired behaviors as well as offering clear directions, reasoning and consequences. To accomplish the goals of our Programs, we have set out TLC’s expectations for our students and their families. Please take some time to review these expectations with your student before he or she starts our Programs.
Students must be respectful to the staff, volunteers and other students. Students must respect other's physical space, physical safety and feelings. Staff and volunteers must also be respectful of students.

Students and families understand that TLC Programs may include students from different schools and diverse cultures, religions, races, languages and ages. Students must be kind to all and accepting of each other.

The use of culturally, racially or religiously insensitive remarks, mimicry, foul language or profanity is not acceptable at any time and will not be tolerated.

All students and families are expected to know and follow the rules of both Teton Literacy Center and Teton County School District. All Teton County School District rules apply when students and families are in Teton Literacy Center Programs. These rules include playground protocol, wearing shoes at all times, sitting while eating snacks, using “inside voices” and walking in the hallways. These policies are put in place to keep all students safe.

Parents or guardians are responsible for picking up their child on time at the end of the program. Parents or guardians are also entirely responsible for arranging the student’s transportation to and from Programs.

Students must remain at their assigned locations for program activities until a parent or guardian signs them out or gives written permission for them to leave. If there is a change in pick-up plans – such as a student needs to leave early, will be picked up by someone else, or needs to walk home – their parent or guardian must notify instructors prior to 2:00 pm.

Students and families understand that there will be consequences for disruptive or dangerous behaviors, or for repeated violations of the rules set out here. The consequences, which are entirely at TLC’s discretion, will depend on the severity and persistence of the student’s behavior.

If there is a discipline problem, the TLC teacher will fill out a “Refocus Form” or “Incident Report,” depending on the severity of the problem. Parents or guardians will be notified in writing of the problem. TLC may schedule a family meeting. If the student persists in misbehaving after the family meeting, TLC may enforce a break in services while the student and family work to build more appropriate behaviors.

Acknowledgement of My Responsibilities as Parent or Guardian

I have read and understood the policies and procedures listed above and agree to comply with them. I have also reviewed these policies and procedures with my child. I understand that if my child or I fail to comply with these policies and procedures my child may lose his or her funded space within this program.
Signature*

Clear

For Out-of-School and Afterschool Programs: Acknowledgement and Assumption of Risk; Release and Waiver of Liability; and Indemnity and Hold Harmless (Acknowledgement and Release)
Scope of Acknowledgement and Release: Teton Literacy Center (TLC) provides out-of-school programs at its own facilities, at facilities that it rents from the Jackson Hole Community School, and at the facilities of organizations with which it collaborates, such as the Jackson Hole Children’s Museum and History Jackson Hole. TLC also provides afterschool programs at various Teton County Public Schools. I understand that all of these facilities, programs, and partner organizations are covered by this Acknowledgement and Release, and that TLC is defined in this Acknowledgement and Release to encompass all of these facilities, programs, and partner organizations.

Acknowledgement and Assumption of Risk: I understand that my minor child’s participation in TLC’s out-of-school and afterschool programs is voluntary and that my child and I are free to choose not to participate. I understand that participation in voluntary out-of-school and afterschool activities includes risks, including risk of injury or illness that may range in severity from minor to disabling to catastrophic including even death. Although serious injuries are not common in out-of-school and afterschool programs, I understand that it is impossible to eliminate all risk. I acknowledge the existence of this range of risks, and knowingly and voluntarily assume them for myself and on behalf of my child.

Acknowledgement that My Child’s Participation is at TLC’s Discretion: I understand that my child is allowed to participate in TLC’s programs entirely at TLC’s discretion. My child has no right to participate. TLC may stop offering a program, change a program, remove my child from a program, change its rules and procedures applicable to a program, enforce its rules and procedures applicable to a program, impose conditions on my child’s participation in a program, change facilities, change partner organizations, and the like, entirely at its discretion.

Release and Waiver of Liability: I understand that TLC, as well as its employees, officers, contractors, directors, agents, and volunteers, including without limitation any employees, officers, contractors, directors, agents, and volunteers of partner organizations, will not be liable for personal injuries, accidents, illness, my reliance on TLC’s programs, emotional distress, or property damage, of any kind or degree, in connection with my child’s participation in such activities, including without limitation those arising from negligence.

Indemnity and Hold Harmless Agreement: On behalf of myself and my child, I agree to release, hold harmless and indemnify TLC, as well as its employees, officers, contractors, directors, agents, and volunteers, including without limitation any employees, officers, contractors, directors, agents, and volunteers of partner organizations, from any loss, cost, damage, or expense, of any kind or degree, including without limitation all attorneys’ fees, costs, and dispute resolution expenses, which I or my child may have, directly or indirectly, in connection with my child’s participation in such activities.

Knowing and Voluntary Agreement: I have read this Acknowledgement and Release, and understand its terms, and understand that my child and I are giving up substantial rights, including without limitation the right to sue. I also understand that my child and I are giving up substantial rights against TLC’s partner organizations, including without limitation the right to sue. I further understand my right to review this Acknowledgement and Release with advisers of my choice, and I have had the opportunity to do so. I am signing this Acknowledgement and Release freely and voluntarily and intend by my signature to be a complete and unconditional release of liability to the greatest extent allowed by law.

Severability. If one or more part this Acknowledgement and Release is found to be unenforceable or illegal, the unenforceable or illegal part shall be severed from other parts of the Acknowledgement and Release without rendering the remaining parts unenforceable.

Choice of Law and Venue. This Acknowledgement and Release shall be interpreted according to the laws of the State of Wyoming and the venue shall be in Wyoming.
Signature*

Clear
Date*

MonthDayYear
Date

Health History and Permission for Emergency Services

This Form must be filled out by each minor student’s parent or guardian before he or she is allowed to participate in TLC’s after-school programs.
Health Insurance Information
Does the student have medical/hospital insurance?*

YesNo
If YES, please provide the carrier and group #:
Health Information
Name of student’s physician:
Phone # of student’s physician:
Does the student have any physical or mental impairments or conditions that could affect participation in TLC’s activities and programs?*

YesNo
If YES, please describe those impairments or conditions:
Allergies
List all known allergies to medications or drugs:
List all known food allergies, such as nuts, gluten:
List all known allergies to insects and animals, such as insect stings, animal dander:
List any other known allergies, such as environmental allergies like hay fever:
Medications Taken by the Student
Does the student use an epi pen?*

YesNo
Other than or in addition to an epi pen, does the student take medication, including over-the-counter medications or non-prescription drugs, on a routine, daily, or frequent basis?*

YesNo
If YES, please describe below:

This student takes medications on a routine, daily, or frequent basis as follows:
Med #1, dosage, and specific times taken each day:
Reason for taking medication:
Med #2, dosage, and specific times taken each day:
Reason for taking medication:
The student must bring enough medication to last the entirety of their time at TLC programming. The medication must be kept in the original packaging or bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration. The student must coordinate his or her use of medication with TLC staff.
Restriction on Student’s Activities
Describe any physical or emotional limitation or restriction on the student’s activities:
Authorization of Medical Services

I have completed and reviewed this form and attest that the information it contains, including the student’s health history, is correct and complete as far as I know.

I understand that TLC will attempt to reach the responsible parent or guardian at the cell phone number provided above in the event of a serious accident, injury, episode, or other medical emergency involving the student.

I also understand that TLC and its staff may need to obtain or provide first aid or emergency medical or dental services for the student, and may need to do so before TLC is able to reach the responsible parent or guardian identified above.

I hereby grant TLC and its staff full authority to take whatever action it considers appropriate under the circumstances regarding the health and safety of the student, including obtaining emergency medical or dental services for the student. I understand that I am financially responsible to providers of any such medical or dental services to the student, including providers of transportation to those facilities, and that I am also responsible for dealing with my insurance carrier (if any).

I further consent to the transportation of the student to a medical facility, including without limitation in a private vehicle or ambulance.
Signature*

Clear
Date*

MonthDayYear
Date

Authorization and Release: Photos, Recordings, Interviews, Art, Writings
I understand that Teton Literacy Center may, from time to time during its interactions with students and their families, take photographs, conduct interviews, make videos and other recordings, and display or use participants’ artwork and writings, for a variety of institutional, educational, and informational purposes, including marketing and fundraising. On behalf of myself and my minor children, I broadly, voluntarily, and unreservedly (1) authorize Teton Literacy Center and its officers, agents, employees, successors, licensees, volunteers, and assigns (collectively, TLC), to do so, and (2) release TLC from all forms of actions or claims, and all types of redress, compensation, or relief, in any forum or venue, whether in the past, present, or future, arising from or associated with the subject matter of this Authorization and Release.

Consistent with this broad authorization and release, I authorize TLC to take photos and make videos and other recordings of me and my minor children and to and use those images, likenesses, and appearances (collectively, photos) without compensation of any kind to me or my minor children, for any institutional, educational, and informational purpose, including marketing and fundraising. I further authorize TLC to use my name, biography, personal information, data, and event, as well as those of my minor children, in connection with any such uses of the photos on the same terms. I understand and agree to the broad authorization and release outlined here and waive any right or interest that I or my minor children may have, including any right to inspect or approve the photos. My authorization and release, for myself and my minor children, is irrevocable and valid for TLC’s use of the photos in any place, manner, or media. The photos may be used in whole or in part, alone or with other photographs or recordings, and may be blurred or modified. I understand that all right, title, and interest in the photos belongs solely to TLC.
Do you give Teton Literacy Center the photographic rights described above?*

YesNo
If you answered yes to the question above, please sign here.

Clear

Jackson Hole Children's Museum Supplemental Information
Parent/Guardian Names, Employers, Employer Addresses and Phones
Please answer for each parent/guardian in the household.
Emergency Contact Names, Addresses and Emails
List any authorized persons who may pick up your child AND their address and phone number.
Emergency Medical Care
Emergency Medical Care

In the case of an emergency, JHCM will not transport your child. They will call the parents or dial 911 for emergency transportation. JHCM staff will not administer medication during programs other than Benadryl and Epi-Pen in the case of an emergency. If your child requires medication during the program, the medication must be in the original container with doctor's orders for the medications. This includes Epi-Pens. If anything is administered, parents will be notified.

JHCM cannot guarantee a food allergen-free environment. Please provide sunscreen for your child(ren). If not provided, JHCM staff will apply program sunscreen if necessary for outdoor activity.
Doctor's Name and Phone Number
Dentist's Name and Phone Number
Do you authorize JHCM to apply sunscreen provided by the parent or program?

YesNo

*If you are only applying for our Summer programing please DO NOT fill out club application and skip to SOAR application*
Club Registration K-5 Students ONLY

Students will participate in clubs at the school they attend and will meet their TLC teachers in the cafeteria immediately afterschool. Students from outlying schools may sign up for clubs at JES. A reminder: Clubs will run from Monday, April 7th until Thursday, May 29th. If your student is likely to miss two or more clubs due to scheduling conflicts, for example, other clubs, sports, etc., we ask that you do not apply for clubs on that day for the spring session.
JES Students: Pick-up is at 5:00pm outside of JES.

Mondays, JES K-5, Amazing AnimalsTuesdays, JES K-5, Spy Club
CES Students: Pick-up is at 5:00pm outside of CES.

Mondays, CES K-5, Amazing Animals
MMES Students: Pick-up will be in the school at 5pm. For those students riding the Activity Bus, pickup will likely be at 5:10pm at CES. Bus spaces will be limited. Students will be invited to ride the Activity Bus based upon enrollment lottery status and parent/guardian must complete additional paperwork to claim the offered space.

Wednesdays, MMES K-5, Amazing AnimalsThursdays, MMES K-5, Spy Club

MMES Students ONLY

This spring, TCSD and TLC will continue to provide an evening activity bus to bring students from MMES to CES. We are working to be more intentional and equitable with our bus sign-up process to ensure highest need families are served first. Thank you for reading this page carefully.
Important to know:
- All MMES families interested in the activity bus must answer the questions below to apply.
- Activity Bus spaces will be limited and will be filled according to lottery status. If a space is available for your student(s), we will reach out to invite you to take the space(s) and provide the next steps needed to do so.
- Families will be notified of their bus invitation/waitlist status on Thursday, March 6th. All invited families will be required to complete a form in order to accept their space on the bus.
- These students will be automatically placed on the bus at the end of club every single week. If you need to pick up at MMES, you must contact the club teacher prior to 2pm.
- If your student has received a space on the bus and is picked up from MMES more than three times, your space on the bus is subject to be removed. Thank you for understanding we have a lengthy waitlist for the bus!
Would you like to request a space for your student on the bus? Pick-up would be at CES at 5:10pm. Students would not be monitored once they step off the bus.

Yes: my student would need a space on the evening bus in order to attend club at MMES.Maybe: it would be convenient, but I am happy to pick-up my student at MMES.No: I will pick up my student at MMES at 5pm.

TLC Summer SOAR & TCSD Summer Programming Collaboration
TLC Summer SOAR & TCSD Summer Programming Collaboration

SOAR is Teton Literacy Center’s free six-week intensive summer program for students in Kindergarten through 7th grade. In 2025, all TLC SOAR students will also be enrolled in TCSD’s free two-week Summer Learning Program, totaling eight weeks of free summer programming for selected students. This year, TCSD’s Summer Learning Program will consist of two weeks of the nationally renowned Camp Invention program. Camp Invention offers exciting, hands-on challenges meant to spark student curiosity and confidence as students dive into opportunities to imagine, experiment and create!

If accepted, each student enrolled must commit to attending all eight weeks of SOAR and TCSD Camp Invention programming.

This collaborative and intensive summer program will run Monday - Thursday from June 23rd - August 14th. There will be no programs on Thursday, July 3. Both SOAR and Camp Invention will run from 9:00am - 4:30 pm daily.

The SOAR program will be led by and located at TLC. The SOAR program will run from June 23rd - July 31st.

TCSD’s Camp Invention will be located at Jackson Hole Middle School and will run from August 4th - August 14th.

While TLC and TCSD hope to continue partnering together in future years, please note that this collaborative 2025 summer structure is a trial structure and may not be carried forth in future years. All families, including private and homeschool families, are welcome to apply. Program enrollment will be based upon TLC’s weighted lottery system.
I would like to apply for TLC Summer SOAR & TCSD Summer Programming Collaboration*

YesNo

Jetsetter (rising 6th, 7th and 8th graders) Application

Required Essay
Similar to previous years, all students applying to be in the Jetsetter Cabin (rising 6th, 7th and 8th graders) must complete a short essay answering the following question:

*Why do you want to be a Jetsetter this summer? What are you hoping to gain by participating in this program?

This essay MUST be written by the student, and be at least two paragraphs long. Students can also turn a hand-written essay into Ms. Anna or Mr. Victor at TLC. Your student’s application will not be considered complete without this essay.

Essays are due at the same time as all SOAR applications, February 23.
Upload essay here -*Why do you want to be a Jetsetter this summer? What are you hoping to gain by participating in this program?

Cancelof
Potential Interview Invite

Once you finish the application and your student has completed their essays. Students will then be invited to an interview with TLC staff between March 3 and March 13 as the next step in the application process (an invitation for your student to participate in this step will be emailed to you). Assuming completion of their interview, final notifications for rising 6th-8th grade applicants will be sent via email on March 18.
Jetsetter Camping Trip

Students in the Jetsetter Cabin will have the special opportunity to attend an overnight camping trip in partnership with Teton Science Schools in Grand Teton National Park. This camping trip is part of our summer curriculum and students are expected to attend. The exact dates of this trip at to be determined, but will be a Tuesday through Thursday during one of the weeks in the middle of SOAR.
If your student is offered a placement in the Jetsetter cabin, can you confirm their attendance for this trip?*

YesNoMaybe
If you have any questions or concerns about this trip, please feel free to call the TLC office and ask to speak with Anna, Victor or Laura.

We require confirmation by May 1st. Late changes will not be accommodated. Last minute cancellations will jeopardize your student’s future programming opportunities, and a cancellation fee may apply.

Parents will fill out the TSS forms at the parent meeting.
Signature - I understand that I must confirm 'yes' or 'no' for my student's attendance for the camping trip by May 1st. *

Clear

Multiple Student Registration
Do you want to apply for another student?

YesNo

Click submit in order to complete the application.

Participant Information
Participant Name*

First NameLast Name
Gender*

M-MaleF-FemaleO-Other
Race
Ethnicity
Birth Date (MM-DD-YYYY)*

MonthDayYear
Date
Grade 2024-2025*
School Attending 2024-2025*

Shared Information Consent
This authorizes Teton Literacy Center and Teton County School District #1 to share written or verbal information regarding my child’s academic performance, diagnosis, history, including medication, progress, psychological and educational testing, medical and legal information, social welfare and rehabilitation, reports and other materials that are relevant to my child's care. I give my permission for the staff of Teton Literacy Center, this 21st CCLC program with services located at Teton Literacy Center, Munger Elementary School, and Jackson Hole Middle School to review my child’s academic and behavior progress reports or their report card in order to document growth and progress in my child during his/her time in this before/after school or summer program. This includes attendance, academic performance, teacher surveys and information about whether my child has an identified exceptionality, an Individual Education Plan or Academic Improvement Plan, and suggestions from my child’s teacher(s) on how my child can best be helped in the program. TLC will send Wyoming Department of Education grade reports from your child’s teacher using WISERID numbers where data will be aggregated at the state level to protect your child’s identification. This data is collected to evaluate the effectiveness of TLC programs.

I understand that my records are protected under the laws regarding confidentiality, and cannot be disclosed without written consent, except in specific situations. This consent is valid throughout my child receiving services at Teton Literacy Center.
Signature*

Clear

For Out-of-School and Afterschool Programs: Acknowledgement and Assumption of Risk; Release and Waiver of Liability; and Indemnity and Hold Harmless (Acknowledgement and Release)
Scope of Acknowledgement and Release: Teton Literacy Center (TLC) provides out-of-school programs at its own facilities, at facilities that it rents from the Jackson Hole Community School, and at the facilities of organizations with which it collaborates, such as the Jackson Hole Children’s Museum and History Jackson Hole. TLC also provides afterschool programs at various Teton County Public Schools. I understand that all of these facilities, programs, and partner organizations are covered by this Acknowledgement and Release, and that TLC is defined in this Acknowledgement and Release to encompass all of these facilities, programs, and partner organizations.

Acknowledgement and Assumption of Risk: I understand that my minor child’s participation in TLC’s out-of-school and afterschool programs is voluntary and that my child and I are free to choose not to participate. I understand that participation in voluntary out-of-school and afterschool activities includes risks, including risk of injury or illness that may range in severity from minor to disabling to catastrophic including even death. Although serious injuries are not common in out-of-school and afterschool programs, I understand that it is impossible to eliminate all risk. I acknowledge the existence of this range of risks, and knowingly and voluntarily assume them for myself and on behalf of my child.

Acknowledgement that My Child’s Participation is at TLC’s Discretion: I understand that my child is allowed to participate in TLC’s programs entirely at TLC’s discretion. My child has no right to participate. TLC may stop offering a program, change a program, remove my child from a program, change its rules and procedures applicable to a program, enforce its rules and procedures applicable to a program, impose conditions on my child’s participation in a program, change facilities, change partner organizations, and the like, entirely at its discretion.

Release and Waiver of Liability: I understand that TLC, as well as its employees, officers, contractors, directors, agents, and volunteers, including without limitation any employees, officers, contractors, directors, agents, and volunteers of partner organizations, will not be liable for personal injuries, accidents, illness, my reliance on TLC’s programs, emotional distress, or property damage, of any kind or degree, in connection with my child’s participation in such activities, including without limitation those arising from negligence.

Indemnity and Hold Harmless Agreement: On behalf of myself and my child, I agree to release, hold harmless and indemnify TLC, as well as its employees, officers, contractors, directors, agents, and volunteers, including without limitation any employees, officers, contractors, directors, agents, and volunteers of partner organizations, from any loss, cost, damage, or expense, of any kind or degree, including without limitation all attorneys’ fees, costs, and dispute resolution expenses, which I or my child may have, directly or indirectly, in connection with my child’s participation in such activities.

Knowing and Voluntary Agreement: I have read this Acknowledgement and Release, and understand its terms, and understand that my child and I are giving up substantial rights, including without limitation the right to sue. I also understand that my child and I are giving up substantial rights against TLC’s partner organizations, including without limitation the right to sue. I further understand my right to review this Acknowledgement and Release with advisers of my choice, and I have had the opportunity to do so. I am signing this Acknowledgement and Release freely and voluntarily and intend by my signature to be a complete and unconditional release of liability to the greatest extent allowed by law.

Severability. If one or more part this Acknowledgement and Release is found to be unenforceable or illegal, the unenforceable or illegal part shall be severed from other parts of the Acknowledgement and Release without rendering the remaining parts unenforceable.

Choice of Law and Venue. This Acknowledgement and Release shall be interpreted according to the laws of the State of Wyoming and the venue shall be in Wyoming.
Signature*

Clear
Date*

MonthDayYear
Date

Health History and Permission for Emergency Services

This Form must be filled out by each minor student’s parent or guardian before he or she is allowed to participate in TLC’s after-school programs.
Health Insurance Information
Does the student have medical/hospital insurance?*

YesNo
If YES, please provide the carrier and group #:
Health Information
Name of student’s physician:
Phone # of student’s physician:
Does the student have any physical or mental impairments or conditions that could affect participation in TLC’s activities and programs?*

YesNo
If YES, please describe those impairments or conditions:
Allergies
List all known allegories to medications or drugs:
List all known food allergies, such as nuts, gluten:
List all known allergies to insects and animals, such as insect stings, animal dander:
List any other known allergies, such as environmental allergies like hay fever:
Medications Taken by the Student
Does the student use an epi pen?

YesNo
Other than or in addition to an epi pen, does the student take medication, including over-the-counter medications or non-prescription drugs, on a routine, daily, or frequent basis?*

YesNo
If YES, please describe below:

This student takes medications on a routine, daily, or frequent basis as follows:
Med #1, dosage, and specific times taken each day:
Reason for taking medication:
Med #2, dosage, and specific times taken each day:
Reason for taking medication:
The student must bring enough medication to last the entirety of their time at TLC programming. The medication must be kept in the original packaging or bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration. The student must coordinate his or her use of medication with TLC staff.
Restriction on Student’s Activities
Describe any physical or emotional limitation or restriction on the student’s activities:
Authorization of Medical Services

I have completed and reviewed this form and attest that the information it contains, including the student’s health history, is correct and complete as far as I know.

I understand that TLC will attempt to reach the responsible parent or guardian at the cell phone number provided above in the event of a serious accident, injury, episode, or other medical emergency involving the student.

I also understand that TLC and its staff may need to obtain or provide first aid or emergency medical or dental services for the student, and may need to do so before TLC is able to reach the responsible parent or guardian identified above.

I hereby grant TLC and its staff full authority to take whatever action it considers appropriate under the circumstances regarding the health and safety of the student, including obtaining emergency medical or dental services for the student. I understand that I am financially responsible to providers of any such medical or dental services to the student, including providers of transportation to those facilities, and that I am also responsible for dealing with my insurance carrier (if any).

I further consent to the transportation of the student to a medical facility, including without limitation in a private vehicle or ambulance.
Signature*

Clear
Date*

MonthDayYear
Date

Authorization and Release: Photos, Recordings, Interviews, Art, Writings
I understand that Teton Literacy Center may, from time to time during its interactions with students and their families, take photographs, conduct interviews, make videos and other recordings, and display or use participants’ artwork and writings, for a variety of institutional, educational, and informational purposes, including marketing and fundraising. On behalf of myself and my minor children, I broadly, voluntarily, and unreservedly (1) authorize Teton Literacy Center and its officers, agents, employees, successors, licensees, volunteers, and assigns (collectively, TLC), to do so, and (2) release TLC from all forms of actions or claims, and all types of redress, compensation, or relief, in any forum or venue, whether in the past, present, or future, arising from or associated with the subject matter of this Authorization and Release.

Consistent with this broad authorization and release, I authorize TLC to take photos and make videos and other recordings of me and my minor children and to and use those images, likenesses, and appearances (collectively, photos) without compensation of any kind to me or my minor children, for any institutional, educational, and informational purpose, including marketing and fundraising. I further authorize TLC to use my name, biography, personal information, data, and event, as well as those of my minor children, in connection with any such uses of the photos on the same terms. I understand and agree to the broad authorization and release outlined here and waive any right or interest that I or my minor children may have, including any right to inspect or approve the photos. My authorization and release, for myself and my minor children, is irrevocable and valid for TLC’s use of the photos in any place, manner, or media. The photos may be used in whole or in part, alone or with other photographs or recordings, and may be blurred or modified. I understand that all right, title, and interest in the photos belongs solely to TLC.
Do you give Teton Literacy Center the photographic rights described above?*

YesNo
If you answered yes to the question above, please sign here.

Clear

Club Registration K-5 Students ONLY

Students will participate in clubs at the school they attend and will meet their TLC teachers in the cafeteria immediately afterschool. Students from outlying schools may sign up for clubs at JES. A reminder: Clubs will run from Monday, April 7th until Thursday, May 29th. If your student is likely to miss two or more clubs due to scheduling conflicts, for example, other clubs, sports, etc., we ask that you do not apply for clubs on that day for the spring session.
JES Students: Pick-up is outside JES at 5:00pm.

Mondays, JES K-5, Amazing AnimalsTuesdays, JES K-5, Spy Club
CES Students: Pick-up is outside CES at 5:00pm.

Mondays, K-5, Amazing Animals
MMES Students: For those students riding the Activity Bus, pickup will likely be at 5:10pm at CES. Bus spaces will be limited. Students will be invited to ride the Activity Bus based upon enrollment lottery status and parent/guardian must complete additional paperwork to claim the offered space.

Wednesdays, MMES K-5, Amazing AnimalsThursdays, MMES K-5, Spy Club

MMES Students ONLY

This spring, TCSD and TLC will continue to provide an evening activity bus to bring students from MMES to CES. We are working to be more intentional and equitable with our bus sign-up process to ensure highest need families are served first. Thank you for reading this page carefully.
Important to know:
- All families interested in the MMES activity bus will answer the questions below to apply.
- Activity Bus spaces will be limited and will be filled according to lottery status. If a space is available for your student(s), we will reach out to invite you to take the space(s) and provide the next steps needed to do so.
- Families will be notified of their bus invitation/waitlist status on Thursday, March 6th. All invited families will be required to complete a form in order to accept their space on the bus.
- These students will be automatically placed on the bus at the end of club every single week. If you need to pick up at MMES, you must contact the club teacher prior to 2pm.
- If your student has received a space on the bus and is picked up from MMES more than three times, your space on the bus is subject to be removed. Thank you for understanding we have a lengthy waitlist for the bus!
Would you like to request a space for your student on the bus? Pick-up would be at CES at 5:10pm. Students would not be monitored once they step off the bus.

Yes: my student would need a space on the evening bus in order to attend club at MMES.Maybe: it would be convenient, but I am happy to pick-up my student at MMES.No: I will pick up my student at MMES at 5pm.

TLC Summer SOAR & TCSD Summer Programming
This collaborative and intensive summer program will run Monday - Thursday from June 23rd - August 14th. There will be no programs on Thursday, July 3. Both SOAR and Camp Invention will run from 9:00am - 4:30 pm daily. Please ONLY APPLY to this summer programming if you can commit to all eight weeks!
Would you like to apply for TLC Summer SOAR & TCSD Summer Programming Collaboration?*

YesNo

Jetsetter (rising 6th, 7th and 8th graders)Application

Required Essay
Similar to previous years, all students applying to be in the Jetsetter Cabin (rising 6th, 7th and 8th graders) must complete a short essay answering the following question:

*Why do you want to be a Jetsetter this summer? What are you hoping to gain from participating in this program?

This essay MUST be written by the student, and be at least two paragraphs long. Students can also turn a hand-written essay into Ms. Anna or Mr. Victor at TLC. Your student’s application will not be considered complete without this essay.

Essays are due at the same time as all SOAR applications, February 23.
Upload essay here - Why do you want to be a Jetsetter this summer? What are you hoping to gain from participating in this program?

Cancelof
Potential Interview Invite

Once you finish the application and your student has completed their essays. Students will then be invited to an interview with TLC staff between March 3 and March 13 as the next step in the application process (an invitation for your student to participate in this step will be emailed to you). Assuming completion of their interview, final notifications for rising 6th-8th grade applicants will be sent via email on March 18.
Jetsetter Camping Trip

Students in the Jetsetter Cabin will have the special opportunity to attend an overnight camping trip in partnership with Teton Science Schools in Grand Teton National Park. This camping trip is part of our summer curriculum and students are expected to attend. The exact dates of this trip at to be determined, but will be a Tuesday through Thursday during one of the weeks in the middle of SOAR.
If your student is offered a placement in the Jetsetter cabin, can you confirm their attendance for this trip?*

YesNoMaybe
If you have any questions or concerns about this trip, please feel free to call the TLC office and ask to speak with Anna, Victor or Laura.

We require confirmation by May 1st. Late changes will not be accommodated. Last minute cancellations will jeopardize your student’s future programming opportunities, and a cancellation fee may apply.

Parents will fill out the TSS forms at the parent meeting.
Signature - I understand that I must confirm 'yes' or 'no' for my student's attendance for the camping trip by May 1st. *

Clear

Multiple Student Registration
Do you want to apply for another student?

YesNo

Click submit in order to complete the application.

Participant Information
Participant Name

First NameLast Name
Gender

M-MaleF-FemaleO-Other
Race
Ethnicity
Birth Date (MM-DD-YYYY)

MonthDayYear
Date
Grade 2024-2025
School Attending 2024-2025

Shared Information Consent
This authorizes Teton Literacy Center and Teton County School District #1 to share written or verbal information regarding my child’s academic performance, diagnosis, history, including medication, progress, psychological and educational testing, medical and legal information, social welfare and rehabilitation, reports and other materials that are relevant to my child's care. I give my permission for the staff of Teton Literacy Center, this 21st CCLC program with services located at Teton Literacy Center, Munger Elementary School, and Jackson Hole Middle School to review my child’s academic and behavior progress reports or their report card in order to document growth and progress in my child during his/her time in this before/after school or summer program. This includes attendance, academic performance, teacher surveys and information about whether my child has an identified exceptionality, an Individual Education Plan or Academic Improvement Plan, and suggestions from my child’s teacher(s) on how my child can best be helped in the program. TLC will send Wyoming Department of Education grade reports from your child’s teacher using WISERID numbers where data will be aggregated at the state level to protect your child’s identification. This data is collected to evaluate the effectiveness of TLC programs.

I understand that my records are protected under the laws regarding confidentiality, and cannot be disclosed without written consent, except in specific situations. This consent is valid throughout my child receiving services at Teton Literacy Center.
Signature*

Clear

For Out-of-School and Afterschool Programs: Acknowledgement and Assumption of Risk; Release and Waiver of Liability; and Indemnity and Hold Harmless (Acknowledgement and Release)
Scope of Acknowledgement and Release: Teton Literacy Center (TLC) provides out-of-school programs at its own facilities, at facilities that it rents from the Jackson Hole Community School, and at the facilities of organizations with which it collaborates, such as the Jackson Hole Children’s Museum and History Jackson Hole. TLC also provides afterschool programs at various Teton County Public Schools. I understand that all of these facilities, programs, and partner organizations are covered by this Acknowledgement and Release, and that TLC is defined in this Acknowledgement and Release to encompass all of these facilities, programs, and partner organizations.

Acknowledgement and Assumption of Risk: I understand that my minor child’s participation in TLC’s out-of-school and afterschool programs is voluntary and that my child and I are free to choose not to participate. I understand that participation in voluntary out-of-school and afterschool activities includes risks, including risk of injury or illness that may range in severity from minor to disabling to catastrophic including even death. Although serious injuries are not common in out-of-school and afterschool programs, I understand that it is impossible to eliminate all risk. I acknowledge the existence of this range of risks, and knowingly and voluntarily assume them for myself and on behalf of my child.

Acknowledgement that My Child’s Participation is at TLC’s Discretion: I understand that my child is allowed to participate in TLC’s programs entirely at TLC’s discretion. My child has no right to participate. TLC may stop offering a program, change a program, remove my child from a program, change its rules and procedures applicable to a program, enforce its rules and procedures applicable to a program, impose conditions on my child’s participation in a program, change facilities, change partner organizations, and the like, entirely at its discretion.

Release and Waiver of Liability: I understand that TLC, as well as its employees, officers, contractors, directors, agents, and volunteers, including without limitation any employees, officers, contractors, directors, agents, and volunteers of partner organizations, will not be liable for personal injuries, accidents, illness, my reliance on TLC’s programs, emotional distress, or property damage, of any kind or degree, in connection with my child’s participation in such activities, including without limitation those arising from negligence.

Indemnity and Hold Harmless Agreement: On behalf of myself and my child, I agree to release, hold harmless and indemnify TLC, as well as its employees, officers, contractors, directors, agents, and volunteers, including without limitation any employees, officers, contractors, directors, agents, and volunteers of partner organizations, from any loss, cost, damage, or expense, of any kind or degree, including without limitation all attorneys’ fees, costs, and dispute resolution expenses, which I or my child may have, directly or indirectly, in connection with my child’s participation in such activities.

Knowing and Voluntary Agreement: I have read this Acknowledgement and Release, and understand its terms, and understand that my child and I are giving up substantial rights, including without limitation the right to sue. I also understand that my child and I are giving up substantial rights against TLC’s partner organizations, including without limitation the right to sue. I further understand my right to review this Acknowledgement and Release with advisers of my choice, and I have had the opportunity to do so. I am signing this Acknowledgement and Release freely and voluntarily and intend by my signature to be a complete and unconditional release of liability to the greatest extent allowed by law.

Severability. If one or more part this Acknowledgement and Release is found to be unenforceable or illegal, the unenforceable or illegal part shall be severed from other parts of the Acknowledgement and Release without rendering the remaining parts unenforceable.

Choice of Law and Venue. This Acknowledgement and Release shall be interpreted according to the laws of the State of Wyoming and the venue shall be in Wyoming.
Signature*

Clear
Date

MonthDayYear
Date

Health History and Permission for Emergency Services

This Form must be filled out by each minor student’s parent or guardian before he or she is allowed to participate in TLC’s after-school programs.
Health Insurance Information
Does the student have medical/hospital insurance?*

YesNo
If YES, please provide the carrier and group #:
Health Information
Name of student’s physician:
Phone # of student’s physician:
Does the student have any physical or mental impairments or conditions that could affect participation in TLC’s activities and programs?*

YesNo
If YES, please describe those impairments or conditions:
Allergies
List all known allegories to medications or drugs:
List all known food allergies, such as nuts, gluten:
List all known allergies to insects and animals, such as insect stings, animal dander:
List any other known allergies, such as environmental allergies like hay fever:
Medications Taken by the Student
Does the student use an epi pen?

YesNO
Other than or in addition to an epi pen, does the student take medication, including over-the-counter medications or non-prescription drugs, on a routine, daily, or frequent basis?*

YesNo
If YES, please describe below:

This student takes medications on a routine, daily, or frequent basis as follows:
Med #1, dosage, and specific times taken each day:
Reason for taking medication:
Med #2, dosage, and specific times taken each day:
Reason for taking medication:
The student must bring enough medication to last the entirety of their time at TLC programming. The medication must be kept in the original packaging or bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration. The student must coordinate his or her use of medication with TLC staff.
Restriction on Student’s Activities
Describe any physical or emotional limitation or restriction on the student’s activities:
Authorization of Medical Services

I have completed and reviewed this form and attest that the information it contains, including the student’s health history, is correct and complete as far as I know.

I understand that TLC will attempt to reach the responsible parent or guardian at the cell phone number provided above in the event of a serious accident, injury, episode, or other medical emergency involving the student.

I also understand that TLC and its staff may need to obtain or provide first aid or emergency medical or dental services for the student, and may need to do so before TLC is able to reach the responsible parent or guardian identified above.

I hereby grant TLC and its staff full authority to take whatever action it considers appropriate under the circumstances regarding the health and safety of the student, including obtaining emergency medical or dental services for the student. I understand that I am financially responsible to providers of any such medical or dental services to the student, including providers of transportation to those facilities, and that I am also responsible for dealing with my insurance carrier (if any).

I further consent to the transportation of the student to a medical facility, including without limitation in a private vehicle or ambulance.
Signature*

Clear
Date*

MonthDayYear
Date

Authorization and Release: Photos, Recordings, Interviews, Art, Writings
I understand that Teton Literacy Center may, from time to time during its interactions with students and their families, take photographs, conduct interviews, make videos and other recordings, and display or use participants’ artwork and writings, for a variety of institutional, educational, and informational purposes, including marketing and fundraising. On behalf of myself and my minor children, I broadly, voluntarily, and unreservedly (1) authorize Teton Literacy Center and its officers, agents, employees, successors, licensees, volunteers, and assigns (collectively, TLC), to do so, and (2) release TLC from all forms of actions or claims, and all types of redress, compensation, or relief, in any forum or venue, whether in the past, present, or future, arising from or associated with the subject matter of this Authorization and Release.

Consistent with this broad authorization and release, I authorize TLC to take photos and make videos and other recordings of me and my minor children and to and use those images, likenesses, and appearances (collectively, photos) without compensation of any kind to me or my minor children, for any institutional, educational, and informational purpose, including marketing and fundraising. I further authorize TLC to use my name, biography, personal information, data, and event, as well as those of my minor children, in connection with any such uses of the photos on the same terms. I understand and agree to the broad authorization and release outlined here and waive any right or interest that I or my minor children may have, including any right to inspect or approve the photos. My authorization and release, for myself and my minor children, is irrevocable and valid for TLC’s use of the photos in any place, manner, or media. The photos may be used in whole or in part, alone or with other photographs or recordings, and may be blurred or modified. I understand that all right, title, and interest in the photos belongs solely to TLC.
Do you give Teton Literacy Center the photographic rights described above?*

YesNo
If you answered yes to the question above, please sign here.

Clear

Club Registration K-5 Students ONLY

Students will participate in clubs at the school they attend and will meet their TLC teachers in the cafeteria immediately afterschool. Students from outlying schools may sign up for clubs at JES. A reminder: Clubs will run from Monday, April 7th until Thursday, May 29th. If your student is likely to miss two or more clubs due to scheduling conflicts, for example, other clubs, sports, etc., we ask that you do not apply for clubs on that day for the spring session.
JES Students: Pick-up is outside JES at 5:00pm.

Mondays, JES K-5, Amazing AnimalsTuesdays, JES K-5, Spy Club
CES Students: Pick-up is outside CES at 5:00pm.

Mondays, K-5, Amazing Animals
MMES Students: Pick-up will be in the school at 5pm. For those students riding the Activity Bus, pickup will likely be at 5:10pm at CES. Bus spaces will be limited. Students will be invited to ride the Activity Bus based upon enrollment lottery status and parent/guardian must complete additional paperwork to claim the offered space.

Wednesdays, MMES K-5, Amazing AnimalsThursdays, MMES K-5, Spy Club

MMES Students ONLY

This spring, TCSD and TLC will continue to provide an evening activity bus to bring students from MMES to CES. We are working to be more intentional and equitable with our bus sign-up process to ensure highest need families are served first. Thank you for reading this page carefully.
Important to know:
- All MMES families interested in the activity bus must answer the questions below to apply.
- Activity Bus spaces will be limited and will be filled according to lottery status. If a space is available for your student(s), we will reach out to invite you to take the space(s) and provide the next steps needed to do so.
- Families will be notified of their bus invitation/waitlist status on Thursday, March 6th. All invited families will be required to complete a form in order to accept their space on the bus.
- These students will be automatically placed on the bus at the end of club every single week. If you need to pick up at MMES, you must contact the club teacher prior to 2pm.
- If your student has received a space on the bus and is picked up from MMES more than three times, your space on the bus is subject to be removed. Thank you for understanding we have a lengthy waitlist for the bus!
Would you like to request a space for your student on the bus? Pick-up would be at CES at 5:10pm. Students would not be monitored once they step off the bus.

Yes: my student would need a space on the evening bus in order to attend club at MMES.Maybe: it would be convenient, but I am happy to pick-up my student at MMES.No: I will pick up my student at MMES at 5pm.

TLC Summer SOAR & TCSD Summer Programming
This collaborative and intensive summer program will run Monday - Thursday from June 23rd - August 14th. There will be no programs on Thursday, July 3. Both SOAR and Camp Invention will run from 9:00am - 4:30 pm daily. Please ONLY APPLY to this summer programming if you can commit to all eight weeks!
Would you like to apply for TLC Summer SOAR & TCSD Summer Programming Collaboration?

YesNo

Click submit in order to complete the application.
Should be Empty:

TLC Spring 2025 Afterschool Clubs & Summer SOAR Application

Participant Information

Participant Education Information

Shared Information Consent

Family Information

Family Information

Family History

Emergency Contact

How will your child get to and from TLC programs?

Pick Up Consent

TLC Student & Family Expectations

For Out-of-School and Afterschool Programs: Acknowledgement and Assumption of Risk; Release and Waiver of Liability; and Indemnity and Hold Harmless (Acknowledgement and Release)

Health History and Permission for Emergency Services

Health Insurance Information

Health Information

Allergies

Medications Taken by the Student

Restriction on Student’s Activities

Authorization and Release: Photos, Recordings, Interviews, Art, Writings

Jackson Hole Children's Museum Supplemental Information

Emergency Medical Care

*If you are only applying for our Summer programing please DO NOT fill out club application and skip to SOAR application*

Club Registration K-5 Students ONLY

MMES Students ONLY

TLC Summer SOAR & TCSD Summer Programming Collaboration

TLC Summer SOAR & TCSD Summer Programming - Application

Jetsetter (rising 6th, 7th and 8th graders) Application

Multiple Student Registration

Click submit in order to complete the application.

Participant Information

Participant Education Information

Shared Information Consent

For Out-of-School and Afterschool Programs: Acknowledgement and Assumption of Risk; Release and Waiver of Liability; and Indemnity and Hold Harmless (Acknowledgement and Release)

Health History and Permission for Emergency Services

Health Insurance Information

Health Information

Allergies

Medications Taken by the Student

Restriction on Student’s Activities

Authorization and Release: Photos, Recordings, Interviews, Art, Writings

Club Registration K-5 Students ONLY

MMES Students ONLY

TLC Summer SOAR & TCSD Summer Programming

TLC Summer SOAR & TCSD Summer Programming - Application

Jetsetter (rising 6th, 7th and 8th graders)Application

Multiple Student Registration

Click submit in order to complete the application.

Participant Information

Participant Education Information

Shared Information Consent

For Out-of-School and Afterschool Programs: Acknowledgement and Assumption of Risk; Release and Waiver of Liability; and Indemnity and Hold Harmless (Acknowledgement and Release)

Health History and Permission for Emergency Services

Health Insurance Information

Health Information

Allergies

Medications Taken by the Student

Restriction on Student’s Activities

Authorization and Release: Photos, Recordings, Interviews, Art, Writings

Club Registration K-5 Students ONLY

MMES Students ONLY

TLC Summer SOAR & TCSD Summer Programming

TLC Summer SOAR & TCSD Summer Programming - Application

Click submit in order to complete the application.

If you are only applying for our Summer programing please DO NOT fill out club application and skip to SOAR application