• Teton Literacy Center K–5 Fall 2027 Afterschool Club Application

    This application is for the January–March 2027 Afterschool Club session. Application closes November 29th. Families will receive an email with their student's club placement on December 10th.
  • Teton Literacy Center K–5 Fall 2027 Afterschool Club

  • Thank you for taking the time to complete this application and carefully read the updates within it.

    • Clubs will take place at CES, JES and MMES. Students can sign up for clubs at their school. Students from outlying school (KES, WES and private/home schools) may be placed at either JES or CES clubs.
    • To promote equitable and accessible educational opportunities, program enrollment is based upon a lottery system. Applying for clubs on one or more days does not guarantee enrollment.
    • We are currently working with TCSD to continue to provide an Evening Activity Bus from MMES to CES after clubs on Wednesdays and/or Thursdays. This is not a guarantee
    • This winter, select students will be invited to take part in literacy small groups. These groups will provide enjoyable and focused reading and writing activities, designed to strengthen literacy skills in a fun and supportive setting.

    Important Updates for the Winter 2027 Club Session:

    1. The application will close on November 29th. Any families who apply after November 29th will be automatically waitlisted. 

    2. We will notify families of enrollment or waitlist status on December 10th. All notifications will be sent via email. If your student is offered a space in club, it is required for you to email or call confirming your students space no later than December 15th. If TLC does not receive confirmation by the stated deadline, your student will be placed on the waitlist and we will reach out to you again if a space becomes available.

    3. Clubs will run from Monday, January 11th until Thursday, March 18th. 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 winter 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.  

     

  • Participant Information

  • Gender*
  • Birth Date (MM-DD-YYYY)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Participant Education Information

  • Does your child have an IEP?*
  • What services does TCSD provide through this IEP? Please check all that apply.
  • Is your child in the English Language Program with TCSD?*
  • Is your child enrolled in free or reduced lunch program with TCSD?*
  • 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.

  • Family Information

  • Language Spoken at Home*
  • In what language(s) would you prefer to receive communications from Teton Literacy Center? (These include newsletters, text messages, phone calls and letters home)*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Family Information

    The following information is used to ensure that the families with the highest needs are served first. This section must be completed each application cycle. All Jackson community families are encouraged to apply for TLC programs.
  • Marital Status*
  • Number of Parents Working Full Time*
  • Annual Household Income Level*
  • Has your child been enrolled in TLC programs in the past? Check all that apply.*
  • Living Situation*
  • Number of Children in the Household*
  • Have you attended TLC family events in the past year?*
  • Has your child missed more than three club days for reasons other than illness this year? (We will reference our attendance reports)*
  • Have you accepted a spot in a club for your child and then withdrawn after the session started within the past two club seasons? (We will reference our attendance reports)*
  • Family History

    The following information is used to help us design culturally responsive programs for our students. We ask these questions in hopes to get to know your student, and your family, better and build a community where all families feel seen, heard, and belong. We appreciate your honesty.
  • What is your current family structure?
  • Would you be interested in volunteering in the classroom or supporting us with any classroom special events? For example, you could come for story time, read books with students, help during parent participation week or holiday celebrations, etc.*
  • Emergency Contact/Authorized Pick Up

    Please provide the name of at least two people not listed on the previous pages. Parents and guardians will always be contacted first.
  • Format: (000) 000-0000.
  • Is this individual authorized to pick-up your student at the end of programs (in addition to previously listed parents/guardians)?*
  • Format: (000) 000-0000.
  • Is this individual authorized to pick-up your student at the end of programs (in addition to previously listed parents/guardians)?*
  • Format: (000) 000-0000.
  • Is this individual authorized to pick-up your student at the end of programs (in addition to previously listed parents/guardians)?*
  • How will your child get to and from TLC programs?

    If your child walks or bikes home after club, parents/guardians need to complete the sign-out form before they can leave the program.
  • Transportation to afterschool clubs*
  • Transportation from afterschool clubs*
  • 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. 

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Acknowledgement and Assumption of Risk, Release of Liability, and Indemnity and Hold Harmless for Out-of-School Programs

  • Acknowledgement and Assumption of Risk: I understand that my minor child’s participation in Teton Literacy Center’s (TLC), Jackson Hole Children’s Museum’s (JHCM), and History Jackson Hole (HJH) out-of-school 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 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 supervised out-of-school 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, and the like, entirely at its discretion.           

    Release and Waiver of Liability:  I understand that TLC, JHCM, and HJH as well as their employees, officers, directors, agents, and volunteers (including without limitation any individual, business, or entity TLC and JHCM uses in providing such programs), 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, JHCM, and HJH, and their employees, officers, directors, agents, and volunteers (including without limitation any individual, business, or entity TLC and JHCM uses in providing such programs), 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 Assumption of Risk, Release of Liability, and Indemnity and Hold Harmless for Out-of-School Programs (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 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.   

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 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?*
  • Health Information

  • Does the student have any physical or mental impairments or conditions that could affect participation in TLC’s activities and programs?*
  • Allergies

  • Medications Taken by the Student 

  • Does the student use an epi pen?*
  • 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?*
  • If YES, please describe below:

    This student takes medications on a routine, daily, or frequent basis as follows: 

  • 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

  • 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.   

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 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?*
  • Jackson Hole Children's Museum Supplemental Information

  • 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. 

  • Do you authorize JHCM to apply sunscreen provided by the parent or program?
  • Club Registration K-5 Students ONLY

    Clubs take place at CES, JES and MMES. Students can sign up for clubs at their school. Students from outlying school (KES, WES and private/home schools) may be placed at either JES or CES clubs. A reminder: Clubs will run from Monday, January 11 until Thursday, March 18th. 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 winter session.
  • JES Students: Pick-up is at 5:00pm outside of JES.
  • MMES Students: Pick-up will be in the school at 5pm. For those students riding the Activity Bus, pick up 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.
  • Would you like your child to be considered for our winter literacy small groups? These small groups offer fun, focused reading and writing activities to build skills and confidence. Space is limited.
  • If you would like your child to participate in a small group, please select all days they are available to attend:
  • MMES Students ONLY

    This winter, 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.
    • Families will be notified of their bus invitation/waitlist status December 14th, once TCSD confirms transportation. 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.
  • Notification emails will be sent on Thursday, December 10th. IMPORTANT: it is required that you email or call to confirm your student’s space. If you do not confirm your student’s space by December 15th, your student will automatically be dropped from the club, and will be placed on the waitlist. If a space becomes available a TLC staff member will contact you.

  • Multiple Student Registration - Elementary school ONLY

  • Do you want to apply for another student?*
  • Click submit in order to complete the application.

  • Participant Information

  • Gender*
  • Birth Date (MM-DD-YYYY)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Participant Education Information

  • Does your child have an IEP?*
  • What services does TCSD provide through this IEP? Please check all that apply.
  • Is your child in the English Language Program with TCSD?*
  • 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.

  • Acknowledgement and Assumption of Risk, Release of Liability, and Indemnity and Hold Harmless for Out-of-School Programs

  • Acknowledgement and Assumption of Risk: I understand that my minor child’s participation in Teton Literacy Center’s (TLC), Jackson Hole Children’s Museum’s (JHCM), and History Jackson Hole (HJH) out-of-school 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 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 supervised out-of-school 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, and the like, entirely at its discretion.           

    Release and Waiver of Liability:  I understand that TLC, JHCM, and HJH as well as their employees, officers, directors, agents, and volunteers (including without limitation any individual, business, or entity TLC, JHCM, and HJH uses in providing such programs), 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, JHCM, HJH, and their employees, officers, directors, agents, and volunteers (including without limitation any individual, business, or entity TLC and JHCM uses in providing such programs), 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 Assumption of Risk, Release of Liability, and Indemnity and Hold Harmless for Out-of-School Programs (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 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.   

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 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?*
  • Health Information

  • Does the student have any physical or mental impairments or conditions that could affect participation in TLC’s activities and programs?*
  • Allergies

  • Medications Taken by the Student 

  • Does the student use an epi pen?
  • 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?*
  • If YES, please describe below:

    This student takes medications on a routine, daily, or frequent basis as follows: 

  • 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

  • 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. 

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 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?*
  • 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, January 11th until Thursday, March 18th. 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 winter session.
  • JES Students: Pick-up is outside JES at 5:00pm.
  • 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.
  • Would you like your child to be considered for our winter literacy small groups? These small groups offer fun, focused reading and writing activities to build skills and confidence. Space is limited.
  • If you would like your child to participate in a small group, please select all days they are available to attend:
  • MMES Students ONLY

    This winter, 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.
    • Families will be notified of their bus invitation/waitlist status December 14th, once TCSD confirms transportation. 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.
  • Notification emails will be sent on Thursday, December 10th. IMPORTANT: it is required that you email or call to confirm your student’s space. If you do not confirm your student’s space by December 15th, your student will automatically be dropped from the club, and will be placed on the waitlist. If a space becomes available a TLC staff member will contact you.

  • Multiple Student Registration - Elementary school students ONLY

  • Do you want to apply for another student?
  • Click submit in order to complete the application.

  • Participant Information

  • Gender*
  • Birth Date (MM-DD-YYYY)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Participant Education Information

  • Does your child have an IEP?*
  • What services does TCSD provide through this IEP? Please check all that apply.
  • Is your child in the English Language Program with TCSD?*
  • 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.

  • Acknowledgement and Assumption of Risk, Release of Liability, and Indemnity and Hold Harmless for Out-of-School Programs

  • Acknowledgement and Assumption of Risk: I understand that my minor child’s participation in Teton Literacy Center’s (TLC), Jackson Hole Children’s Museum’s (JHCM), and History Jackson Hole (HJH) out-of-school 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 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 supervised out-of-school 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, and the like, entirely at its discretion.           

    Release and Waiver of Liability:  I understand that TLC, JHCM, and HJH as well as their employees, officers, directors, agents, and volunteers (including without limitation any individual, business, or entity TLC, JHCM, HJH uses in providing such programs), 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, JHCM, and HJH their employees, officers, directors, agents, and volunteers (including without limitation any individual, business, or entity TLC, JHCM, and HJH uses in providing such programs), 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 Assumption of Risk, Release of Liability, and Indemnity and Hold Harmless for Out-of-School Programs (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 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.   

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • 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?*
  • Health Information

  • Does the student have any physical or mental impairments or conditions that could affect participation in TLC’s activities and programs?*
  • Allergies

  • Medications Taken by the Student 

  • Does the student use an epi pen?
  • 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?*
  • If YES, please describe below:

    This student takes medications on a routine, daily, or frequent basis as follows:

  • 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

  • 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. 

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 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?*
  • 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, January 11th until Thursday, March 18th. 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 winter session.
  • JES Students: Pick-up is outside JES at 5:00pm.
  • 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.
  • Would you like your child to be considered for our winter literacy small groups? These small groups offer fun, focused reading and writing activities to build skills and confidence. Space is limited.
  • If you would like your child to participate in a small group, please select all days they are available to attend:
  • MMES Students ONLY

    This winter, 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.
    • Families will be notified of their bus invitation/waitlist status late December 12th, once TCSD confirms transportation. 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.
  • Notification emails will be sent on Thursday, December 10th. IMPORTANT: it is required that you email or call to confirm your student’s space. If you do not confirm your student’s space by December 15th, your student will automatically be dropped from the club, and will be placed on the waitlist. If a space becomes available a TLC staff member will contact you.

  • Click submit in order to complete the application.

  • Should be Empty: