Club Registration Winter 2021

TLC Program Application

Please fill out all the fields below to apply for Spring Afterschool Clubs and/or the Summer SOAR Program. You will be able to choose which programs and clubs to apply for after you have filled out all required information.
COVID-19 Pandemic - TLC Spring and Summer Programs Subject to Change
Teton Literacy Center is closely monitoring the COVID-19 situation, guidelines and ordinances. At this point, it is our hope to run our typical 2021 Spring Afterschool and Summer SOAR programs.

Regarding our our afterschool clubs, in effort to align with TCSD podding efforts, students will have limited club options based upon which elementary school they attend. Additionally, we will cap clubs at twelve students in order to maintain social distancing while present in our facilities. Because of these efforts, it is possible that your student may land on the waitlist even if they have typically been granted a space in the past. For those whose students are often enrolled in more than one club, it is likely that your student will be placed in fewer clubs than they have in the past.

Regarding our Summer SOAR program, we will determine what we believe to be a safe number of students to serve per "cabin" as we get closer to the summer. However, we do expect to serve less students than we have in typical summers and expect an extensive waitlist to this highly-sought summer programming. We will try to connect all waitlisted families with other community programs and resources. As always, we will do our best to accommodate as many students as safely possible.

We are currently planning to run our spring programs from Monday, April 12th – Thursday, June 3rd. We are currently planning to run our Summer SOAR program from June 21 - August 12 (Full Days: June 21 - July 15; Afternoons: July 19 - August 12). Please note that there is no afterschool programming for middle schoolers this spring, but we are planning on having SOAR for middle school students (6th - 7th graders) this summer.

It is possible that we will need to alter or cancel our programs at any point (possibly unexpectedly). As such, these dates and our programs are subject to change at any point. Following are a few of the many factors that could impact our programs:
- State and/or local COVID-19 guidelines and ordinances.
- Teton County School District – we will strive to follow the decisions of TCSD. If at any point TCSD determines they will continue with their Adaptive Learning Plan, TLC will likely resume our virtual programs in lieu of physical programs.
- A TLC student, staff member or volunteer testing positive for COVID-19.
- TLC staff illness may result in short or long-term cancellation of specific TLC programs that staff member is associated with.
In the event of an unexpected program cancelation, TLC will communicate with all families involved via email and texts.

Finally, we hope to notify families of their status for spring clubs on Thursday, March 11th and SOAR on Thursday, Marth 18th (all notifications will be sent via email).

We thank you for your flexibility and patience as we continue to navigate this situation. We also appreciate your continued support and involvement in our programs during these trying times.

Thank you,

Teton Literacy Center Team

Participant Information
Participant Name *

First Name Last Name
Gender *

Male Female
Birth Date *

Month Day Year
Grade 2020-2021 *
School Attending 2020-2021 *
TCSD Teacher *

First Name Last Name

Participant Education Information
Does your child have an IEP? *

Yes No
Is your child in the English Language Program with TCSD? *

Yes No
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

City State / Province

Postal / Zip Code
E-mail *
example@example.com
Parent/Guardian Work-Company Name
1st Parent/Guardian Name *

First Name Last Name
Cell Phone *

Area Code Phone Number
Home Phone *

Area Code Phone Number
Work Phone *

Area Code Phone Number
2nd Parent/Guardian Name

First Name Last Name
Cell Phone

Area Code Phone Number
Home Phone

Area Code Phone Number
Work Phone

Area Code Phone Number
Language Spoken at Home *
Sibling Names and Grades

Emergency Contact

(Please provide the name of two people not listed on the previous page - parents/guardians will always be contacted first)
Emergency Contact Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Relationship *
Emergency Contact Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Relationship *
Emergency Contact Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Relationship *
Emergency Contact Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Relationship *
How will your child get to and from TLC programs?
Transportation to afterschool clubs *

Parent Walk School Bus
Transportation from afterschool clubs *

Parent Walk School Bus
Pick Up Consent

The following individuals are authorized to pick up my child at the end of the program (in addition to previously listed parents/guardians):
Name

First Name Last Name
Phone Number

Area Code Phone Number
Relationship
Name

First Name Last Name
Phone Number

Area Code Phone Number
Relationship

Policies and Procedures
This Teton Literacy Program is funded through 21st Century Community Learning Centers funding, which is a FREE PROGRAM for students that could benefit from a variety of stimulating personal enrichment activities that promote school success and well-being in a safe environment. Active attendance and engagement are essential to the student and program’s success. I understand that the requirements of the program include the following:
- Failure to maintain attendance standards may result in termination from the program.
- Parents must attend at least (2) family events during the school year in order for youth to maintain active status in the program.
- Youth will maintain a consistent weekly attendance and may not have more than 2 unexcused absences. Parents or student must call to inform staff in advance if they will not be attending that day (307-733-9242).
- Parents/guardians are required to notify the program if a youth will be absent and/or prior to withdrawal from the program.
- Youth will participate in programming activities with an emphasis on reading, writing, science and/or math skills, as provided.
- Youth will complete pre and post assessments as required by the grant funded contract.
- Parents/Guardians will participate in a satisfaction survey process at least once per year.
- Youth will participate in a satisfaction survey process at least once per year.
Appropriate behavior must be maintained. If there are any disruptive students, every effort will be made to work with the parents to resolve the matter. However, TLC may remove the student from the program if any of the following occurs:
- Verbal abuse or physical abuse of another student, tutor, teacher or staff member.
- Disruptive behavior that affects other learners.
- Disregard for the TLC or school premises.
I have read, understand and agree to comply with the requirements of the policies and procedures listed above. I realize that failure to comply with these requirements may result in loss of my funded space within this program. I release the Teton Literacy Center, its staff, Board of Directors and volunteers from any liability.
Signature *

Clear

Student Expectations
Teton Literacy Center after school Enrichment clubs are free programs for students that promote school success and student wellbeing in a safe environment. Throughout our clubs we aim to guide student behavior in a positive way through providing examples, offering clear directions and reasoning, using reflective language, and questioning. To reach our programmatic goals, the following is a list of expectations for our students. Please take the time and talk with your student about the following points and assure they understand the expectations of students while at TLC.
- Student will respect, listen to, and follow the directions of adults in the classroom. They are here to help students learn and have fun!
- Shoes must be worn at all times in TLC classrooms.
- Personal belongings (cell phone, toys, etc.) need to stay in a closed backpack at all times unless given permission by a TLC staff member or volunteer.
- Student needs to sit at a table while eating snack.
- Student needs to participate in activities to the best of his/her ability.
- Student must follow TLC’s playground protocols.
- Student understands that there can be students from different schools and of different ages in clubs. Student will be kind to them and be willing to make new friends.
- Student will utilize an indoor voice while in TLC classrooms to be respectful of others working in quiet spaces.
- Student must ask a teacher before leaving the classroom space for any reason.
- Student must respect others’ physical safety and feelings.
- Student understands that consequences will be applied to disruptive or dangerous behaviors. These will vary depending on the severity of the behavior.
I agree that I will discuss these expectations with my student(s) prior to their first day of a new TLC club.
Signature *

Clear

Teton Literacy Center Consent, Release and Liability Wavier
I/we understand that my child’s participation in Teton Literacy Center and Jackson Hole Children’s Museum out of school programs is voluntary and that my child and I/we are free to choose not to participate. I understand that participation in voluntary out of school activities includes risk of injury that may range in severity from minor to disabling to even death. Although serious injuries are not common in supervised school programs, it is impossible to eliminate the risk.

I understand that Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers will not be liable for personal injuries and/or property damage as a result of my child’s participation in such programs or activities.

I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any loss, cost, damage and/or expense of any nature, including all attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s participation in afterschool programs or activities.

I/We give permission for our son/daughter to participate in all Teton Literacy Center and Jackson Hole Children’s Museum afterschool activities and do forever indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any and all actions, all known and unknown personal injuries or property damage of said minor arising out of said activities, and also all claims or right of action for damages which said minor has or hereafter may acquire.

I also have made arrangements to secure timely pick up of my child at the conclusion of each scheduled program. I understand that Parents/guardians are responsible for providing student transportation to and from activities.

I have read, understand and agree to comply with the requirements of the policies and procedures listed above. I realize that failure to comply with these requirements may result in loss of my funded space within this program. I/we accept the risk and responsibility of participation in Teton Literacy Center and Jackson Hole Children’s Museum afterschool programs and we Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers from any liability.
Signature *

Clear
Medical Treatment Consent
In the event of an emergency, I hereby certify that I am the parent/lawful guardian of {name}, and grant to Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers full authority to take whatever action they may consider appropriate under the circumstances involved regarding the health and safety of my child and authorize them to obtain emergency medical or dental services for my child, if necessary, at my expense. I further consent to transportation of the above named child to the nearest or most appropriated medical facility. I authorize the hospital and attending physicians to submit claims to the above named company and hereby assign benefits directly to this company. I understand that I am financially responsible to providers of service for charges not covered by any insurance payments.
Signature *

Clear
Name of Primary Health Insurance *
Group Number
Policy Number
Allergies *
Does your child have a physical or psychological condition? *
Is your child carrying medication we should know about? *

Spring/Summer 2021 COVID-19 Program Participation Acknowledgement and Disclosure

Please initial each statement below.
I understand that during this COVID-19 Public Health Emergency I will NOT be permitted to enter the facility beyond the designated drop-off and pick-up area. I understand that this procedure change is for the safety of all persons present in the facility and to limit to the extent possible everyone’s risk of exposure. I understand that it is my responsibility to inform any Emergency Contact persons of the information contained herein.
Signature *

Clear
I understand that IF there is an emergency requiring me to enter the facility beyond the designated drop-off and pick-up area I MUST use hand sanitizer before entering, wash hands immediately upon entering, and wear a mask. While in the facility I must practice social distancing and remain 6ft from all other people, except for my own child.
Signature *

Clear
I understand that to enter the facility premises my child must be free from COVID-19 symptoms. If, during the day, any of the following symptoms appear my child will be separated from the rest of the people in the center. I will be contacted, and my child MUST be picked up from the facility within 30 minutes of being notified. I agree to provide 4 emergency contact names and numbers in case I am unavailable.

Symptoms include:

·   Fever of 100 Degrees Fahrenheit or Higher

·   Dry Cough

·   Shortness of Breath

·   Chills

·   Loss of Taste or Smell

·   Sore Throat

·   Muscle Aches

·   Vomiting

·   Diarrhea

While we understand that many of these symptoms can also be related to non-COVID-19 related issues, we must proceed with an abundance of caution during this Public Health Emergency. These symptoms typically appear 2-7 days after being infected so thank you for taking them seriously. Your child will need to be symptom free without any medications for 72 hours before returning to the facility.
Signature *

Clear
I have read and understand all new TLC policies and procedures related to the COVID-19 Public Health crisis including the updated illness policy and exclusion policy.
Signature *

Clear
I understand that I am required to report on my child’s symptoms before coming to programs each morning, and I also understand that my child’s temperature will be taken upon arrival at TLC programs.
Signature *

Clear
I understand that my child will be required to wash their hands using CDC recommended handwashing procedures before entering the center and throughout the day using warm running water and rubbing with soap for at least 20 seconds.
Signature *

Clear
I understand that outside of care, in order to control my child’s exposure in the community, I will comply with any and all state, county or local social distancing orders and will follow any recommendations from the CDC that limits my risk for exposure including wearing a mask in all public areas and remaining 6ft from all other people.
Signature *

Clear
I will immediately notify Teton Literacy Center management if I become aware of any person with whom my child or I have had contact exhibits any of the symptoms listed in Number 3 above, is advised to self-isolate, quarantine, or has tested positive, or is presumed positive for COVID-19.
Signature *

Clear
I understand that if my child has been tested for COVID-19 for any reason, regardless if they are exhibiting symptoms, my child may not return to TLC without proof of a negative test. I will keep my child home from TLC programs if anyone in our household is awaiting COVID-19 test results. My child will only return to programs if those results are negative.
Signature *

Clear
I understand that while present in the facility each day my child will be in contact with children, teachers and other employees who are also at risk of community exposure. I understand that no list of restrictions, guidelines or practices will remove 100% of the risk of exposure to COVID-19 as the virus can be transmitted by persons who are asymptomatic and before some people show signs of infection. I understand that I play a crucial role in keeping everyone in the facility safe and reducing the risk of exposure by following the practices outlined herein.
Signature *

Clear
I understand that if there is a confirmed case of COVID-19 at Teton Literacy Center, the site will be closed immediately and reopened in consultation with the Teton County Department of Health.
Signature *

Clear
I understand that all new information given since the closure due to COVID-19 supersedes all previous policies and procedures outlines in the Parent Handbook or any other TLC correspondence.
Signature *

Clear
I understand that if any medical provider suggests that my child be tested for COVID-19 for any reason, my child may not return to TLC without proof of a negative test result.
Signature *

Clear
I understand that this is a rapidly changing situation and the policies and procedures may change without notice in accordance with any new guidance released from the Health Department, the Department of Family Services, the CDC, or any other regulatory bodies.
Signature *

Clear
I certify that I have read, understand, and agree to comply with the provisions listed herein. I acknowledge that failure to act in accordance with the provisions listed herein, or with any other policy or procedure outlined by Teton Literacy Center will result in disciplinary action up to and including termination of care.
Signature *

Clear

Photography Consent
The Teton Literacy Center may photograph, interview or videotape my children to use for volunteer instruction, marketing purposes and/or program fundraising. Please indicate below whether your child’s writings or photograph may be used for these purposes:

Photographic Release. Participant does hereby grant and convey unto Teton Literacy Center all right, title, and interest in any and all photographic images, video and/or audio recordings made by TLC during the Participant's activities with TLC, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. I further grant to the Teton Literacy Center and its representatives the right to reproduce, use, exhibit, display, broadcast, distribute and create derivative works of these images and recordings in any media now known or later developed as well as my/their name for promoting, publicizing or explaining the Teton Literacy Center and its activities and for administrative or educational purposes.
Signature

Clear

Jackson Hole Children's Museum Supplemental Information (JES, WES and KES Students Only)

JHCM clubs require additional information. If you plan to apply for a club that takes place at JHCM (JES Students Only), please fill out the following information. If you do not plan to apply for a club at JHCM, you can click "Next."
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

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
Authorize JHCM to apply sunscreen provided by parent or program.

Yes No

Class Registration - Jackson Hole Children's Museum Based Programs (Open Only to JES, WES and KES Students)
Elementary students from JES, WES and KES are invited to join Teton Literacy Center in collaboration with Jackson Hole Children's Museum (JHCM) for afterschool clubs to be held at JHCM. Spaces will be filled based upon TLC's enrollment lottery.

JES students will be met in the JES cafeteria immediately following the school day. WES and KES parents will need to arrange transportation via the TCSD Activity Bus for transportation to the Recreation Center, where they will be met by JHCM staff.

All pickup will be at 5:00pm at Jackson Hole Children's Museum.
2nd - 4th Grade Students

Monday - Wonderland
Kinder - 1st Grade Students

Tuesday - Wonderland

Class Registration - Teton Literacy Center Based Programs (CES, WES and KES Students Only)
Colter students will be met at the Colter Cafeteria immediately following the school day.

WES and KES parents will need to arrange transportation via TCSD's Activity Bus for transportation to the Gregory Lane@Pathway bus stop, where they will be met by a TLC staff member.

All pick up is at 5:00pm at Teton Literacy Center.
Kindergarten & 1st Grade Colter Students

Thursday - SPRINGing for STEAM
1st & 2nd Grade Colter Students

Tuesday - Mythology
3rd, 4th & 5th Grade Colter Students

Monday - SPRINGing for STEAM

Class Registration - Munger Mountain Elementary Based Programs (MMES Students Only)
Munger students will be met at Munger Cafeteria immediately following the school day. Pick up is at 5:00pm at Munger Elementary School.
Kindergarten - 1st Grade Munger Students

Thursday - Mythology
1st & 2nd Grade Munger Students

Wednesday - Mythology
1st, 2nd & 3rd Grade Munger Students

Thursday - SPRINGing for STEAM
3rd, 4th & 5th Grade Munger Students

Wednesday - SPRINGing for STEAM

Class Registration - Middle School Based Programs (Primarily for JHMS Students)
Our SPARK programming will not be scheduled for this Spring due to staffing shortages at TLC. However, please complete the Summer SOAR application for your middle school student by clicking on the "Apply for SOAR" button at the bottom of this page.

In the meantime, please consider enrolling your student in one of the following TLC programs meant to support your middle school student:
- Academic Mentorship
- THRIVE
- On-Demand Activities and Resources (found on our website)
- IXL
Please reach out to carisa@tetonliteracy.org with any questions you may have about these programmatic opportunities.

SOAR at TLC

Summer Opportunities in Academics and Recreation
SOAR is a free eight-week intensive summer program for students exiting Kindergarten through 7th grade this school year. SOAR consists of four weeks of full-day programming and four weeks of half day programming, designed to coincide with TCSD's Summer Camp.

Each student enrolled must commit to attending all eight weeks of SOAR.

Dates:

Full Day (9am-4:30pm) June 21st - July 15th (No programs on July 5th)

Half Day (3pm-5pm for K-5 & 1pm-3pm for 6-8) July 19th - August 12th

Please only apply for TLC's SOAR if you can commit to all 8 weeks of programs!
Would you like to apply for TLC's SOAR summer program?

Yes No

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

Yes No

Click submit in order to complete the application.

Participant Information
Participant Name

First Name Last Name
Gender

Male Female
Birth Date

Month Day Year
Grade 2020-2021
School Attending 2020-2021
TCSD Teacher

First Name Last Name

Participant Education Information
Does your child have an IEP?

Yes No
Is your child in the English Language Program with TCSD?

Yes No
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

Teton Literacy Center Consent, Release and Liability Wavier
I/we understand that my child’s participation in Teton Literacy Center and Jackson Hole Children’s Museum out of school programs is voluntary and that my child and I/we are free to choose not to participate. I understand that participation in voluntary out of school activities includes risk of injury that may range in severity from minor to disabling to even death. Although serious injuries are not common in supervised school programs, it is impossible to eliminate the risk.

I understand that Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers will not be liable for personal injuries and/or property damage as a result of my child’s participation in such programs or activities.

I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any loss, cost, damage and/or expense of any nature, including all attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s participation in afterschool programs or activities.

I/We give permission for our son/daughter to participate in all Teton Literacy Center and Jackson Hole Children’s Museum afterschool activities and do forever indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any and all actions, all known and unknown personal injuries or property damage of said minor arising out of said activities, and also all claims or right of action for damages which said minor has or hereafter may acquire.

I also have made arrangements to secure timely pick up of my child at the conclusion of each scheduled program. I understand that Parents/guardians are responsible for providing student transportation to and from activities.

I have read, understand and agree to comply with the requirements of the policies and procedures listed above. I realize that failure to comply with these requirements may result in loss of my funded space within this program. I/we accept the risk and responsibility of participation in Teton Literacy Center and Jackson Hole Children’s Museum afterschool programs and we Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers from any liability.
Signature

Clear
Medical Treatment Consent
In the event of an emergency, I hereby certify that I am the parent/lawful guardian of {participantName}, and grant to Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers full authority to take whatever action they may consider appropriate under the circumstances involved regarding the health and safety of my child and authorize them to obtain emergency medical or dental services for my child, if necessary, at my expense. I further consent to transportation of the above named child to the nearest or most appropriated medical facility. I authorize the hospital and attending physicians to submit claims to the above named company and hereby assign benefits directly to this company. I understand that I am financially responsible to providers of service for charges not covered by any insurance payments.
Signature

Clear
Name of Primary Health Insurance
Group Number
Policy Number
Allergies
Does your child have a physical or psychological condition?
Is your child carrying medication we should know about?

Photography Consent
The Teton Literacy Center may photograph, interview or videotape my children to use for volunteer instruction, marketing purposes and/or program fundraising. Please indicate below whether your child’s writings or photograph may be used for these purposes:

Photographic Release. Participant does hereby grant and convey unto Teton Literacy Center all right, title, and interest in any and all photographic images, video and/or audio recordings made by TLC during the Participant's activities with TLC, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. I further grant to the Teton Literacy Center and its representatives the right to reproduce, use, exhibit, display, broadcast, distribute and create derivative works of these images and recordings in any media now known or later developed as well as my/their name for promoting, publicizing or explaining the Teton Literacy Center and its activities and for administrative or educational purposes.
Signature

Clear

Class Registration - Jackson Hole Children's Museum Based Programs (Open to JES, WES and KES Students Only)
Elementary students from JES, WES and KES are invited to join Teton Literacy Center in collaboration with Jackson Hole Children's Museum (JHCM) for afterschool clubs to be held at JHCM. Spaces will be filled based upon TLC's enrollment lottery.

JES students will be met in the JES cafeteria immediately following the school day. WES and KES parents will need to arrange transportation via TCSD's Activity Bus for transportation to the Recreation Center, where they will be met by JHCM staff.

All pickup will be at 5:00pm at Jackson Hole Children's Museum.
2nd - 4th Grade Students

Monday - Wonderland
Kinder - 1st Grade Students

Tuesday - Wonderland

Class Registration - Teton Literacy Center Based Programs (CES, WES, and KES Students Only)
Colter students will be met at the Colter Cafeteria immediately following the school day.

WES and KES parents will need to arrange transportation via TCSD's Activity Bus for transportation to the Gregory Lane@Pathway bus stop, where they will be met by a TLC staff member.

All pick up is at 5:00pm at Teton Literacy Center.
Kindergarten & 1st Grade Colter Students

Thursday - SPRINGing for STEAM
1st & 2nd Grade Colter Students

Tuesday - Mythology
3rd, 4th & 5th Grade Colter Students

Monday - SPRINGing for STEAM

Class Registration - Munger Mountain Elementary Based Programs (MMES Students Only)
Munger students will be met at Munger Cafeteria immediately following the school day. Pick up is at 5:00pm at Munger Elementary School.
Kindergarten - 1st Grade Munger Students

Thursday - Mythology
1st & 2nd Grade Munger Students

Wednesday - Mythology
1st, 2nd & 3rd Grade Munger Students

Thursday - SPRINGing for STEAM
3rd, 4th & 5th Grade Munger Students

Wednesday - SPRINGing for STEAM

Class Registration - Middle School Based Programs (Primarily for JHMS Students)
Our SPARK programming will not be scheduled for this Spring due to staffing shortages at TLC. However, please complete the Summer SOAR application for your middle school student by clicking on the "Apply for SOAR" button at the bottom of this page.

In the meantime, please consider enrolling your student in one of the following TLC programs meant to support your middle school student:
- Academic Mentorship
- THRIVE
- On-Demand Activities and Resources (found on our website)
- IXL
Please reach out to carisa@tetonliteracy.org with any questions you may have about these programmatic opportunities.

SOAR at TLC

Summer Opportunities in Academics and Recreation
SOAR is a free eight-week intensive summer program for students exiting Kindergarten through 7th grade this school year. SOAR consists of four weeks of full-day programming and four weeks of half day programming, designed to coincide with TCSD's Summer Camp.

Each student enrolled must commit to attending all eight weeks of SOAR.

Dates:

Full Day (9am-4:30pm) June 21st - July 15th (No programs on July 5th)

Half Day (3pm-5pm for K-5 & 1pm-3pm for 6-8) July 19th - August 12th

Please only apply for TLC's SOAR if you can commit to all 8 weeks of programs!
Would you like to apply for TLC's SOAR summer program?

Yes No

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

Yes No

Click submit in order to complete the application.

Participant Information
Participant Name

First Name Last Name
Gender

Male Female
Birth Date

Month Day Year
Grade 2020-2021
School Attending 2020-2021
TCSD Teacher

First Name Last Name

Participant Education Information
Does your child have an IEP?

Yes No
Is your child in the English Language Program with TCSD?

Yes No
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.
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Teton Literacy Center Consent, Release and Liability Wavier
I/we understand that my child’s participation in Teton Literacy Center and Jackson Hole Children’s Museum out of school programs is voluntary and that my child and I/we are free to choose not to participate. I understand that participation in voluntary out of school activities includes risk of injury that may range in severity from minor to disabling to even death. Although serious injuries are not common in supervised school programs, it is impossible to eliminate the risk.

I understand that Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers will not be liable for personal injuries and/or property damage as a result of my child’s participation in such programs or activities.

I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any loss, cost, damage and/or expense of any nature, including all attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s participation in afterschool programs or activities.

I/We give permission for our son/daughter to participate in all Teton Literacy Center and Jackson Hole Children’s Museum afterschool activities and do forever indemnify Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers, from any and all actions, all known and unknown personal injuries or property damage of said minor arising out of said activities, and also all claims or right of action for damages which said minor has or hereafter may acquire.

I also have made arrangements to secure timely pick up of my child at the conclusion of each scheduled program. I understand that Parents/guardians are responsible for providing student transportation to and from activities.

I have read, understand and agree to comply with the requirements of the policies and procedures listed above. I realize that failure to comply with these requirements may result in loss of my funded space within this program. I/we accept the risk and responsibility of participation in Teton Literacy Center and Jackson Hole Children’s Museum afterschool programs and we Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers from any liability.
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Medical Treatment Consent
In the event of an emergency, I hereby certify that I am the parent/lawful guardian of {participantName148}, and grant to Teton Literacy Center and Jackson Hole Children’s Museum, their employees, Board of Directors and volunteers full authority to take whatever action they may consider appropriate under the circumstances involved regarding the health and safety of my child and authorize them to obtain emergency medical or dental services for my child, if necessary, at my expense. I further consent to transportation of the above named child to the nearest or most appropriated medical facility. I authorize the hospital and attending physicians to submit claims to the above named company and hereby assign benefits directly to this company. I understand that I am financially responsible to providers of service for charges not covered by any insurance payments.
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Name of Primary Health Insurance
Group Number
Policy Number
Allergies
Does your child have a physical or psychological condition?
Is your child carrying medication we should know about?

Photography Consent
The Teton Literacy Center may photograph, interview or videotape my children to use for volunteer instruction, marketing purposes and/or program fundraising. Please indicate below whether your child’s writings or photograph may be used for these purposes:

Photographic Release. Participant does hereby grant and convey unto Teton Literacy Center all right, title, and interest in any and all photographic images, video and/or audio recordings made by TLC during the Participant's activities with TLC, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. I further grant to the Teton Literacy Center and its representatives the right to reproduce, use, exhibit, display, broadcast, distribute and create derivative works of these images and recordings in any media now known or later developed as well as my/their name for promoting, publicizing or explaining the Teton Literacy Center and its activities and for administrative or educational purposes.
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Class Registration - Jackson Hole Children's Museum Based Programs (Open to JES, WES and KES Students)
Elementary students from JES, WES and KES are invited to join Teton Literacy Center in collaboration with Jackson Hole Children's Museum (JHCM) for afterschool clubs to be held at JHCM. Spaces will be filled based upon TLC's enrollment lottery.

JES students will be met in the JES cafeteria immediately following the school day. WES and KES parents will need to arrange transportation via TCSD's Activity Bus for transportation to the Recreation Center, where they will be met by JHCM staff.

All pickup will be at 5:00pm at Jackson Hole Children's Museum.
2nd - 4th Grade Students

Monday - Wonderland
Kinder - 1st Grade Students

Tuesday - Wonderland

Class Registration - Teton Literacy Center Based Programs (CES, WES and KES students)
Colter students will be met at the Colter Cafeteria immediately following the school day.

WES and KES parents will need to arrange transportation via TCSD's Activity Bus for transportation to the Gregory Lane@Pathway bus stop, where they will be met by a TLC staff member.

All pick up is at 5:00pm at Teton Literacy Center.
Kindergarten & 1st Grade Colter Students

Thursday - SPRINGing for STEAM
1st & 2nd Grade Colter Students

Tuesday - Mythology
3rd, 4th & 5th Grade Colter Students

Monday - SPRINGing for STEAM

Class Registration - Munger Mountain Elementary Based Programs (MMES Students)
Munger students will be met at Munger Cafeteria immediately following the school day. Pick up is at 5:00pm at Munger Elementary School.
Kindergarten - 1st Grade Munger Students

Thursday - Mythology
1st & 2nd Grade Munger Students

Wednesday - Mythology
1st, 2nd & 3rd Grade Munger Students

Thursday - SPRINGing for STEAM
3rd, 4th & 5th Grade Munger Students

Wednesday - SPRINGing for STEAM

Class Registration - Middle School Based Programs (Primarily for JHMS Students)
Our SPARK programming will not be scheduled for this Spring due to staffing shortages at TLC. However, please complete the Summer SOAR application for your middle school student by clicking on the "Apply for SOAR" button at the bottom of this page.

In the meantime, please consider enrolling your student in one of the following TLC programs meant to support your middle school student:
- Academic Mentorship
- THRIVE
- On-Demand Activities and Resources (found on our website)
- IXL
Please reach out to carisa@tetonliteracy.org with any questions you may have about these programmatic opportunities.

SOAR at TLC

Summer Opportunities in Academics and Recreation
SOAR is a free eight-week intensive summer program for students exiting Kindergarten through 7th grade this school year. SOAR consists of four weeks of full-day programming and four weeks of half day programming, designed to coincide with TCSD's Summer Camp.

Each student enrolled must commit to attending all eight weeks of SOAR.

Dates:

Full Day (9am-4:30pm) June 21st - July 15th (No programs on July 5th)

Half Day (3pm-5pm for K-5 & 1pm-3pm for 6-8) July 19th - August 12th

Please only apply for TLC's SOAR if you can commit to all 8 weeks of programs!
Would you like to apply for TLC's SOAR summer program?

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Click submit in order to complete the application.
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TLC Program Application

COVID-19 Pandemic - TLC Spring and Summer Programs Subject to Change

Participant Information

Participant Education Information

Shared Information Consent

Family Information

Family Information

Emergency Contact

How will your child get to and from TLC programs?

Pick Up Consent

Policies and Procedures

Student Expectations

Teton Literacy Center Consent, Release and Liability Wavier

Medical Treatment Consent

Spring/Summer 2021 COVID-19 Program Participation Acknowledgement and Disclosure

Photography Consent

Jackson Hole Children's Museum Supplemental Information (JES, WES and KES Students Only)

Class Registration - Jackson Hole Children's Museum Based Programs (Open Only to JES, WES and KES Students)

Class Registration - Teton Literacy Center Based Programs (CES, WES and KES Students Only)

Class Registration - Munger Mountain Elementary Based Programs (MMES Students Only)

Class Registration - Middle School Based Programs (Primarily for JHMS Students)

SOAR at TLC

Multiple Student Registration

Click submit in order to complete the application.

Participant Information

Participant Education Information

Shared Information Consent

Teton Literacy Center Consent, Release and Liability Wavier

Medical Treatment Consent

Photography Consent

Class Registration - Jackson Hole Children's Museum Based Programs (Open to JES, WES and KES Students Only)

Class Registration - Teton Literacy Center Based Programs (CES, WES, and KES Students Only)

Class Registration - Munger Mountain Elementary Based Programs (MMES Students Only)

Class Registration - Middle School Based Programs (Primarily for JHMS Students)

SOAR at TLC

Multiple Student Registration

Click submit in order to complete the application.

Participant Information

Participant Education Information

Shared Information Consent

Teton Literacy Center Consent, Release and Liability Wavier

Medical Treatment Consent

Photography Consent

Class Registration - Jackson Hole Children's Museum Based Programs (Open to JES, WES and KES Students)

Class Registration - Teton Literacy Center Based Programs (CES, WES and KES students)

Class Registration - Munger Mountain Elementary Based Programs (MMES Students)

Class Registration - Middle School Based Programs (Primarily for JHMS Students)

SOAR at TLC

Click submit in order to complete the application.