2020-2021 Fall Student Registration Form
Welcome families to the 2020-2021 school year! We are very excited to start our Fall Virtual Programs September 8, 2020, and to see your scholars back in programs again. Bienvenidos padres y alumnos a nuestro año escolar 2020-2021! iEstamos super emocionados de anunciar que nuestros programas de despues de escuela seran virtualesy iniciaremos septiembre 8.! No se pierda la oportunidad ya que 21st Century ofrecera programas de alta calidad este año.
For Fall 2020, all 21st Century programs will be virtual. There is not an in-person option at this time. Please indicate below how you want your child to participate in 21st Century this year. / Nuestros programas iniciaran virtuales, hay la posibilidad que regresemos a los salosnes de clases. Nos gustaria saber su decision
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I want my child to start virtual programming until further notice./Mi hijo(a) participara Solamente en programas virtuales, y ya que regresen a salones de clases seguiremos participando.
I want my child to ONLY participate virtual even if in person program is offered later in the year./Queremos participar UNICAMENTE en clases virtuales, aunque se regrese a clases mas adelante.
I am currently NOT interested that my child participates virtual, we will wait until in person/Por el momento NO estaremos particpando virtual, nos esperaremos a cuando regresen a los salones de clases.
Student Name #1/Nombre de Alumno(a)
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First Name
Middle Name
Last Name
Birth Date/Fecha de Nacimiento
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Gender/Genero
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Please Select
Male
Female
N/A
Student Grade /Grado Actual
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Please Select
kinder
1st
2nd
3rd
4th
5th
Please list any health concerns your child may have (allergies, illnesses, prescribed medications). / Favor de informarnos si su hijo/a tiene algun progrema de salud(alergias,enfermedades,medicamentos)
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PLease rate 1, 2 3 4, 5 for your top choices.Students in the grades K-2 will have the option to choose from these 4 activities, Please choose 3. If a class gets filled up, your child will be placed in the secind choice, or third.
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Students in the grades K-2 will have the option to choose from these 4 activities, Please choose 3. If a class gets filled up, your child will be placed in the secind choice, or third./Alumnos de k-2 tendran la oportunidad the seleccionar 3 actividades, en caso que las clases esten a capacidad, se le asignara a la 2a o 3a opcion.
Dance (22 spots)
arts and crafts (25 spots)
Cooking/Recipe Club (25 spots)
Soccer/Fitness (25 spots available)
Folklorico (22 spots available)
Address/Direcion
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Next
Do you have have another child that you want to register in 21st Century programs? /Desea registrar a otro alumno(a) a nuestros programas? *Esta aplicacion, puede registar 2 alumnos solamente*
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Yes.
No
Student Name #2
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First Name
Middle Name
Last Name
Birth Date/ Fecha de Nacimiento
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Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender/genero
*
Please Select
Male
Female
N/A
Student Grade/ Grado Actual
Please Select
kinder
1st
2nd
3rd
4th
5th
Students's Age/ Edad de alumno(a)
Please list any health concerns your child may have (allergies, illnesses, prescribed medications). / Favor de informarnos si su hijo/a tiene algun progrema de salud(alergias,enfermedades,medicamentos)
Students in the grades K-2 will have the option to choose from these 4 activities, Please choose 3. If a class gets filled up, your child will be placed in the secind choice, or third.
Dance (22 spots)
arts and crafts (22 spots)
soccer/fitness (25 spots)
Cooking/ Recipe Club (25 spots available)
Folklorico (22 spots available)
PLease rate 1, 2 3 4, 5 for your top choices.
Back
Next
Parent/Guardian Information
Informacion de padre de familia o guardian.
Parent #1
First Name/Primer nombre
Middle Name/
Last Name
Mobile Number/Numero de telefono
Parent Email Address/Correo Electronico
example@example.com
Parent #2
First Name
Middle Name
Last Name
Phone Number/Numer de telefono
Parent Email Address/Correo Electronico
example@example.com
Emergency Contact and Transportation Information
In the event that we return to campus and in-person programming, we will need to have a record of your child's approved emergency contacts. Please complete the information below.En caso de regresar al salon de clases y programas en persona, nos gustaria colectar la informacion de contactos de emergencia.
Emergency Contact #1 /Contacto de emergencia #1
Relationship to Student/relacion al alumno(a)
Contact Phone Number/Numero de telefono
Emergency Contact #2/Contacto de emergencia #2
Relationship to Student/relacion al alumno(a)
Contact Phone Number/Numero de telefono
Emergency Contact #3
Relationship to Student/relacion al alumno(a)
Contact Phone Number/Numero de telefono
How is it that your child gets home?/Como es que su hijo(a) llega a casa.
Please Select
Bus
Walk
Car pick-up / Daycare pick-up
**PLEASE READ THE FOLLOWING BEHAVIOR POLICY EXPECTATIONS CAREFULLY. CHECK EACH BOX TO ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTAND AND SUPPORT YOUR CHILD'S APPROPRIATE BEHAVIOR WHILE THEY PARTICIPATE IN 21ST CENTURY**/ Favor de leer la poliza de comportamiento, y expectativas. Yo me comprometo y entiendo que mi hijo(a) de de tener buena coducata para participar en nuestros programas de 21st Century.
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I understand that if my child does not follow the rules, he or she will receive a verbal warning, and notification of that warning will be sent home. / Entiendo que si mi niño/a nosigue las reglas él o ella recibe una advertencia verbal.
I understand that if the behavior issues continue, I will receive a phone call about my child's behavior. / Entiendo que si la mala conducta continúa,recibiré una llamada telefónica sobre mi hijo(a)
I understand that if the behavior issues continue after the phone call, my child will be dismissed from the program. / Entiendo que si el problema continúa, despedirána mi hijo(a) del programa.
I understand that fighting and/or inappropriate behavior will result in immediate dismissal from the program. I hereby give permission for the participant(s) listed in this application to take part in Texas 21st Century activities. / Entiendo que el pelear y el comportamiento inadecuadodarán lugar a despido inmediato de el programa.YO le doy permiso a mi hijo (a) departicipar en el programa Tejas ACE, que consiste de asistencia académica, y recreación y deporte.
I understand that because this program is grant funded, my child will commit to attending programs 2-5 times a week./Yo me comprometo a que mi hijo(a) asistan a los programas 2-5 dias a la semana.
I understand that if my child does not participate virtually, they may not be eligible for in-person programming, if that becomes available./Yo entiendo que si mi hijo(a) no participa en los programas virtuales, puede que no sea elegido para los programas ya que regresemos a la escuela.
Signature/Firma
Date/Fecha
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Month
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Day
Year
Date
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