St. Lucie Public Schools

Application for 21st Century Community Learning Center Program

This program is being offered to your child to improve his/her math, reading, writing, and science skills. The after-school program will consist of project-based learning incorporating academics and extracurricular/personal enrichment activities. Reading, Writing, and STEM (Science, Technology, Engineering, and Math), will be taught through project-based learning. Students will work collaboratively to investigate, research, and employ the 21st century skills learned in order to complete a variety of projects throughout the year. Students will also be provided time to work on homework and participate in extracurricular activities such as sports, arts, tutorials, and mentoring activities.

The session is from

The program will be offered

Each student will be provided with breakfast upon arrival and lunch prior to dismissal. Meals will be served at no cost to the parent/student(s). Seats in our program are limited and are offered on a first come first serve basis. If our numbers are more than we are able to accommodate, your child will be placed on a waiting list. Please note the rules that are listed below:

Transportation is provided for students participating in the program. If your child walks home, please send in a note stating this.
If your child signs up, attendance is mandatory unless absent from school on that day. A note from the parent must be brought in when absent.
No student will be allowed to leave campus without written notification (from the parent) to the site coordinator. Parents will need to sign students out in the office if picking up early.
Students are bound to the St Lucie Public Schools Code of Student Conduct during their participation in the 21st CCLC. https://www.stlucie.k12.fl.us/pdf/CodeofConduct.pdf
Disruptive behavior will result in termination from the program – no exceptions. Students must respect their peers, faculty and staff.
Parent involvement is a key part of the 21st CCLC program. You are expected to attend at least two parent nights.
Students must be picked up by the specified time below each evening. After 3 late pickups, they will be terminated from the program.

Specified Pickup Time:

Application for 21st Century After-school Program

Student Name*

Birth Date*

Homeroom Teacher*

Grade*

ID# (56 number)*

Does the child have siblings attending this school?*

Yes

Siblings Attending This School*

Student Receives Services In

Exceptional Student Education (ESE)

English as Second Language (ESOL)

Home Address*

Parent Name*

Parent Home Phone*

Cell*

Work*

Emergency Contact*

Phone*

Special Comments Regarding Medications or Health Issues

Persons Authorized to Pick Student Up*

If you wish to receive communication by email, please provide an email address

I have thoroughly read and discussed the requirements and rules on this application with my child and will uphold these throughout the year. I understand that my child must be picked up on time each day. After 3 late pickups, he/she/they may be terminated from the program.

The Parent/Guardian must acknowledge this agreement.*

I Agree

RELEASE OF INFORMATION

I agree that the following information may be released for my child (Failure to check “NO” may result in the release of information):

My child’s name, photo, voice & video to the press for recognition or news purposes.*

Yes

My child’s name, photo, voice & video for publicly accessible school or district websites or broadcast.*

Yes

My child’s name, photo, voice & video for publicly accessible Florida Department of Education or 21st CCLC websites or broadcast.*

Yes

My child’s name, photo, and contact information to the yearbook photographers.*

Yes

My child’s directory information (student’s name and grade)*

Yes

The Parent/Guardian must acknowledge this agreement.*

I Agree

This field should be left blank

21 Century Application

St. Lucie Public Schools

Application for 21st Century Community Learning Center Program