Full Name // Nombre Completo
*
First Name
Last Name
Date of Birth // Fecha de Nacimiento
*
MM
DD
YYYY
School // Escuela
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Kennett Middle School
Kennett High School
Avon Grove Intermediate
Fred S. Engle Middle School
Avon Grove High School
Avon Grove Charter School
Other
Grade // Grado
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6th
7th
8th
9th
10th
11th
12th
Student ID // ID de Escuela
Student Cell Phone // Teléfono Celular del Estudiante
(###)
###
####
Skyward/Powerschool Username // Nombre de Usario de Skyward/Powerschool
Skyward/Powerschool Password // Contraseña de Skyward/Powerschool
Student Email // Correo Electrónico del Estudiante
Home Address // Dirección de Domicilio
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Parent or Guardian Name // Nombre de Contacto Primario
*
First Name
Last Name
Relationship // Relación
*
Preferred Language // Idioma Preferido
*
English
Español
Other
Cell Phone Number // Número Celular
*
(###)
###
####
E-mail // Correo Electrónico
Preferred Communication // Comunicación Preferido
Emergency Contact Name // Nombre de Contacto de Emergencia
Relationship // Relación
Preferred Language // Idioma Preferido
English
Español
Cell Phone Number // Número Celular
(###)
###
####
Email // Correo Electrónico
Preferred Communication // Comunicación Preferido
Allergies or Medical Conditions // Alergias o otras condiciones médicas
*
Does your child carry an EPIPen? // ¿Su hijo tiene un EPI Pen?
*
Is The Garage authorized to approve medical treatment? // ¿ El Garage está autorizado para aprobar el tratamiento médico?
*
Is your child covered by personal/family medical insurance? // ¿Su hijo está cubierto por un seguro médico personal?
*
If Yes, Name of Insurer // En caso de afirmativo, nombre de la aseguaradora:
Policy or Group Number // El numero de la póliza o el grupo:
Is your child eligible to receive free or reduced lunch? // ¿Su hijo es elegible para recibir almuerzo escolar gratuito o reducido?
*
Is your child currently enrolled in an ELL/ESL program? // Su hijo está inscrito en un programa de ELL/ESL?
Does your child have a current IEP or 504 Plan? // Su hijo tiene un plan IEP o un Plan 504?
Ethnicity // Etnicidad
Caucasian // Caucásico
African-American // Afroamericano
Latino
Mixed-Race // Raza Mixta
How many people live in your household? // ¿Cuántas personas viven en su hogar?
*
1
2
3
4
5
6
7
8
8+
How long has the student lived in the U.S.? // ¿Cuánto tiempo ha vivido el estudiante en los Estados Unidos?
Born here // Nací Aquí
0-3 years/años
4-6 years/años
7-10 years/años
10+ years/años
Did the student’s parents graduate from high school? // Los padres del estudiante se graduaron de la escuela secundaria?
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Neither / Ninguno
One parent / Un Padre
Both parents / Ambos Padres
I don’t know / No Sé
Did the student’s parents graduate from college? // ¿Los padres del estudiante se graduaron de la universidad?
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Neither / Ninguno
One parent / Un Padre
Both parents / Ambos Padres
I don’t know / No Sé
Photo Release // Lanzamiento de Fotos
*
Mark yes if The Garage is authorized to use pictures of your child for publicity? // ¿Pone sí, si el Garage está autorizado a usar fotos de su hijo para publicidad?
Report Card and Grade Release // Libreta de Calificaciones y Liberación de Calificaciones
*
To better support your child’s academic efforts, we request a copy of your child’s grades be sent to our office. All report cards are confidential and will be seen only by Garage staff and a volunteer tutor or mentor. Is The Garage authorized to receive a copy of your child’s grades? // Para apoyar mejor los esfuerzos académicos de su hijo, solicitamos que se envíe una copia de las calificaciones de su hijo a nuestra oficina. Todas las boletas de calificaciones son confidenciales y serán vistas solo por el personal del Garage, el tutor o los mentores voluntarios. ¿El Garage está autorizado para recibir un copy de las calificaciones de su hijo?
School Advocacy Release // Comunicado de Defensa Escolar
*
I am the parent or legal guardian of the above-mentioned student and hereby authorize the Garage and the Kennett Consolidated School District or the Avon Grove Area School District to receive and disclose any information that addresses my child’s social, emotional, academic, or career-related progress. // Yo, el padre o tutor legal del estudiante mencionado anteriormente, por la presente autorizo al Garage, y al Distrito Escolar Consolidado de Kennett o al Distrito Escolar del Área de Avon Grove, a recibir y divulgar cualquier información que sea útil para abordar el progreso social, emocional, académico o profesional de mi hijo.
Body Shop Release // Lanzamiento de Body Shop
I acknowledge that participation in weight lifting and physical fitness activities involves risk to the student and may result in various types of injury. I accept personal financial responsibility for any injury or other loss sustained during Body Shop activities, as well as for any medical treatment rendered to the student that is authorized by The Garage. I release and promise to indemnify, defend, and hold harmless the activity sponsor any injury arising, directly or indirectly, out of the described activity, or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise.
Reconozco que la participación en actividades de levantamiento de pesas y acondicionamiento físico implica un riesgo para el estudiante y puede resultar en varios tipos de lesiones. Acepto la responsabilidad financiera personal por cualquier lesión o otra pérdida sufrida durante las actividades de Body Shop, así como por cualquier tratamiento médico brindado al estudiante que esté autorizado por El Garage. Libero y prometo indemnizar, defender y eximir de responsabilidad al patrocinador de la actividad de cualquier lesión que surja, directa o indirectamente, de la actividad descrita, o del transporte hacia y desde la actividad, ya sea que dicha lesión surja de la negligencia del patrocinador de la actividad, el participante, o de otra manera.
Makerspace Release // Lanzamiento de Makerspace
I acknowledge that participation in Makerspace activities involves risk to the student and may result in various types of injury. I accept personal financial responsibility for any injury or other loss sustained during use of power tools, kiln, or other Makerspace equipment, as well as for any medical treatment rendered to the student that is authorized by The Garage. I release and promise to indemnify, defend, and hold harmless the activity sponsor any injury arising, directly or indirectly, out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise.
Reconozco que la participación en las actividades de Makerspace implica un riesgo para el estudiante y puede resultar en varios tipos de lesiones. Acepto la responsabilidad financiera personal por cualquier lesión u otra pérdida sufrida durante el uso de herramientas eléctricas, hornos u otros equipos de Makerspace, así como por cualquier tratamiento médico brindado al estudiante que esté autorizado por The Garage. Libero y prometo indemnizar, defender y eximir de responsabilidad al patrocinador de la actividad de cualquier lesión que surja, directa o indirectamente, de la actividad descrita o del transporte hacia y desde la actividad, ya sea que dicha lesión surja de la negligencia del patrocinador de la actividad, el participante, o de otra manera.
Transportation Release - Local // Liberación de Transporte - Local
*
I consent to allow my child to ride Garage/District provided transportation (via Krapf, Garage van, staff/volunteer cars) to/from the Garage, community service, or other local activities. // Doy mi consentimiento para permitir que mi hijo viaje en El Garage / distrito proporcionando transporte (a través de Krapf, furgoneta del Garage, personal / coches voluntarios) hacía / desde el Garage, servicio comunitario, u otras actividades locales.
Transportation Release - To Home // Liberación de Transporte - A Casa
*
The Garage provides transportation home for our students who do not live within walking distance of the Garage. Would you like the Garage to drive your student home after programming? *We aim to maintain the integrity of our programs, therefore we enforce that each student who rides the bus home must participate in both homework hour and daily activity.* // El Garage ofrece transporte a casa para nuestros estudiantes que no viven a una corta distancia a pie del Garage. ¿Le gustaría que el Garage lleve a su estudiante a casa después de la programación? *Nuestro objetivo es mantener la integridad de nuestros programas, por lo tanto, vamos a hacer cumplir que cada estudiante que viaja en la furgoneta del Garage o autobús must participar en la hora de la tarea y la actividad diaria.*
If your student will be missing program due to family vacation, please indicate the dates they would be missing: // Si su estudiante faltará al programa debido a vacaciones familiares, indique las fechas en las que faltará:
Participation Agreement // Acuerdo de Participación
I acknowledge that participation in the activity described above involves risk to the Participant (and to Participant’s parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage. In consideration for the opportunity to participate in the activity described above (the “Activity”), the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the Activity. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activity or during transportation to and from the activity, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the “Activity Sponsor”). Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.
**Out of concern for our students, staff, and volunteers’ safety, The Garage will continue to operate in accordance with all CDC guidelines, and school district regulations, regarding COVID-19, as well as maintain cleaning and sanitizing practices.**
Reconozco que la participación en la actividad descrita anteriormente implica un riesgo para el Participante (y para los padres o tutores del Participante, si el Participante es menor de edad), y puede resultar en varios tipos de lesiones, incluyendo, pero no limitado a, los siguientes: enfermedad, lesiones corporales, muerte, lesiones emocionales, lesiones personales, daños a la propiedad y daños financieros. En consideración a la oportunidad de participar en la actividad descrita anteriormente (la "Actividad"), el Participante (o padre/tutor si el participante es menor de edad) reconoce y acepta los riesgos de lesiones asociados con la participación y el transporte hacia y desde la Actividad. El Participante (o padre/tutor) acepta la responsabilidad financiera personal por cualquier lesión u otra pérdida sustained durante la Actividad o durante el transporte hacia y desde la actividad, así como por cualquier tratamiento médico prestado al Participante que esté autorizado por el Patrocinador o sus agentes, empleados, voluntarios o cualquier otro representante (colectivamente denominado en lo sucesivo el "Patrocinador de la Actividad"). Además, el Participante (o padre/tutor) libera y promete indemnizar, defender y eximir de responsabilidad al Patrocinador de la Actividad por cualquier lesión que surja directa o indirectamente de la Actividad descrita o del transporte hacia y desde la Actividad, ya sea que dicha lesión surja de la negligencia del Patrocinador de la Actividad, el Participante o de otra manera. Si surge una disputa sobre este acuerdo o cualquier reclamo por daños y perjuicios, el Participante (o padre/tutor)agre es para resolver el asunto a través de un proceso alternativo de resolución de disputas mutuamente aceptable. Si el Participante (o padre/tutor) y el Patrocinador de la Actividad no pueden ponerse de acuerdo sobre dicho proceso, la disputa se someterá a un panel de arbitraje de tres miembros para su resolución de conformidad con las reglas de la Asociación Americana de Arbitraje.
**Por preocupaciones de la seguridad de nuestro personal, estudiantes, y voluntarios, El Garage va a funcionar conforme a las recomendaciones del CDC, y el distrito de la escuela, con respeto a COVID-19, y también mantenemos las prácticas de limpieza y desinfección.**
Code of Conduct & Expectations
The Garage aims to provide academic, vocational, social-emotional guidance, to be a safe and welcoming community, and to advocate on behalf of our youth and their families. While at The Garage, students should maintain a positive attitude, strive to work on their academics, seek support for vocational and educational opportunities, build healthy relationships, and seek support and resources from The Garage and other organizations in the community. In an effort to maintain a healthy environment and to further the mission of The Garage, any student that consistently demonstrates an attitude that is in opposition to the mission and values of The Garage may be asked to leave The Garage.
The Garage expects that all students, volunteers, and staff adhere to our code of conduct and expectations while participating in Garage programming. If a student violates the code of conduct or expectations of The Garage, they will first 1) be given a formal warning, followed by 2) a one day suspension from The Garage, then 3) a week suspension, and if there are continued violations 4) a student might be permanently removed from the program. Parents will always be alerted if disciplinary action is taken on a student.
- Students are expected to attend all Garage daily, planned programming, including homework hour and daily activity. Students that refuse to participate will not be permitted to ride the bus home and will need to have a parent come and pick them up. If a student lives within walking distance of The Garage, and refuses to participate, they will be asked to go home and their parents will be contacted.
- There is no consumption or possession of: tobacco/vaping products or paraphernalia, alcohol, and/or drugs during programming hours as well as inside or outside of Garage facilities (building, vehicles, etc.). The Garage has the discretion to search any students that are suspected of possessing, or consuming, tobacco/vaping products, alcohol, or drugs.
- The Garage has a zero tolerance for bullying. Instances of bullying should be reported to Garage staff as soon as they are observed, and will be addressed immediately.
- There is no explicit language permitted during Garage programming.
Students may not leave the building or other Garage areas (including field trips) without parent permission or without being accompanied by a Garage staff or volunteer. This includes students wanting to go home with another student.
- There is no inappropriate touching, fighting, or other forms of physical contact towards any student, volunteer, or staff.
- The Garage follows the school district’s dress code, so any clothing deemed inappropriate at school is also not permitted at The Garage. If someone arrives at The Garage with clothing deemed inappropriate, Garage staff can decide to ask that student to change or be picked up by a parent.
- The Garage provides free forms of technology to benefit students in their learning. Use of Garage technology is, first and foremost, to be used constructively; recreational use of Garage technology is at the discretion of Garage staff. Garage technology is never to be used for: chat rooms, pornography, or other scenarios deemed inapproprate or unsafe by Garage staff or volunteers.
- In an effort to maintain the integrity of Garage programming, Garage staff will collect phones during program time. Students will not be permitted to have their phones until they leave at the end of the day. If a parent needs to contact their child while at The Garage, Kennett parents can contact Jamie Wagner, and Avon Grove parents can contact Esmeralda Carrillo. Any student who refuses to turn in their cell phone will be asked to go home.
I have read the participation agreement, expectations, and code of conduct. // He leído el acuerdo de participación, las expectativas, y el código de conducta.
*
Parent Signature // Firma del Padre
First Name
Last Name
I agree to uphold this participation agreement, expectations, and code of conduct. // Estoy de acuerdo en mantener este acuerdo de participación, expectativas, y código de conducta.
*
Student Signature // Firma del Estudiante
First Name
Last Name
How did you hear about The Garage? // ¿Cómo te enteraste del Garage?
