Community Kids Hubs Enrollment Form

Community Kids Hubs for Grades K to 4

We are so excited to meet you and your child! Please complete the enrollment form below and a Community Kids Hubs staff member will contact you. Parents, we will use communication tools by phone calls, text messages and emails to keep you informed of daily progress and if there are any concerns. We look forward to working with your student and you to make this a productive, educational and positive social experience for ALL participants. Contact information is below, please feel free to call us with any questions!

Project Coordinator: Kara Finkel, 724-257-1638 (call or text)

2023 - 2024 Afterschool Sessions will begin Tuesday, Sept. 5.

Community Kids Hubs only operate on full days of school on the Highlands SD calendar from 3:30 PM to 6:30 PM.

Community Kids Hubs Enrollment Form

Student Name (Last, First)

Preferred Name / Nickname

Gender

Grade

School

Please list any allergies or medical concerns. If none, mark N/A

Date of Birth

Teacher

Who may your child be released to? (Must show ID)

Transportation

My child needs transported home and I consent to transportation.

My child does not need transported home.

I consent to my child being transported for field trips.

I do not consent to my child being transported for field trips.

Address

Parent Name (Last, First)

Phone

Parent Name (Last, First)

Phone

Emergency Contact Name (Last, First)

Phone

At the Community Learning Hubs, we will be interacting with your student, class and teacher while assisting students in academic goals. In order to have the most impact and be of the most assistance, we may need to speak to your teacher about your student’s assignments, learning challenges or missing work. Hub staff will not discuss your child/children’s academic record, attendance, challenges or other personal information outside of class or with anyone other than you (parent / guardian) and the child’s teacher(s). I authorize Highlands School District to release information contained in my student’s file. This information may include assessment results, attendance, demographics, goals and all programmatic paperwork. I understand that the information will help the interdisciplinary team in implementing my educational plan. I understand that the information may be shared in dialog in both oral and written form. My educational team consists of the following persons: Highlands Partnership Network Community Learning Hubs staff (Instructors, support staff) Additionally, this program is funded through Allegheny County Department of Children’s Initiatives program funds. In order to be accountable for this funding, we collect attendance and demographic data. Please review the following: I consent to share my child/children’s name, school attended, grade level, date of birth, and days attended with Department of Human Services (DHS) and Department of Children’s Initiatives (DCI) for data purposes. I understand that this information will be shared in order to secure appropriate data to fund my child/children appropriately for the 2023-2024 School Year Session. I understand that legally I am NOT required to consent to the release of information. I voluntarily give permission in order to help my educational team provide the best service to me. This release expires one (1) year from the date of the signature and I may request permission to be revoked at any time.

I REVIEWED THIS WITH MY CHILD: We want to make sure everyone has a safe and clean space to learn. Please review the Code of Conduct and help your student understand these are important at the Community Kids Hubs: We use nice words. We keep our hands to ourselves. We wash our hands. We respect our teachers and their helpers. We tell an adult if we have a problem. We respect and clean up our spaces. We do not come to Hubs if we are experiencing a fever, cough, cold or flu symptoms. We are honest. We like to have fun!

Thank you! We’ll be in touch.