The Teen Spot Enrollmen...

The Teen Spot for Grades 6 to 12

We are so excited to meet you and your youth! Please complete the enrollment form below, and a staff member will contact you. Parents, we will use communication tools such as phone calls, text messages, and emails to keep you informed of upcoming activities, events, and opportunities. 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 call us with any questions!

Highlands Partnership Network 412-274-0783

2024 - 2025 Afterschool Sessions will begin Tuesday, August 27, 2024.

The Spot only operates on full days of school on the Highlands SD calendar from 3 PM to 6 PM at

1005 Idaho Avenue, Natrona Heights PA 15065.

The Spot Enrollment Form

Student Name (Last, First)

Preferred Name / Nickname

Gender

Grade

School

Please list any allergies or medical concerns.

Date of Birth

List any academic or social challenges we can help with!

Transportation

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

Email Address

Parent Name (Last, First)

Phone

Email Address

Emergency Contact Name (Last, First)

Phone

On occasion, our program coordinator will share our activities and program projects on the program website, social media accounts, and in presentations to our funders with the use of activity descriptions and participant photos. Students will be made aware of when photographs will be taken, and will have the opportunity to opt out of photos at all times. I give permission for my student to be photographed for use on Highlands Partnership Network accounts, publications and activity promotions.

At “The Spot”, we will be interacting with your student, class and teacher to support them in achieving their academic, post-secondary, future career and attendance 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, upcoming tests or other academic goals. “The Spot” staff will not discuss your child/children’s academic record, attendance, challenges or other personal information outside of the program or with anyone other than you (parent / guardian) and the student’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 The Spot for Teens staff (Instructors, support staff) Additionally, this program is funded through Allegheny County Department of Human Services Out-of-School Time 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 The Department of Human Services (DHS) for data tracking purposes. I understand that this information will be shared with DHS in order to secure appropriate data to fund my child/children appropriately throughout the sessions. 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 give consent for my child to participate in The Teen Spot afterschool program that has been designed to support our community’s youth with their academic goals, future plans, social wellness, health goals and cultural identity. The program is available during the school year and in the summer. It is headquartered at 1003 Idaho Avenue, Natrona Heights PA 15065. Planned activities, projects and informational sessions through the program year may include, but is not limited to: Mentoring / Tutoring (All staff and volunteers have required clearances and training) Drivers Education (separate parent permission forms will be required; student academic and attendance goals must be met) Allegheny County Health Department Presentations / Information (sex education; intimate partner violence awareness; overdose prevention; addiction awareness; drug use prevention) Physical and Mental Health Awareness (support groups) Arts Education (music, art) Field trips (will require permission form when scheduled to participate)

I give consent to any medical care and the administration of anesthesia determined by a medical professional to be necessary for the welfare of my child while said child is under the care of The Teen Spot and I am not reasonably available by telephone to give consent.

The Spot Behavior and Discipline Agreement

Behavior and discipline are collaborative efforts by the parents, guardians, kids, and staff. The focus of The Spot Behavior and Discipline Agreement is to promote positive behavior choices by recognizing kids who engage in consistent positive behavior. However, mistakes are a natural part of growth. We help our teens reflect on errors in judgment and behavior and support them in learning how to make better decisions. We teach and model positive behavior including listening, cooperation, and mutual respect. We encourage the kids to make independent decisions and act responsibly towards others and with property. When this occurs, we believe that a very positive and productive environment will result, enabling these kids to strive for excellence.

Examples of Unwelcome Behaviors:

MINOR:

Inappropriate clothing

Pushing and/or running

Talking/using phone during presentations

Loud disruptive behavior outside of the building

Lying

Teasing

Not signing in

MIDDLE:

Disrespecting Staff
Inappropriate representation of The Spot
Leaving and returning
Smoking/Vaping
Inappropriate language

Eating in areas were prohibited

Inappropriate use of electronic equipment

MAJOR

Weapons
Fighting/Physical aggression
Inappropriate use of emergency equipment

Sexual Behavior

Use of or under the influence of drugs and alcohol

Racism & other forms of discrimination

Defacing property

Theft

Threats of violence

Vandalism

Bullying

Examples of disciplinary actions:

Referral to program board for review and action plan

Home contact made by staff

Meeting with parents

Program suspension

Written/verbal apology to offended parties before return to the program

NOTE: The Spot staff reserves the right to expedite the disciplinary action pending circumstances

I have read and undrestand The Spot Behavior and Discipline Agreement

Your Signature

Select a date

Thank you! We’ll be in touch.