GTCHS Smart Center - Salvation Army Boys & Girls Clubs

GTCHS Smart Center - Salvation Army Boys & Girls Clubs

2015 - 2016 Membership Application (One Student Per Application)

The application site is Greenville Tech Charter High School (GTCHS).

Hours of operation: 2:45-5:45, M-Th

Starting date: Monday, august 29, 2016

Please make checks payable to GTCHS.

The GTCHS Smart Center fee is $200.00 per student for the year. This includes membership to the Salvation Army Boys & Girls Clubs and access to the Kroc Center facilities.

Child’s full name: ______Nickname:______Age:______

Address:______City/State______Zip:______

Date of Birth:______

PARENT OR GUARDIAN INFORMATION

Mother’s name:______Employer______

Work Phone: ( )______ext.______CELL: ______

Mother’s email:______

Father’s name: ______Employer ______

Work Phone: ______ext.______CELL: ______

Father’s email:______

EMERGENCY CONTACTS

In the event of an emergency the following people should be called after attempts to contact the primary Guardian(s) have been unsuccessful. NOTE: It is very important that emergency contacts are aware that the GTCHS Smart Center, in the event of an emergency, may contact them. APPLICATIONS WILL NOT BE ACCEPTED WITHOUTH EMERGENCY INFORMATION!

Name______CELL:______Relationship______

MEDICAL INFORMATION:

Family Doctor Name:______Phone______

Preferred Hospital:______

What medication(s) is your child taking:______

______

Allergies:______

Severe Allergy to:______Epipen On Person? Yes______No______

Asthma:______Inhaler on person? Yes______No______

Is your child able to participate in physical activity? If not, please explain: ______

______

Parent/guardian signature:______Date:______

Please see the guidelines to be signed on the reverse side.

Smart Center Guidelines

Please review the following Smart Center guidelines and sign that you understand and will abide by them. Applications will not be accepted without signed guidelines. Thank you!

· Unless a student is seeing a teacher, he/she should come straight to the Smart Center after school. If a student is seeing a teacher, he/she must get a signed pass, with the date and time, when finished and then come straight to the Smart Center. Students are not permitted to go anywhere else before coming to Smart Center. Students who come late without a note will not be allowed to stay in Smart Center. Any location other than a teacher’s classroom, the Smart Center, or the student pick-up area is off limits. Students in off-limits areas will receive a referral.

· To ensure the safety of students, students must check in with a Smart Center teacher before leaving, and students are not to leave the Smart Center until their rides have arrived. Once a student leaves the Smart Center to be picked up, he/she should not be anywhere other than the student pick-up location. Students who are driving must leave campus immediately after leaving the Smart Center.

· The Smart Center is a resource for students to benefit from extra help in studying and completing assignments. Anyone in the Smart Center who becomes a distraction to others and will be asked to leave.

· Smart Center students are to be in GTCHS dress code at all times.

· Smart Center students are to remain in the MPR at all times unless given permission to leave. This includes walking out into the lobby for any reason.

· Laptop computers are for academic use only. Students may sign out computers to complete assignments or testing practice. Students not involved in one of these activities should not be on a computer.

· No food or drink is allowed while using the computers.

· Cell phones are allowed only for academic reasons or to contact parents. Cell phone use that becomes disruptive or distracting will result in the phone being confiscated and turned over to GTCHS administration.

· Students who do not abide by these guidelines will not be allowed to attend Smart Center.