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Nathan Hale Junior High

January 22 – April 4, 2019 4:20 PM – 6 PM What is the AfterOpp? This spring we are piloting a new concept for Tulsa – an after-school “campus” of activities for junior high students at selected schools. Through this FREE pilot, youth will enjoy fun, safe after-school programs — ranging from sports, arts and music, to hands-on science -- in the AfterOpp, a partnership with Hale Junior High School, Youth At Heart, and The Opportunity Project. We'd like your student to be one of them! And the AfterOpp always welcomes families and guardians as guests into the program – just check with your sight coordinator. Youth in the AfterOpp will enjoy: • High quality, safe programs offered by experienced program providers from some of Tulsa’s best organizations, teachers, and trained youth workers. • A healthy snack at the start of the program. Junior high students who regularly attend high-quality after-school programs attend school more, do better in math, want to learn during the school day and have better relationships with their teachers and other adults. Students who participate regularly during junior high graduate from high school at a higher rate than their peers, and the activities prepare them for success in careers and college. Please note that students are enrolled on a “first-come, first-served” basis, so the sooner your student returns this brochure, the more likely they are to have a spot. We can’t guarantee that students will be enrolled in programs they select, but we will offer other available programs similar to their choice program or put them on a waiting list for their choice programs. Families will receive a phone call letting them know if their student has been accepted for particular programs. • Youth are required to attend ALL days their particular programs meet, and those who have more than two

unexcused absences or who do not comply with AfterOpp code of conduct can be removed from programs and their slots offered to someone on the waiting list.

Programs run:

• 4:20 PM – 6 PM / Monday through Thursday / January 22-April 4, 2019. While we are working to schedule school-buses to drop youth off at stops near their neighborhoods at the end of

programs, families are ultimately responsible for organizing transportation home at the end of the day; the various

options are outline in the TRANSPORTATION section below. Please know that you are also always welcome to pick up

your child at the end of the program day at 6:00 p.m.

For more information on the AfterOpp or how to register, please contact:

Gabe Masterson, Youth At Heart gmasterson@youthatheart.org / 636-259-6530

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REGISTRATION INSTRUCTIONS

• Return completed brochures (pages 4-8) to your school's main office ONLY. ALL sections in these brochures must be complete before you submit this form.

• Completed forms must be signed by a parent or legal guardian. • SIGN UP EARLY-programs fill up quickly! • Programs are free. However, we cannot guarantee that youth will be

enrolled in programs they select.

Reserve your spot! Spots are confirmed on a first-come, first-served

basis. Please complete this form and return to the office.

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Day(s) Program Description

Mon & Wed Robotics Club Create, build, and program your own Robot! Robotics Club is led by the Youth At Heart organization, and engages students in STEM learning through the exciting challenge of building and programming robots!

Mon & Wed Mind Lab Mind Lab provides a learning environment where students can participate in exciting brain games as well as receive test-prep, homework help or tutoring if needed!

Mon & Wed Young Fashion Designers

Love fashion and design? The Young Fashion Designer’s Project encourages you to showcase your style – learn about fashion design and upcycling clothing. Make your mark and have fun constructing original clothing designs!

Tue & Thurs Environmental Science Club

Through the Environment Science Club, students will learn how to preserve our planet through hands-on creative projects! Students will participate in a Recycle Relay Race; they'll build stomp rockets out of repurposed materials; they'll make their own recycled paper; and they will learn about compost and meet one of the animals that make decomposition possible - worms!

Mon only Hale Film Society Love video? Want to be on our YouTube channel? Check out Hale Film Society where there is a space for students to create & star in student films!

Mon only Rubik’s Cube Club Do you enjoy a challenge? Take part in unique Rubik’s cube games and activities and learn to conquer the complex cube. Students will collaborate with peers as they investigate strategies to solve the puzzle at hand. Students will walk away with a new and impressive skill!

Mon only Yearbook Club Yearbook club offers students a creative community where they are equipped to build and develop skills in photography, editing, copy writing and leadership! Yearbook students have the opportunity to be more involved in their school by attending and documenting school sponsored events. Students involved in yearbook club create a lasting keepsake for the entire student body!

You will be contacted to confirm your enrollment!

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Mon only (returning students only) OR Tue only (newcomers)

Rowing Club with gRow Tulsa

gROW Tulsa provides participants with the opportunity to receive rowing instruction and use rowing machines! In addition to developing rowing technique and increasing fitness levels, the program will also include STEM-based activities using data collected by the rowing machine to further understanding in math, science and technology. Join us and gROW!

Tue only Teens in Action with Camp Fire

Do you want to bring positive change to your community? Would you like the opportunity to voice your concerns and explore ways to improve the world around you? Teens in Action will allow you the opportunity to explore problems within your community and take action to solve them!

Tue only Coding Club Through coding club students will investigate the strategies and methods of computer programming. They will use online platforms to develop and practice coding skills that can be incredibly useful in the technology-based society that exists today! *No prior knowledge of coding is necessary*

Tue only Bike Club Young people and caring adult volunteers meet weekly after school, to ride bikes, improve cycling skills and develop vital life skills through this exciting physical activity. Students with all levels of cycling experience are welcome!

Tue only OR Thur only

Chef Club Ready to cultivate your cooking skills? Come hungry and ready to discover exciting flavors and ingredients! We will have fun making delicious food that we will enjoy together. Young people build independence and self-confidence by cooking simple dishes while gaining valuable experience in budgeting, problem-solving, grocery shopping, dining etiquette, and much more.

Wed only Theatre Club Interested in acting? Want to learn about building sets? In Theatre Club students with learn about both onstage and backstage skills, play theater games, receive coaching for acting and public speaking, and learn life skills by awakening their creativity.

Wed only Hip Hop Dance Club In Hip-Hop Dance Club, students will take part in up-beat, rhythmic activities as they learn new dance moves and work together to choreograph dances to popular music. Students have the chance to express themselves through this creative and active dance club.

Wed only OR Thur only

Sports U Performance Club

Have a passion for sports, fitness and health? Through Sports U, students will take part in fitness training, flexibility training, and power training exercises. Sports U’s experienced training staff assists each student in discovering their fitness potential and sports related passions!

Thur only Academic Bowl Rangers, check out this fun, fast-paced, all-subject quiz competition where teams compete to “buzz in” with the right answers. Show your school pride as we compete against other schools for the top spot.

Thur only Poetry Poetry Club allows students to voice their opinions, emotions and ideas in a creative way. Students can expect to take part in self-reflection exercises and improve writing skills in a fun and artistic way!

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Time to Choose Your Programs!

STUDENT NAME ______________________________________________

Sample Schedule:

Mondays Tuesdays Wednesdays Thursdays

1st choice Robotics Club (meets 2-days)

Environmental Science Club (meets 2-days)

Robotics Club (meets 2-days) Environmental Science Club (meets 2-days)

2nd choice (if any)

Hale Film Society Chef Club Hip Hop Dance Club Poetry Club

Your Schedule:

Mondays Tuesdays Wednesdays Thursdays

1st choice

2nd choice (if any)

2018-19 ACADEMIC YEAR STUDENT INFORMATION Please complete the form below in its entirety. Be sure to include your gender and grade.

First Name:

Last Name:

Birthdate:

Gender: _____________________ ___________ Grade in School:

Homeroom Teacher: ____ Student Lunch ID #:

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TRANSPORTATION and PICK UP

THIS SECTION IS REQUIRED. Please check yes or no for EACH statement. It is important that we know your preferences for EVERY option listed below:

____Yes ____ No I will pick my child up at the school at the end of the day, at 6:00 p.m. ____ Yes ____ No I grant my child permission to walk home alone from the program at the end of the day. ____ Yes ____ No I grant my child permission to take the school late bus, as these details become confirmed. ____ Yes ____ No In the event that neither I nor the persons authorized for pick up are not able to arrive on

time, I will allow my child to take the late bus or to be dropped off by a program provider, staff member, or police officer.

Pick-Up List Families and other designated adults are always welcome to pick up students at the end of the program day. My student may be picked up by:

Name Relationship Phone number(s)

Please add as many names to this pick-up list as you like on additional sheet of paper. Only those listed above or on your additional sheet will be allowed to pick up students. My child may NOT be picked up by:

Name Relationship Phone number(s)

FAMILY INFORMATION

Parent / Guardian 1 Parent / Guardian 2 (or emergency contact)

Name

Relationship

Cell phone

Other phone

Address, city, ZIP code

Email

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MEDICAL INFORMATION and PERMISSIONS

THIS SECTION IS REQUIRED. Please check yes or no for EACH statement and please provide detailed information, as requested; if you need more room, please attach an additional sheet:

____ Yes ____ No

Does your child take any medications regularly? If yes, please describe type and frequency of medications:

____ Yes ____ No

Does your child have any known allergies If yes, please detail the allergies and note any known things that trigger the allergy:

____ Yes ____ No

Does your child have any disability or chronic or reoccurring illness? (This information will not affect your child's enrollment. We will work with you and TPS to possibly gain additional support.) If yes, please detail the disability or illness:

____ Yes ____ No

My child may receive first aid and/or CPR, or emergency medical treatment as authorized by the program staff, if needed, while participating in the AfterOpp program and related activities.

____ Yes ____ No I give permission for my child to be transported by an emergency vehicle to a nearby medical facility if I cannot be reached to name a preferred hospital or facility or if my child is on a field trip off school grounds.

I confirm that these above responses are correct and that a photocopy or digital copy of this consent form shall be as binding as the original: Name of parent / guardian (please print) :__________________________ ______ ____ Signature of parent/guardian:__________________________ __________ Date: ____________________

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PERMISSION

Please place a check mark before each of the statements below, if you agree with them and grant permission:

____ Yes ____ No

I understand the AfterOpp is asking my permission to access my child's student record, and I grant permission to Tulsa Public Schools to share that information with the AfterOpp.

____ Yes ____ No

I understand the AfterOpp is asking to share information about my child collected by AfterOpp staff with appropriate school faculty and Tulsa Public Schools, and I grant permission to the AfterOpp to share information about my child with Tulsa Public Schools.

____ Yes ____ No

I hereby agree and consent that AfterOpp and its partners may publish, broadcast and/or copyright for all purposes, my child’s statements and/or pictures taken of my child and/or my property for advertising and public relations purposes, and I waive all claims for compensation for such use.

____ Yes ____ No

I understand to improve the AfterOpp, surveys might be conducted of my child and our family. These surveys will ask questions about what my child is learning and what types of programs should be offered in the AfterOpp. I understand that you might also conduct outcome measurement surveys and program evaluations and these will be used to improve and to evaluate the AfterOpp.

Please carefully read and sign the following.

I, the undersigned, hereby understand, acknowledge, and agree that:

• I have read and understood the foregoing information.

• Participation by my child in the AfterOpp Program (the "Program") and providing information about my child may

involve certain risks.

• By allowing my child to participate in the Program and consenting to provide information as described herein, I am

assuming all of these risks, including (but not limited to) any physical risks or risk of injury that may be associated with

the nature of the Program.

• All Program employees are employees of the individual providers operating the Program and that these providers are

responsible for the operation of the Program and the supervision of the personnel associated with their individual

programs or handling my child's information.

• The Opportunity Project and its partners as listed in this brochure take no responsibility for any occurrence relating to

or arising out of these programs operated by the individual providers or the use or receipt of my child's information.

• My child may ride on school buses, and Program partner vehicles between program sites and to corner stops near my

home neighborhood, if applicable.

• My child may participate in activities at my child's school as well as other off-site locations throughout Tulsa, as

specified in the registration brochure, realizing that this might include special activities, such as off-site events, end-of-

session celebrations, performances, and field trips and realize that some of these may take place outside of regular

AfterOpp program hours.

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• In accordance with state law, I hereby waive any liability that The Opportunity Project, AfterOpp site management

agencies, program providers, and any of their officers, directors, trustees, agents, servants, or employees might have

for, and agree that they shall not be liable for any bodily injury to my child incurred while he/she is practicing for, or

participating in, any contest or exhibition of an athletic, or sports nature AfterOpp-sponsored activity, I hereby assume

the risk of any bodily injury incurred by my child while practicing for or participating in any of these activities.

• Further I agree that I will not seek to hold The Opportunity Project, nor its partners as listed in this brochure

responsible for any losses or damages which I or my child may incur in connection therewith, including any mistakes,

negligence, omissions, or acts whatsoever of any party in connection with the Program.

I understand that my records are protected under the Federal Confidentiality Regulations (42CFR Part 2), Mental Health

Law (40.1-2- 26) and Health Care Information Act (RI General Laws 5.37.3-4), and cannot be disclosed without my

written consent except as otherwise specifically provided by law. Any information released or received as a result of this

consent shall not be relayed in any way to another person, organization or entity, without additional written consent

from me unless it is by the Executive Director of the The Opportunity Project acting in my behalf.

I understand that state law mandates reporting of suspected abuse/neglect (to children, elderly and disabled persons) to

the appropriate State authorities. I may withdraw this consent by giving written notification to the above party, at any

time prior to the disclosure or release of the information. I understand and consent to my child's case file, and record

being reviewed and information being used for administrative case review and program evaluation. I have read (or had it

read to me), understand and agree to the conditions as outlined in this release.

Print Parent/Guardian Name:

Parent/Guardian Signature: Date: / /

Return completed, signed forms to your school's main office ONLY.

If you have any questions or concerns about the above information and would like to discuss it with someone, please

call Caroline Shaw from the The Opportunity Project at (918) 895-6344, ext. 102

or Gabe Masterson from Youth At Heart at (636) 259-6530.

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Thank You Partners!

For more information on the AfterOpp or how to register, please contact: Gabe Masterson, Youth At Heart -- gmasterson@youthatheart.org / 636-259-6530

To learn more about The Opportunity Project, go to www.theopp.org or call (918) 895-6344.