HOW DO WE REGISTER?
STEP 1: Choose your class(es)
STEP 2: Complete and return enrollment form: You can obtain an enrollment form at the Laurel
office or on line at www.jcles.org. Please send the enrollment information and payment back with
your student, drop off at the front office, or mail it to:
Junction City Connection
1401 Laurel St.
Junction City, OR 97448
Cost and Payment options: Tuesday and Thursday session $35, Game club $5
Cash and Checks accepted, checks payable to JCSD.
Please see the After School Connection bulletin board located near the Laurel Elementary Office for
details about scholarships.
Still have questions?
Call 541-998-2386 and ask for Earnest (E.J.).or Jamie, or email us at
[email protected] or [email protected]
Look for the current schedule at the
beginning of each term. They will be sent home with all K-5
Junction City School District students. They are also available at
the Junction City Public Library or by contacting the front office
at Laurel.
Volunteers are a critical part of the After School Connection. Your talents are needed in a variety of
areas. Volunteer to tutor a student in our Homework Club, teach a class, assist in a class, spend time
with a child, or help with planning the program. An hour a week or once a month can make a
difference in the life of a child.
Name ______________________________________________ Phone: __________________
Student‘s Name:
Current Grade:
Teacher:
School:
□ Knowledge Club
□
Art Club
□
Game Club
Mailing Address:______________________________________City/Zip:_________________________________
Parent’s Name:______________________________________Home Phone #:____________________________
Employer:________________________________ Work#:______________Other Phone #:_________________
Parent’s Name:______________________________________Home Phone #:____________________________
Employer:________________________________ Work#:______________Other Phone #:_________________
Emergency Contact:_______________________________________________
Phone:___________________
Names of people allowed to pick up your child: ____________________________________________________
Staff will check for picture identification of the people listed above.
Children will not be allowed to leave premises without parent’s written permission.
How will your child be getting home? ____________________________________________________________
Please send a note to the Junction City Connection if your child has alternate plans from what you have specified.
Do you want staff to call if your child is absent? Yes or No
If yes what phone number? _________________
Is your child taking any medications?_____ Please list_______________________________________________
Does your child have any allergies?__
Does your child have any special needs?
____________________________________________________________
Student/Parent Contract Important please read and sign
The Junction City Connection will follow the School District procedures and policies regarding behavior
and discipline. Children will be expected to participate in after school activities in a safe, respectful
and responsible manner. Students are expected to follow the same rules as they do during the
school day. The Junction City After School Connection follows a three strikes rule. Three referrals and
your child will be suspended from the After School Connection for an indefinite period of time.
I have read the After School Connection’s discipline procedures with my child and I agree to them.
Parent/Legal Guardian Signature:______________________________Date:_______________
Student Signature:__________________________________________Date:_______________
Liability Release
Name of Student:___________________________________
I (we) the parent(s) or legal guardian(s) of the above named participant do assume all risks and hazards incidental to the
conduct of the activity; and I (we) do further release, absolve, indemnify and hold harmless the organizers and supervisors of
the Family Resource Network, Junction City School District, Junction City Connection and all programs and services being
provided within the Junction City Connection and all other coordinating and participating agencies.
Parent/Legal Guardian Signature: ____________________________________
Photo Permission
Junction City School District, After School Connection would like to document activities and performances by students. We
may also want to use the students’ artwork for the publications and fundraising efforts for the Junction City Connection. We
need your permission to photograph, make videos and use the artwork of your student(s). I give the Junction City
Connection, Junction City School District, permission to photograph, videotape, or use my student’s artwork.
Parent/Legal Guardian Signature: _____________________________________________________Date:_______________