Allegories of Me After School- Employment Application Combined

Allegories of Me
A!er School:
Enrollment
Application

There’s a one-time $25 enrollment process
fee per child. Incomplete applications will
elongated process and risk of student mis
enrollment deadline. Processing fee will b
refunded if we have reached capacity.
All registrations are received and reviewed
Irst come, Irst serve basis. Upon Illing al
spots, all additional submissions will be a
to our waiting list.

* Required

A!er School Care Fall & Spring Sess
Registration (2020-2021)

1. Pick When (Summer Session Only) *

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sing
l incur
ssing
be

d in a
ll open
added

sions

2. Seeking Free Program options?
Mark only one oval.

I have contacted Crystal Stairs and
submitted my request to participate in A
programming.

I have not contacted Crystal Stairs
but plan to do so before May 31, 2020 b
visiting crystalstairs.org for more inform

I do not understand why this option
encouraged and would like to learn more

My household income exceeds the
programming limit and I would like to lea
more about paid options.

Student Information #1

3. Full Name (First Name, Last Name) *

4. Gender *
Mark only one oval.

Female
Male

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d
AOMAS

yet,
by
mation.

n is
e.

e free
arn

5. School District Enrolled *

6. School A"ending *

7. Grade A"ending *

8. Which programs are your student
interested in (choose up to 2 options
Homework Suppo# is mandatory): *

Check all that apply.
Film Production
Theater
Literature
Music
Graphic Design
Dance
N/A

9. Health Care #: *

:

s only;

10. Doctor's Name: *

11. Doctor's Phone Number: *

Student (Enter N/A in all Ields if you
Information have an additional student
#2 enrolling)

12. Full Name (First Name, Last Name) *

13. Gender *
Mark only one oval.

Female
Male
N/A

14. School District Enrolled *

:

u do not

*

15. School A"ending *

16. Grade A"ending *

17. Which programs are your student
interested in (choose up to 2 option
Homework Suppo# is mandatory):

Check all that apply.
Film Production
Theater
Literature
Music
Graphic Design
Dance
N/A

18. Health Care #: *

19. Doctor's Name *

:

ns only;
*

20. Doctor's Phone Number *

Student (Enter N/A in all Ields if you
Information have an additional student
#3 enrolling)

21. Full Name (First Name, Last Name) *

22. Gender *
Mark only one oval.

Female
Male
N/A

23. School District Enrolled *

24. School A"ending *

:

u do not

*

25. Grade A"ending *

26. Which programs are your student
interested in (choose up to 2 option
Homework Suppo# is mandatory):

Check all that apply.
Film Production
Theater
Literature
Music
Graphic Design
Dance
N/A

27. Health Care #: *

28. Doctors Name *

29. Doctors Phone Number *

Parent/Guardian Information 1

:

ns only;
*

30. Full Name (First Name, Last Name) *

31. Home #: *

32. Cell #:

33. Work #:

34. E-mail: *

35. Address - Same As Child:
Mark only one oval.

Yes
No
N/A

:

*

36. Parent/Guardian 1 Address:

Parent/Guardian Information 2
37. Full Name (First Name, Last Name)
38. Home #:
39. Cell #:
40. Work #:
41. E-mail:

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42. Address - Same As Child's
Mark only one oval.

yes
No
N/A

43. Address

44.
Mark only one oval.

Option 1

45.
Mark only one oval.

Option 1

Other Information

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46. Is your child immunized? *
Mark only one oval.

Yes
No

47. Does your child have any allergies?
Mark only one oval.

Yes
No

48. If yes please list, including any food
drug allergies.

:

*
d or

49. Does your child have any medical
conditions?

50. Does your child require any medica
yes, please list these medications.

51. Do you authorize us to administer t
medications listed above?
Mark only one oval.

Yes
No

:

ation? If
the

52. Please list the people authorized to
up your child and contact numbers.

53. Comments

Emergency Contact- Other than
Parent/Guardian
54. Full Name (First Name, Last Name):

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o pick
.*

*

55. Address: *

56. Home #: *
57. Cell #:
58. Work #:

Household Demographics
59. How many reside in household?

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60. How many of those residing in hous
are 17 and under?

61. What is your household total annua
income (gross salary)?

62. Do you or anyone in your household
receive public assistance?

63. Do you or anyone in your household
receive public assistance?

Check all that apply.

CalWorks
CalFresh
NSLP - Free/Reduced
Unemployment
SDI/SSI
SNAP
N/A

Disclosure Statements (Man

:

sehold
al
d
d

ndatory)

64. Must check o$ all boxes to proceed

Check all that apply.

I agree to pick up my child by the ex
hours of operation.

I promise that my child will attend a
20 hours per week or risk forfeiting prog
enrollment.

My child will not miss more than 5 d
session during Fall, Spring and Summer
day) sessions.

I will accompany my child to a sche
orientation prior to them attending progr

65. My child will pa#icipate in the follow
transpo#ation program during Fall
Spring sessions: *

Check all that apply.

I will transport my child from schoo
school program Monday thru Friday.

I will pay for transportation for my c
be transported from school to after scho
program for $50 per session per child.

I’m unable to afford transportation c
Please contact me to determine my opti
student enrollment and transportation. I
understand that choosing this option mi
minimize my chances of securing a spot
AOMAS program.

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d: *

xhibited

at least
gram

days per
(1/2

eduled
ram.

wing
&

ol to after

child to
ool

costs.
ions for
I
ight
t in the

All registrations are received and reviewed in a Irst
come,Irst serve basis. Upon Illing all open spots, al
additional submissions will be added to our waiting

66. I am interested in pa#icipating in th
following volunteer capacities:

Check all that apply.
Outing Chaperone
Event Planning/Decorating
Theatre Production Support
Administrative Support
Event Catering/Kitchen Support
None of the Above

Other:

I acknowledge that I have completed this applicatio
accurately to the best of my knowledge. I will return
Allegories of Me Website to verify that my payment
been processed via the Programs &Enrollment page

67. Type Name (First Name, Last Name

68. Application Date *

Example: January 7, 2019

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list.

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Allegories of Me
A!er School:
Employment
Application

Applicant must upload the following items
this application (upload appointment or
payment
receipt as con?rmation for LiveScan / TB
until results are received):
* Required

1. Resume *
Files submitted:

2. LiveScan Receipt / Results *
Files submitted:

3. LiveScan Receipt / Results *
Files submitted:

4. Ce"i#cations
Files submitted:

:

s to
Test

5. Le$ers of Recommendation
Files submitted:

6. Typing Test Results
Files submitted:

7. In 500 words or less, please explain w
you are a good #t for this program a
you could suppo" in facilitating educ
and a"s to 1st-8th graders:

Internship Summer Session (2019-20
Program Fall & Spring Sessions (202
Registration 2021)

:

why
and how
cation

020) /
20-

8. Which programs are your student
interested in: *

Check all that apply.

Film Production
Theater
Literature
Music
Graphic Design
Dance
Tutoring / Homework Support
OYce / Administrative Support
Kitchen Support (Obtaining SafeServe
Certi?cation)

:

e

9. Grades you have instructed / worked
Mark only one oval.

1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
No Teaching / Educational OYce
Experience

Applicant Information

10. First Name *

11. Last Name *

:

d with:

12. Gender *
Mark only one oval.

Female
Male

13. Bi"h Date *

Example: January 7, 2019

14. School Graduated *

15. Degree / Ce"i#cation Received *

16. Mobile Number: *

: