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LWAS Registration Form

LWAS Registration Form

  • LearningWorks Afterschool is pleased to offer elementary students in select Portland, South Portland, Biddeford, and RSU 57 schools a free and fun afterschool enrichment program that will increase your student's academic self-confidence, while helping them improve their math and reading skills. Apply today to see if your student is eligible!
  • School Info

  • Please note that LWAS will check with your child's teacher to confirm that your child is eligible for the program.
  • Is this student partially proficient or not proficient in math and/or reading? Please provide this student's most recent NWEA scores for math and reading.
  • Student Info

  • MM slash DD slash YYYY
  • Parent/Legal Guardian Info

  • Email is used for program announcements and communications with staff, and will be kept confidential.
  • Student Technology

    If your student wishes to participate in remote-only activities this summer, we'd like to know a bit more about their technology access at home, so we can provide them with tools if needed.

  • Medical Needs

    If a student needs access to prescribed or over-the-counter medication during program hours, the student's parent or legal guardian should the school's LWAS Site Coordinator for further information. Some of our sites have access to Epi-Pens and inhalers, others do not.

  • If the student has no known medical needs, please type "no known medical needs."
  • Transportation

    For our summer program, transportation from and to home is provided upon request for eligible students. Some students may need to walk up to a half-mile home from corner bus stops. The school's LWAS site coordinator will contact caregivers with bus details for eligible students.

  • Please list the full names of all adults that are authorized to pick up your child.
  • Program Releases + Consents

  • Online Privacy Notice + Consent to Virtual Learning

  • In order for LearningWorks Afterschool to provide your child with the most effective learning experience, we need to abide by the rules of the Children’s Online Privacy Protection Act (COPPA) that require parental permission as outlined below.

    COPPA requires that we gain verifiable consent for your child to participate in interactive online and video remote learning offerings. LearningWorks Afterschool uses several computer software apps and web-based services operated by third parties, including Google Apps for Education, Seesaw, Zoom, NearPod, Kahoot!, and Flipgrid, and the operators of any additional web-based educational programs and services which LearningWorks may decide is necessary during the program year.

    In order for your child to use our educational program and services, certain basic personal information -- your child’s name, username, email address, geolocation, IP address, and video recordings of your child’s interactions with LearningWorks Afterschool staff -- must be collected, used, and/or disclosed by us. We are asking for your permission to collect, use, and disclose your child’s personal information for the purpose of monitoring your child’s program participation, collecting assignments and projects submitted online, interacting with your child online, and promoting the LearningWorks Afterschool program and its partners.

    Please review the following statements regarding your rights before giving your consent:

    ✔ Website accounts managed by LearningWorks provide access to content, materials, and resources relating to LearningWorks' programs and activities, including information pertaining to LearningWorks AfterSchool;

    ✔ LearningWorks will not grant my child access to any website account managed by LearningWorks AfterSchool unless I provide them with permission below;

    ✔ I can contact LearningWorks Director of Programs Jessica Moninski at (207) 775-0105 ext. 133 to ask to review my child’s personal information collected by LearningWorks and have the information deleted;

    ✔ I have the right to opt out of any further use or collection of my child’s personal information by LearningWorks, by contacting Jessica Moninski at (207) 775-0105 ext. 133; and

    ✔ I understand that by opting out of LearningWorks’ collection and use my child’s personal information, my child will not be able to participate in some LearningWorks AfterSchool activities and assignments.

    By signing this form below, I certify that I consent to the collection, use and/or disclosure of my child’s personal information as described in this Privacy Notice.

  • A parent or legal guardian must sign this section in order for their student to be considered for this program.
  • Photograph + Media Release

  • Program Consent + Waiver of Liability

  • ✔ I give permission for my child to attend LearningWorks Afterschool.

    ✔ I give permission for my child to participate in field trips off school property during program hours.

    ✔ I give permission for emergency medical treatment to be given to my child if I cannot be reached by phone.

    ✔ In consideration for being allowed participant privileges in the LearningWorks 21st CCLC Program, I hereby assume full responsibility for any risk of bodily injury, death, or property damage and/or while using the premises or any facilities or equipment here-in. I understand that this program includes physical activity (including swimming) and I also understand that any program or sport that includes such activity carries with it an inherent risk of physical injury. I further agree to hold harmless the LearningWorks 21st CCLC program, their partners, directors, officers, employees, agents, and volunteers from any and all claims that may result from any action for damages, including but not limited, to such claims that may result from injury or death, accident or otherwise, during or arising in any way from said activity. I acknowledge that this General Release of Liability of the LearningWorks/21st CCLC Program and its partners is binding on me and my heirs, personal representatives, successors, and assigns.

    ✔ I give permission for LearningWorks to collect student information on my child (academic progress, assessment data, behavior, free/reduced lunch status, special services, student ID number, and behavior) from my student's school district. I give permission for LearningWorks to use this information for required grant reporting and to coordinate services with the school district and LearningWorks staff.

  • A parent or legal guardian must sign this section in order for their student to be considered for this program.
  • Filling out this form does not guarantee your student a place in the program. Acceptance to the program is subject to your student's eligibility, and the availability of open slots. Please allow 5-7 business days for your application to be processed.

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