Steam After-School Program

Child’s Information

Parent / Legal Guardian Information

Emergency and Medical Information

**The people listed below should be responsible individuals who can: 1) give permission to administer health care; and 2) have the authority to speak on behalf of the parent or legal guardian**

Desired Major

The program would like to gain a better sense of what art forms the students would like to participate in. We ask that you fill out your child’s desired major is while they attend our program. Please fill in Visual Art, Dance, Music or Theater.

Enrollment Agreements

Emergency Care Release: In the event of an emergency in which I cannot be reached, I authorize emergency medical personnel to provide the necessary first aid and/or hospitalization.

Photography Release: I understand that my child may be photographed, videotaped, and/or interviewed for the purpose of PAEP promotional use. If I do not want my child photographed, videotaped, and/or interviewed, I must notify PAEP in writing.

Enrollment Agreement: I understand that this enrollment form must be filled out completely. Missing sections may prevent my child from attending the program.

Code of Conduct: I understand my child is required to follow The School District of Philadelphia’s Student Code of Conduct. I understand that all parents and children are expected to respect the program and school staff. If my child exhibits inappropriate behavior during the program a behavior report will be issued. After three behavior reports, my child may be suspended or removed from the program.