Free Wednesday Afterschool at Audubon Interest Form

This is an application for children to be considered for admission to Audubon's free afterschool program on Wednesdays for the 2023-2024 school year. Application for admission does not guarantee a space in the program. Applications will be reviewed in early August and families notified of acceptance or if they were waitlisted by mid- August. If you are selected for a space, you will be contacted separately and asked to complete applicable health and safety forms.

Students will be able to ride the school bus directly from either Brewster Pierce Elementary or Richmond Elementary pending MMUUSD Transportation Depot approval. Audubon Vermont is unable to provide transportation at this time. Families from other surrounding towns may apply to attend but must get their student to and from Audubon themselves.

Please be sure to review the program page for full details at https://vt.audubon.org/programs/afterschool-audubon-vermont

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* 1. By submitting this application, you agree to EACH of the following if your child/ren are selected (please check each box showing you agree):

I agree to attend the program as scheduled. I agree to have an 80% or better attendance record. I will let Audubon staff know of any absences and contact the education manager or program teacher in the event of a family or medical situation that prevents attending the program as scheduled. Audubon cancellations do not count against my attendance and Audubon thanks you for keeping sick children at home. Should my attendance slip below 80% for an unapproved reason, I understand that I will not be offered a space in future sessions.

I agree to complete the program feedback survey when it is sent to me to help Audubon continue to improve program content and offerings.

I agree to complete the demographic survey so Audubon Vermont can better understand who we serve. I understand that it will be sent separately and I can choose not to disclose particular information.

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* 2. Parent/Guardian contact information (to be used to notify you about this program.)

Name

City/Town

Email Address

Phone Number

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* 3. I understand that this program is for elementary-aged students, in Kindergarten- Fourth grade.

Yes

Yes, but I would like to be notified if a program starts for 5th-8th grade students. I care for a middle school child who would be interested in participating as well

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* 4. We offer 2 sessions, Fall and Spring. This program takes a break for winter from Thanksgiving- February Vacation. I am interested in (check all that apply):

The Fall session, Wednesday Sept 6- Wednesday Nov 15th, 2023 (11 weeks)

The Spring Session, Wednesday March 6- Wednesday May 22, 2023 (11 weeks, does not meet on 4/24)