Teen Registration

The Teen Spot for Grades 6 to 12

We are so excited to meet you and your youth! Please complete the enrollment form below, and a staff member will contact you. Parents, we will use communication tools such as phone calls, text messages, and emails to keep you informed of upcoming activities, events, and opportunities. We look forward to working with your student and you to make this a productive, educational, and positive social experience for ALL participants. Contact information is below; please call us with any questions!

Highlands Partnership Network 412-274-0783

The Spot only operates on full days of school on the Highlands SD calendar from 3 PM to 6 PM on Mondays, Tuesdays, and Wednesdays at 1005 Idaho Avenue, Natrona Heights PA 15065.

Student First name

Student Last name

Preferred Name/Nickname

Address

Birthday

Month

Day

Year

Grade

School Attended

Race

Gender

Please list any allergies or medical concerns.

Please list any academic or social challenges we can help with.

I give consent for my child to be transported for fieldtrips and outings.

Parent/Gradian Name

Phone

Parent/Guardian Name

Phone

Emergency Contact

Emergency Contact Phone

I consent to use of electronic communications and electronic signatures.

At “The Spot,” we work closely with your student, their class, and their teacher to help them achieve their academic, post-secondary, future career, and attendance goals. To provide the most effective support, we may need to communicate with your child’s teacher about their assignments, upcoming tests, and other academic objectives. Please be assured that the staff at “The Spot” will not discuss your child’s educational record, attendance, challenges, or any other personal information outside of the program or with anyone other than you (the parent or guardian) and the student’s teacher(s).

I authorize my child's school to release information from my student’s file. This information may include assessment results, attendance records, demographic data, goals, and all program-related paperwork.

I understand that this information will assist the interdisciplinary team in implementing my student’s educational plan.

I acknowledge that this information may be shared in both oral and written forms. My educational team includes the following individuals: Highlands Partnership Network and The Spot for Teens staff (instructors and support staff).

This program is funded through Allegheny County Department of Human Services Out-of-School Time program funds. To be accountable for this funding, we collect attendance and demographic data. Please review the following:

I consent to share my child/children’s name, school attended, grade level, date of birth, and days attended with The Department of Human Services (DHS) for data tracking purposes.

I understand this information will be shared with DHS to collect data to fund my child/children throughout the sessions appropriately.

I understand that legally, I am NOT required to consent to the release of information.

I voluntarily give permission to help my educational team provide the best service to me.

I give my consent for my child to participate in The Teen Spot afterschool program. This program is designed to support the youth in our community in achieving their academic goals, planning for the future, promoting social wellness, health goals, and exploring their cultural identity. The program is available during the school year and in the summer. It is located at 1003 Idaho Avenue, Natrona Heights, PA 15065.

Planned activities, projects, and informational sessions throughout the program's duration may include, but are not limited to:

- Mentoring and tutoring (All staff and volunteers are required to have clearances and training)

- Driver education (Separate parent permission forms will be required; students must meet academic and attendance goals)

- Presentations and information sessions by the Allegheny County Health Department on topics such as sex education, intimate partner violence awareness, overdose prevention, addiction awareness, and drug use prevention

- Physical and mental health awareness initiatives, including support groups - Arts education, including music and art

- Field trips (Permission forms will be required for participation)

Thank you for supporting our program and your child's growth!

I give my consent for any necessary medical care and the administration of anesthesia for my child while they are under the care of The Teen Spot, in the event that I am not reasonably available by telephone to provide consent.

The Spot Behavior and Discipline Agreement

At The Spot, behavior and discipline are collaborative efforts involving parents, guardians, kids, and staff. Our Behavior and Discipline Agreement emphasizes promoting positive behavior by recognizing children who consistently demonstrate good choices. We understand that mistakes are a natural part of growth, and our goal is to help teens reflect on their errors in judgment and behavior. We support them in learning to make better decisions. We teach and model positive behaviors, such as listening, cooperation, and mutual respect. We encourage children to make independent choices and to act responsibly toward others and their surroundings. When everyone participates in this manner, we create a positive and productive environment that allows kids to strive for excellence.

Examples of Unwelcome Behaviors:

Minor:

- Inappropriate clothing

- Pushing and/or running

- Talking or using phones during presentations

- Loud or disruptive behavior outside the building

- Lying

- Teasing

- Not signing in

Middle Level:

- Disrespecting staff

- Inappropriate representation of The Spot

- Leaving and returning without permission

- Smoking or vaping

- Using inappropriate language

- Eating in prohibited areas

- Misusing electronic equipment

Major:

- Possession of weapons

- Fighting or physical aggression

- Inappropriate use of emergency equipment

- Sexual behavior

- Use of or being under the influence of drugs or alcohol

- Racism and other forms of discrimination

- Defacing property

- Theft

- Threats of violence

- Vandalism

- Bullying

Examples of Disciplinary Actions:

- Referral to the program board for review and action plan

- Contacting home by staff - Meeting with parents

- Program suspension

- Written or verbal apology to affected parties before returning to the program

Note: The Spot staff reserves the right to expedite disciplinary actions based on the circumstances.

I have read and undrestand The Spot Behavior and Discipline Agreement

I understand The SPOT program is not responsible for any lost, stolen, or damaged personal belongings. Students are encouraged to keep valuables at home.

Signature

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