Name of Student *

First Name

Last Name

New or Returning French student? *

New

Returning

Name of Guardian *

First Name

Last Name

Guardian Phone *

(###)

###

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Guardian Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Statement on Student Safety and Parental Responsibility *

This document is to be reviewed and approved by parents/guardians at the time of registration. Parents must submit this form to the Alliance Française de Minneapolis/St. Paul with the box checked before the first class. No registration is considered valid, and students will not be permitted to attend class unless this document has been approved and returned to the Alliance Française de Minneapolis / St. Paul, hereafter referred to as AFMSP. General Terms: The AFMSP provides a service to the public by allowing children and adolescents to attend the Afterschool French classes at Kenwood Elementary. The AFMSP provides no supervision of any kind for any person under the age of 18 who is present in its facilities other than the supervision of teachers in the designated classroom during scheduled Afterschool French class time. Check in / check out: At the end of class, a parent or other approved adult guardian must check in with the AFMSP staff in charge and SIGN OUT each student under the age of 18. A parent or other adult guardian must pick up each student under the age of 18 shortly after the end of the class. DO NOT LEAVE THE BUILDING WITHOUT SIGNING OUT. Students MUST be picked up by the end of their classes. If the designated responsible adult has not picked up the child by the end of the class, a late pick up fee may be charged. In case of unexpected delay please call our office at 612 332 0436 or call the AFMSP French teacher directly.

I understand and agree to check out my student at the end of every class. I also assume full responsibility of my student outside of scheduled class time, and understand that a late fee may be charged in the event that I do not pick up my student on time and do not alert AFMSP staff of my tardiness.

AFMSP Behavior Policy *

Behavior Guidance: We strive to create an environment that is developmentally appropriate and engaging for every child. Our general practice is to encourage and reward positive behavior. However, in order to minimize disruptive or unacceptable behavior, staff may also use a variety of techniques such as preventative measures, redirection, verbal intervention, and breaks away from activities. We make every attempt to work with children and teach appropriate behavior. A student may be dismissed from Afterschool French class as a last resort. General Behavior Rules: - Be Kind - keep hands, feet, and objects to yourself - Be Respectful - to staff, others, yourself, and your environment - Be Safe - stay with an AFMSP staff member - Be Open - engage as much as possible with the French language, don’t be afraid to make mistakes! Unacceptable Behavior: · Refusing to follow our behavior guidelines or class rules · Using profanity, vulgarity or obscenity · Stealing or damaging personal, AFMSP or school property · Refusal to participate in activities or cooperate with staff · Disrupting the program · Leaving the program without permission · Endangering the health and safety of yourself, other children, and/or staff · Physical violence or bullying/teasing toward another student or staff When Class Rules Are Broken Staff will redirect the child to more appropriate behavior. If inappropriate behavior continues, the child will be reminded of behavior guidelines and class rules and will be asked to participate in determining action steps to correct his/her behavior. Staff will document the situation, the inappropriate behavior, and action taken. Parents will be notified (either by phone or at pick-up) of any situation in which action was taken. Guidance from parents is welcomed and a behavior plan may be developed. If the situation is not resolved and the unacceptable behavior continues, the child may be dismissed from Afterschool French class.

I understand the AFMSP Behavior Policy. I understand that my child may be dismissed from class under certain circumstances.

Emergency Treatment Release Form *

I hereby give permission that the above student may be given emergency treatment as needed by AFMSP staff members. I also give permission for my child to be transported by ambulance or aid car to the emergency center for treatment. In the event that I or my preferred physician cannot be contacted, I further consent to medical, surgical, or hospital care, treatment and procedures to be performed for my child by a licensed physician or hospital when deemed immediately necessary or advisable by a physician to safeguard my child’s health. I agree that I will not hold the AFMSP or any member of the staff, liable for damages, injuries, or losses during the above-mentioned student’s participation with the AFMSP.

By checking this box, I am signing the Emergency Treatment Release Form.

Physician *

First Name

Last Name

Physician's Phone *

(###)

###

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Emergency Contact *

First Name

Last Name

Phone *

(###)

###

####

Second Emergency Contact:

First Name

Last Name

Phone

(###)

###

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Photo Consent: Child attending French Class with the Alliance Française *

I, the undersigned, being legal guardian of the AFMSP summer camp or class attendee below, grant to Alliance Française de Minneapolis / St. Paul the right to use his/her photograph or likeness with or without his/her name, for publicity and educational purposes. I hereby release any claims of copyright, libel, slander, violation of privacy or similar rights that I may have.

I understand that by checking this box I am signing this form.

I understand that by checking this box, I am NOT signing this form.