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Enrichment Program - Hybrid / In person Enrollment Application 2020-2021

Thank you for your interest in enrolling your child in the Enrichment Program.

Please keep in mind that completing this application does not guarantee your student's physical enrollment in the program. Our enrollment specialist will contact you and guide you through the next steps of the enrollment process.

Students enrolled in the Enrichment Program should participate regularly. 
Due to Public Health & School District the Enrichment Program may be offered in Person, Hybrid or Distance Learning.

This form should take less than 15 minutes to complete; please be sure to complete all fields. Questions with an asterisk are required. 

If you any questions, please call our office at 626-967-9337.

Student Information

School attending in 2020-21 school year*
Answer Required
Grade level in 2020-21 school year*
Answer Required
What group does your student belong for Hybrid? *
Answer Required
Is your child enrolled in the free or reduced cost lunch program?*
Answer Required
Does your child need any accommodations to be successful in this program?*
Answer Required
Does your child have any health concerns and/or medical conditions? *
Answer Required
Is your child designated as an English Learner (EL)?*
Answer Required
In accordance with Education Code Section 8483, students who are experiencing homelessness or are foster youth are entitled to first priority for enrollment in ASES programs. Please check the appropriate box if the student meets either of these criteria.*
Answer Required
Ethnicity (optional): Mark the ethnicity which your child most closely identifies.
Answer Required

Medical coverage

Does your student have health insurance?
Answer Required

Parent/guardian emergency and identification information

Please list additional persons over 18 years of age who may be called in an emergency and are authorized to remove child from the facility.  Student(s) will be released to mother/father/guardian unless other legal guardianship documentation is provided.

Emergency Contact #1

Emergency Contact #2

Emergency Contact #3

The Enrichment Program might be offering a summer program; due to Public Health & School District guidelines the summer program may be offered in Person, Hybrid or Distance Learning. The tentative dates for the summer program are June 14th to July 9th, 2021.

If you are interest in summer, please indicate. *
Answer Required

Enrichment Program policies


Options for Learning has a commitment to serve families in our programs. However, in a limited number of circumstances, it may be impossible for Options for Learning to offer or continue to provide services to particular families. A child may be terminated from the program based on the behavior of the client/child that threatens the health and safety of children and/or staff and/or other client. The decision to not accept an application for care, not to admit a family or to terminate services to a family will be made by the division director of the program or programs involved and the parents will be notified in writing of the decision.

Circumstances that may prevent services or lead to termination of services are: The client refuses to follow legitimate instructions, directions, or program policies and procedures. The client has verbally threatened staff or physically assaulted staff and/or children. A weapon or drugs have been brought into an Options for Learning facility. The client has stalked and/or harassed staff and/or children and/or other clients. The client or child were previously terminated from another child care or comparable program for physical violence or bringing drugs or weapons into the program or other serious offenses. The child has had repeated, serious episodes of physical aggression against other children and/or staff and/or other clients. The child is expelled from the public school where the Options for Learning program is located (applicable to school age children). Other serious offenses that would threaten the mental or physical safety of children or staff or other clients listed above may also lead to non-admittance or termination. Child repeatedly fails to remain with center based staff whether group is inside or outside.

If you have not already done so, please read our Enrichment Program Parent Handbook.

If you have not already done so, please review Distance Learning Etiquette for Students with your child(ren). 

Thoroughly read and check each statement below.

Answer Required
I have carefully read and completely understand the Client Non-admittance and Termination Policy outlined above.
I have viewed and/or received a copy of the Enrichment Program Parent Handbook (as referenced above) and understand the importance of the contents within including the terms, guidelines and conditions of the program’s Policy, Procedures and Student Code of Conduct.
I understand that the Enrichment Program staff may collaborate with the school staff in order to best serve my child(ren).
As the parent/legal guardian, I give consent to Options for Learning's Enrichment Program to call for all emergency medical assistance at my expense, prescribed by a duly licensed physician (MD), for my child(ren) named above.
I have viewed and/or received a copy of the Distance Learning Etiquette for Students
I understand that my child must practice social distancing and wear a mask while at the program. Also we must follow and adhere to all safety guidelines ordered from Public Health.

Thank you for completing this in hybrid application. Someone will contact you regarding the next step of the enrollment process.

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