Xtreme Challenge Registration Form

Xtreme Challenge Registration Form

North Elementary School

P. O. Box 833

Omak, WA 98841

Bobbi Nessly (509) 557-5918 Racie McKee (509)826-7680

Students First Name:______Last: ______

Date of Birth: ______Age:______Gender M F

Students Ethnic Background: Hispanic - Native American - Asian – African American – Caucasian

Mailing Address:______

Physical Address (Bus Drop) ______

Parent Name:______Phone Number:______

Parent Name:______Phone Number:______

Emergency Contact:______Phone Number:______

2nd Contact Person:______Phone Number:______

Students Teacher:______Grade:______

Health Concerns:______

Classes begin after school each day. Snacks are provided at no cost to families. Tuesday- Friday ending time is 4:40pm. Mondays are not yet determined. Please be on time to pick-up your child.

Transportation and Participation Guidelines

No stops in Conconully or Disautel

Bus transportation is available to key locations. For more information contact the bus garage at (509) 826-2240

It is important that both students and families are aware of all program guidelines. Please go over all program rules and expectations on the back of this form with your child. As a family you will need to decide on the best form of transportation for your home situation. Select one of the following. Be sure your child is aware of how you expect them to get home. Remind them that they MUST adhere to this plan for safety reasons.

______I will provide my child with transportation after the program.

______My child will use bus transportation.

______My child will walk home after the program.

Any changes in transportation MUST be in writing and signed by the parent/guardian. All students MUST be signed out before leaving the building.

All students are eligible of the Xtreme Challenge Program. Parents of participating students are also eligible adult classes.

Instructors request that students attend on a regular basis. Classes are organized in M/W/F and T/TH to allow students greater variety in class selection. The grant requires an attendance of 30 days over the course of the school year, so we encourage continued participation, and are flexible to allow for seasonal sports.

Program Guidelines

Code of Behavior:

Participants follow expectations set forth in the student handbook. This includes all discipline guidelines and procedures.

Participants are responsible for treating school equipment and supplies with respect.

Participants are expected to treat staff, peers and volunteer with respect.

Participants should attend activities with an open mind and a willingness to learn new things.

Participants are expected to honestly respond to activity surveys, which will help guide Xtreme Challenge in program choices.

Participants are allowed 3 strikes for discipline then are suspended from the program for a quarter.

Fee Guidelines:

Xtreme Challenge is a free, grant funded program.

Some classes must meet a minimum enrollment number to be held..

Please sign the spaces provided that apply to you and your child

We like to promote and publicize student accomplishments in Xtreme Challenge classes and community events through print, photos and video footage. Parental permission is required before releasing images of your student for these purposes. Please indicate by signing below giving Xtreme Challenge permission to use photos and/or video footage of your child for publicity purposes. Last names of students will not be used.

Signed: ______

I give Xtreme Challenge permission to use photos and/video footage of my child.

Signed: ______

I have communicated with my child about transportation and program guidelines.