Account

Account Step 1 of 4

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We strongly recommend that you use your personal email address.

Contact Info

Contact Info Step 2 of 4

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Security

Security Step 3 of 4

The password must be at least 8 characters in length, contain one uppercase letter, contain one lowercase letter, contain one number and contain one special character.

Length (8):  
Uppercase:  
Lowercase:  
Number:  
Special (i.e. ~`!@#$%^&*_()-+={}[]|\;:<>,./?"):  

Agreement

Agreement Step 4 of 4

Declaration of Truth

If you are applying for the sliding scale system:

I am applying for the sliding scale fee program with the Woodburn After School Program. This sliding scale provides funds for families who need additional support to send their students to the program.

By submitting this form, I attest to the following:

    • I have submitted complete and accurate income information for all adults in the home.
    • I do not have any other undeclared sources of income.
    • I cannot afford to send my student to the ASC program without the sliding scale assistance.

I swear under penalty of perjury that the above information is true and correct.  With this application I agree to submit full and accurate income information for all adults living in the household by providing either their tax return OR completing Form 4506T-EZ for each and every adult in the household. I understand that Woodburn After School Program will verify my income and authorize them to collect data for this purpose, which may include a home visit, including total number of adults and household size as part of my application for the sliding scale fee.  Additionally, I understand that falsification of information on this form may result in revocation of the sliding scale award AND/OR being billed for the full amount of the scholarship AND/OR removal from the program. 


Woodburn After School Club

1390 Meridian Drive, Woodburn, OR 97071

503-308-9272

bit.ly/woodburnasc

asc@woodburnsd.org

 

Registration Agreement

Woodburn ASC Registration Agreement

Student Registration:

  1. I certify that I am the parent or legal guardian of the student being registered.
  2. I understand and confirm that participation in this WASC program is voluntary and hereby consent and grant permission for my child to participate in all activities in conjunction with this program. I further understand that my child's participation may involve risk of injury and loss, both to person and to property. On behalf of my child, I assume all risks in any way connected with said participation and I accept personal responsibility for any liability, injury, loss, or damage in any way connected with said participation.
  3. I do certify that I, the undersigned, in consideration of the benefits and opportunities derived by my child who is a participant of WASC, do hereby release and discharge the Woodburn School District and the WASC, its officers, agents, staff, and employees from any and all claims, demands, suits, actions, or courses of  action which may, can, or shall have reason of illness, injury, or accident incurred or suffered by said child while in attendance of said WASC while traveling to or from, attending, or participating in said program no matter how caused or occasioned.
  4. I understand and acknowledge that neither basic accident and health insurance nor personal property insurance will be offered or provided by WASC in connection with WASC activities, field trips, etc, and that the provision of such insurance is my/our own personal responsibility.
  5. I understand and agree that all rules, polices, and procedures of Woodburn School District remain in effect for the duration of my student’s enrollment in this program and that violation of rules may result in disciplinary action.  I have discussed these rules with my student and they have agreed to abide by them.
  6. Should there arise a medical or similar emergency during the program, I authorize the Director or his designee to secure proper medical treatment and to authorize emergency medical procedures for my child until I can be reached.  I further agree to indemnify the Woodburn School District and WASC and staff for the costs incurred by such treatment.  I understand program staff will make every effort to contact myself or my designated emergency contacts prior to treatment, if reasonable to do so.
  7. I and my student(s) agree to adhere to the provisions of the WASC Parent Handbook and that we meet the criteria stipulated therein.
  8. I understand and agree to pay the fees as indicated above, and acknowledge that the late fee for picking up students after 5:30PM is $1/minute starting at 5:45.
  9. I understand that payments are due on the 25th of each month and late on the last day of the month. Students with outstanding balances must be resolved by the first day of the month or they will be withdrawn from the program until payment is made.
  10. I understand that all registrations must be accompanied by a payment or administrative voucher.  I further understand that students with outstanding balances without a voucher that have not been resolved may lose their place in the registration queue and be placed back on the wait list.
  11. I understand that falsification of any information on this registration form is grounds for revocation of the registration and/or removal from the program.
  12. I/we agree that failure to abide by these agreements, including those contained within the WASC Family Handbook, is cause for removal form WASC.  

Adult Registration:

  1. I understand and confirm that participation in this WASC program is voluntary and hereby apply for myself to participate in all activities in conjunction with this program. I further understand that my participation may involve risk of injury and loss, both to person and to property. On behalf of my child, I assume all risks in any way connected with said participation and I accept personal responsibility for any liability, injury, loss, or damage in any way connected with said participation.
  2. I do certify that I, the undersigned, in consideration of the benefits and opportunities derived by myself, who is a participant of WASC, do hereby release and discharge the Woodburn School District and the WASC, its officers, agents, staff, and employees from any and all claims, demands, suits, actions, or courses of  action which may, can, or shall have reason of illness, injury, or accident incurred or suffered by myself while in attendance of said WASC program, while traveling to or from, attending, or participating in said program no matter how caused or occasioned.
  3. I understand and acknowledge that neither basic accident and health insurance nor personal property insurance will be offered or provided by WASC in connection with WASC activities, field trips, etc, and that the provision of such insurance is my/our own personal responsibility.
  4. I understand and agree that all rules, polices, and procedures of Woodburn School District remain in effect for the duration of my enrollment in this program and that violation of rules or policies may result in disciplinary action.  I have discussed these rules with my family and we have all agreed to abide by them.
  5. Should there arise a medical or similar emergency during the program, I authorize the Director or his designee to secure proper medical treatment and to authorize emergency medical procedures for my child until I can be reached.  I further agree to indemnify the Woodburn School District and WASC and staff for the costs incurred by such treatment.  I understand program staff will make every effort to contact myself or my designated emergency contacts prior to treatment, if reasonable to do so.
  6. I and my student(s) agree to adhere to the provisions of the WASC Family Handbook and that we meet the criteria stipulated therein.
  7. I agree to ensure the appropriate behavior of my student(s) registered above during FamU and that I will personally be in attendance each and every day that my children are in attendance at FamU.
  8. I understand that falsification of any information on this registration form is grounds for revocation of the registration and/or removal from the program.
  9. I/We agree that failure to abide by these agreements, including those contained within the WASC Family Handbook, is cause for removal form WASC.  

Woodburn After School Club

1390 Meridian Drive, Woodburn, OR 97071

503-308-9272

bit.ly/woodburnasc

asc@woodburnsd.org

 Registration Agreement Document