Vine Street 21CCLC Registration

Vine Street 21CCLC Online Registration

18 Questions

First Last

  • Releases & Permissions

    Please contact the Director of the 21st CCLC Program with any questions about these releases and permissions.

  • Online Learning

    Release to waive Family Education Right to Privacy Act (FERPA) for a Zoom meeting - This form gives permission for your child to participate in Zoom classroom experiences with program staff and other students. By signing below, I state that I understand that other students, students' parents, siblings, or friends who are in the room during the Zoom session may learn protected educational information about my child during these Zoom meetings and I do not hold the Bangor School Department responsible if information about my child is disclosed as a result of a Zoom camp meeting.

  • Photographs and Videos

    This form gives permission for your child's photograph and/or video to be used to advocate and/or publicize our 21st CCLC Program. These publications may be used in our school newsletter, brochures, on our website, television, or any other type of publication. By entering my name below, I give permission for my child to participate in any photo or video session that may be part of Vine Street School's 21st CCLC Program.

  • 21st CCLC Permission

    In order to provide evidence to maintain our 21st CCLC grant we need to keep track of student demographics, free and reduced lunch status, academic progress and activity participation. All information collected will be restricted and used solely for serving student needs and program evaluation purposes. By entering my name below, I authorize the release of my child's information in order to provide evidence to maintain Vine Street School's 21st CCLC grant and to track overall student progress for program evaluation.

  • Release of Liability

    By entering my name below, I/we agree to hold harmless and indemnify the Bangor school department, officers, agents, employees, volunteers and contractors from all claims, demands, causes of action that arise from any unintentional or claimed negligent act or omission resulting from any student's participation in the 21st CCLC program.