REGISTRATION

Registration

Program Details

Program Dates: July 7, 2025 – August 15, 2025
Program Hours: Monday – Friday, 8:00 AM – 4:00 PM
Afternoon care available until 6:00 PM

Student Information (Please fill out a form for each child)

Student's First Name

Student's Last Name

Date of Birth

Month

Day

Year

Home Address:

Phone

Any Health Conditions we should be aware of?

Allergies

Special Medication?

Parent/Guardian Information

Parent/Guardian Name:

Parent/Guardian Phone Number:

Email

What grade level will your child complete this school year (2024-25)?

Which school did your child attend this year? If multiple, please write the school where they ended the year.

Discovery students MUST be students who attend school in Wayne, Macomb or Oakland counties. Which county did you attend?

Wayne

Macomb

Oakland

Other

Please share the ZIP code of the school your child attends. If multiple, please write the ZIP code where they ended the year.

What is your child’s racial and/or ethnic identity?

What is your child’s gender?

Male

Female

Prefer not to answer

Is your child an English learner or English as a second language student?

Yes

No

Not sure

Prefer not to answer

At school, is your family eligible to receive free lunch?

Yes

No

Not Sure

Why are you registering your child for the program? (Select all that apply)

To get help with academics

To participate in enrichment

To have fun & safe place to go during the day

Did your child attend a Summer Discovery program last year (2024)?

Yes

No

Not sure

Students who register for Summer Discovery programming must commit to attending programming throughout the summer. Summer Discovery is not a drop-in program, and students need to attend daily to receive the program's full benefits.

Your student would be expected to attend 18 or more days (70% attendance), do you agree?

Yes

No

To further allow us to assess program-related successes and challenges, you may be invited to participate in an optional focus group with researchers from MGT this summer.

If you are interested in being contacted to participate, please indicate as much below.

Yes, I may be interested in participating in a family focus group. Please get in touch with me with more details.

No, I am not interested in participating in a family focus group.

Im not sure.

Emergency Contact (Other than Parent)

Name

Phone Number

Relationship to Student

Authorized Pick-Up (Other than Parent)

Please list the names of individuals authorized to pick up your child:

Name(s) of Authorized Person(s):

Phone Number(s) of Authorized Person(s):

Would your child need afternoon care?

Yes

No

Transportation Needs

I need transportation for my child.

I will provide transportation for my child.

Summer School T-Shirt Size

Code of Conduct & Ethics

Students are expected to:

Treat all staff, students, and others with respect and kindness.
Follow instructions and participate in activities.
Keep the environment safe by adhering to program rules.
Avoid bullying, harassment, or any disruptive behavior.
Show integrity by being honest and responsible.

Dress Code

To ensure comfort and safety, students are asked to adhere to the following dress code:

Tops: T-shirts, tank tops, or other comfortable (appropriate) clothing.
Bottoms: Shorts, skirts, or pants appropriate for summer activities.
Footwear: All weather appropriate shoes but no house shoes allowed
Students should dress appropriately for physical activities and field trips.

Media Consent

I consent to my child's picture, video, or likeness being taken during the program forprogram-related promotional purposes, including but not limited to flyers, website, social media, and local media coverage.

Yes I consent to media use

No,I do not consent to media use

Students are allowed to use program-provided technology for educational purposes

only. Personal devices are not allowed unless otherwise stated. The use of devices for

inappropriate content, gaming, or excessive screen time during program hours is

prohibited. Any misuse of technology will result in disciplinary action.

Disciplinary Actions

Disciplinary actions will be taken for behaviors that violate the Code of Conduct,

including but not limited to:

Verbal warning

Parent/Guardian notification

Temporary removal from activities

Dismissal from the program in extreme cases

Students and parents/guardians will be notified of any actions taken.

“Along with assessments, your child will be asked to complete a pre- and post-survey during the program so that we can evaluate any program-related successes and challenges this year in order tocontinue to improve Summer Discovery to best serve all students and families. No further action is required to provide consent for your child to participate. If you would prefer that your child not participate, please notify Omiga Carter or Michelle Tuck (tlcenroll25@gmail.com) confirming you would like to opt-out of student surveys.”

Consent and Acknowledgment

By signing below, I acknowledge that I have read and understand the following policies

for the Transformation Life Center Detroit Summer Discovery Program:

Code of Conduct & Ethics

Dress Code

Media Consent

Technology Policy

Disciplinary Actions

Assessment Acknowledgment

I understand that my child is expected to follow these rules and guidelines throughout

the program. I consent to these policies being enforced as necessary.

Parents Signature

Date

Month

Day

Year

Parent/Guardian Information

Transformation Life Center

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