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Chicago Lights Summer Day Student Application 2024












PARENT/GUARDIAN INFORMATION







STUDENT CONTACT INFORMATION


EMERGENCY CONTACT INFORMATION




AUTHORIZED CONTACT INFORMATION # 1
Please complete the below information for anyone other than you that is allowed to pick up your child/children: 




AUTHORIZED CONTACT INFORMATION #2
Please complete the below information for anyone other than you that is allowed to pick up your child/children: 




STUDENT SCHOOL INFORMATION




PROGRAM INFORMATION
























CAREER PREP PROGRAM
The Career Prep Program for rising 7th-9th graders is a unique summer experience that combines career exploration, academic and arts learning, experiential trips, and FUN! There is limited space available in this program, so we want to make sure the students that are most committed and ready for this program are selected. Therefore, please answer the questions below.
Parents, please share more about your child:



Students, please answer the following:





Please sign below if you and your child can commit to the following rules and expectations:

  • Upon entering class, students will be required to place their phones in lock box until the end of class.
  • Students must be ready and willing to actively participate; respect themselves, each other, and the staff; and resolve conflict that may arise.
  • If the above does not happen, parents/guardians will be contacted by staff:
    • First call home is a warning.
    • Second call home is a write -up and meeting with parent and student. In person or over Zoom.
    • Third call home is a temporary suspension from the program or loss of a field trip.
    • Fourth call home dismissal from program.
  • Please note: physical fighting and blatant disrespect towards staff members may result in immediate dismissal.



TRANSPORTATION

The Summer Day Program offers free bus transportation contracted by Ron’s Transportation to and from the program each day from the near north, near west and south side neighborhoods of Chicago at the following locations and times:

  • NORTH SIDE
    • 8:00am - HALSTED ST. AND EVERGREEN ST.
    • 8:05am – SEDGEWICK AND BLACKHAWK
    • 8:10am - MANIERRE SCHOOL (1420 N. Hudson)
    • 8:15am - SEDGEWICK AND GOETHE
    • 8:20am - SEWARD PARK (Orleans & Division)

  • WEST SIDE
    • 8:00am - ST. MALACHY (Oakley & Maypole) 
If those bus stops are not convenient for you, parents may also drop off and pick up their student, or if old enough, students may walk or use public transportation. Please Note: Participants of Chicago Lights Programs who are under the age of 18 are prohibited from using ride sharing services, such as Uber and Lyft, as transportation to and from the program. If the parent/guardian is unable to transport the participant to and from the program, please do not send the participant to the program on that day. Additionally, volunteers and staff of Chicago Lights are not permitted to chaperone students on any ride sharing service.




Transportation Release

Please Note:

After Summer Day, students will be dropped off between 3:15 pm and 3:30 pm at the bus stops listed above.

You MUST stay with your child until the bus arrives and you MUST be present when your child is dropped back off at the bus stop.


The following transportation program release form MUST BE SIGNED by a parent for any student who uses the Summer Day bus service, provided by Ron's Transportation, Inc. After reading, YOU MUST enter your name.

I give permission for my child to use the Chicago Lights bus service, provided by Ron's Transportation. for the purpose of transportation to and from the Summer Day Program. I hereby release Fourth Presbyterian Church and Chicago Lights from any liability and assume full responsibility for the safety of my child at all times. I recognize that Fourth Presbyterian Church and Chicago Lights are not responsible for my child while walking to or from the designated bus stops. I understand that Fourth Presbyterian Church and Chicago Lights will utilize all reasonable safety precautions.



PHOTOGRAPHY AND VIDEO
The staff of Chicago Lights and Fourth Presbyterian Church periodically take photographs and video of our tutors, students, and staff for use in celebrating and promoting the work of the Chicago Lights Summer Day program. These images are among our most compelling representations of Summer Day and are vital to our effort to generate funding to support the program. These photographs and videos, which are used in print pieces and electronic communications, are used only by Chicago Lights and Fourth Church. They are never sold, nor are they used by other individuals or organizations without permission from those in the photographs. Similarly, no individuals in the photographs are ever identified by name without their permission. By completing this application, you agree that unless you indicate otherwise below, you grant your permission for Chicago Lights and Fourth Presbyterian Church to photograph or film your child and use such photos or videos in these ways to depict the work of the Summer Day program.

NON DISCRIMINATION POLICY
We want to make you aware of the non discrimination policy we follow and provide information on where to file a complaint when you need to. Thank you! 
In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity. Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation.

The completed AD-3027 form or letter must be submitted to USDA by:   
1. mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights1400 Independence Avenue, SW Washington, D.C. 20250-9410; or   
2.fax:(833) 256-1665 or (202) 690-7442; or   
3.email:program.intake@usda.gov                                           

This institution is an equal opportunity provider.  

TUITION PAYMENT
Tuition costs $50 per child. Form of payments will be sent with a confirmation letter.  

FIELD TRIP/OUTDOOR RECREATION PERMISSION FORM AND PROGRAM WAIVER
II hereby give my permission for my student to attend all program-sponsored field trips and Outdoor Recreation Classes during the 2024 Summer Day Program.  All field trips will be age-appropriate and include trips to the park, beach, museums and theaters.  Outdoor recreation classes will include an hour of fitness with activities, including but not limited to: kickball, obstacle courses, softball and other outdoor games.


I understand that prior to each field trip, my child will be sent home with a notice of the place, date, time and method of transportation for the trip.  If I do not want my child to attend a scheduled field trip, I will inform Mark Dennison at
mdennison@chicagolights.org as soon as possible, and keep my child home the day of the trip.

I understand that for outdoor recreation classes, my child will go outside two days per week to our playground supervised by the outdoor recreation class Instructors.  If I do not want my child to participate in the outdoor recreation class or if I have any concerns about my child’s ability to participate in the class, I will inform Mark Dennison at
mdennison@chicagolights.org as soon as possible.

Furthermore, I understand that while Fourth Presbyterian Church and Chicago Lights will utilize all reasonable safety precautions
during the 2024 Summer Day Program, I release and relinquish Fourth Presbyterian Church and Chicago Lights from any liability and cause(s) of action for any accident that may occur and assume full responsibility for the safety of my child at all times.