High School English 2026-2027 After School Program Parent Handbook

Parent Agreement

HLPUSD After School Program 2026-2027
School
What School Does The Student Attend?
Parent/Guardian Phone Number

Area CodePhone Number
BASIC INFORMATION AND RULES

Enrollment:
- Priority will be given to: Homeless, Foster Youth, English Learners and students eligible for Free and Reduced Meals.
- Applications will require 5 working days to be processed.
Walker Form:
- Parents must complete an Authorization to Walk Form (page 9) to authorize their child to leave the program without a parent or guardian pickup.
- Students on the Walker Authorization List must leave the campus immediately after sign-out.
- A completed Authorization to Walk Form must be on file before a student can be released.
Attendance:
- Students are encouraged to attend consistently to gain the full benefits of the after-school program.
- Students must check into the before-school program from 6:30am-7:00am.
- Students must check into after-school first at 3:30pm before attending any programs.
- Valley High School students must check into the before-school program from 7:30am-8:00am.
- Valley High Students must check into the after-school program at 12:50pm.
Student Pick-Up (Students without an Authorization to Walk Home)
- Students can be picked-up from designated program check-out untill 6:00pm.
- A current California ID or California driver's license may be requested, and the adult must be 18 and over.
- Only the parents or guardians listed in the student's AERIES account are permitted to pick them up.
- Students picked up after dismissal time (6:00 pm) might be cared for by local law enforcement.
- Repeated late pick-ups may be cause for dismissal from the program.
- Student’s may not be released to parent/guardian if they appear to be under the influence or intoxicated.
- Verbal authorization will NOT be permitted by parent/guardian for student(s) to be released to a non-authorized designee.
General Daily Schedule:
- Program check-in, 6:30 am (Before School)
- Breakfast, 6:30 am-7:00 am
- Enrichment Program, 7:00 am-8:25 am
- Program check-in, 3:30 pm (After School)
- Supper, 3:30 pm-4:00 pm
- Enrichment program, 4:00 pm-5:30 pm
- Program closes, 6:00 pm
Emergency Contact Information:
- Parent/guardians must notify the Site Director whenever emergency contact information changes.
- Please ensure your information matches HLPUSD's student information system (AERIES). Updates must be provided to both the school office and the After School Program Site Director.
Education and Literacy Element:
- The After School Program's goal is to support day school instruction, not replicate it.
- Provides tutoring and/or homework assistance designed to help students meet state standards in core academic subjects (reading/language arts, mathematics, history/social studies or science.)
- A broad range of activities may be offered based on student needs and interests.
Homework Assistance:
- Homework completion during program is NOT guaranteed.
- Parents/guardians are responsible for reviewing and ensuring homework is completed at home.
- Students are responsible for bringing the materials or devices needed to complete assignments.
Discipline:
- Students must follow all Program rules and HLPUSD standards at all times.
- The After School Program is a privilege; violations may lead to suspension or dismissal.
- Leaving a supervised group or classroom without permission may result in immediate dismissal.
- Disrespectful or disruptive behavior toward students or staff may result in immediate dismissal.
- Damaging school/personal property may result in dismissal; parents are responsible for repair costs.
- Electronics (phones, iPads, headphones, etc.) are not permitted during program hours.
- The After School Program and HLPUSD are not responsible for lost or mispaced items.
- Recording, filming or photographing is strictly prohibited and may result in dismissal.
- Violence or serious misconduct toward students or staff may result in automatic removal.
- Program discipline, including suspension, may carry over into the day school program.

Parental/Guardian Support:
- Parent/guardian are welcome and encouraged to discuss their child’s behavior with the Site Director.
- Civil communication is required when discussing concerns; failure to maintain civility may affect program placement.
- Any current custody issues, restraining orders, or related documentation must be disclosed and submitted to the Site Director.
- For separated parents/guardians with joint custody, both parties must complete registration forms.
- Parent/guardian visitation during program hours isnot permitted without prior written approval.
- Any changes to medical or contact information must be reported to the Site Director immediately.
Consent

I have read and understand all the above information. I agree to follow all the rules and help my child succeed, understand, and follow the rules.
Parent/Guardian Signature

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Parent/Guardian Signature

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Student Signature

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Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearToday's Date

Student Registration Form

Student Information HLPUSD After School Program 2026-2027
Grade Level in 2026-2027 school year:
What is your child's grade level?
Please enter child's school again:
What is your child's school?
Student's Name

First NameMiddle NameLast NameSuffix
Student's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDOB
Student's Gender is identified as:
Student's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information

Information of parent/guardian of student
Parent/Guardian #1

First NameMiddle NameLast NameSuffix
Home Phone # of Parent/Guardian #1

Area CodePhone Number
Cell Phone # of Parent/Guardian #1

Area CodePhone Number
Email
Email of parent/guardian #1
Parent/Guardian #2

First NameMiddle NameLast NameSuffix
Home Phone # of Parent/Guardian #2

Area CodePhone Number
Cell Phone # of Parent/Guardian #2

Area CodePhone Number
Email
Email of parent/guardian #2
Emergency Contact Information

In the event the parent/guardian is not available, please list at least 2 contacts

Emergency Contact Information - Please list at least 2

Rows	Full Name	Phone #	Relationship
1
2
3
4
5

Please note that submitting the registration application DOES NOT guarantee that your student will be enrolled in the program.

The After School Vendor will need a minimum of 5 business days to process the application. They will contact you to confirm your student’s enrollment into the program.

Doctor/Medical Information

Student's medical information
Doctor's Name   First Name   Last Name
Address   Street Address      City   State   Zip
Phone #   Area Code   Phone Number
E-mail Address   Email

Medical Questions

Rows	Yes/No	If NO please type: N/A If YES, what? If student has medication, please list location.
Is the student allergic to any foods?
Is the student allergic to bee stings?
Does the student have asthma?
Is the student allergic to any medications?
Does the student have any other special needs?
Does the student take medications during the school day?

Please note that after-school staff cannot administer any medications to students during programing. Please speak with the Site Director for any questions or concerns.

Other Questions

Rows	Yes/No	If NO, write: N/A If YES please explain.
Are there any court orders in relation to your child?
Is there a person or persons who may NOT take child away from school?

If yes above, upload court documents here:

Browse Files

Cancelof
Signature of Parent/Guardian

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Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearToday's Date

Release For Emergency Treatment

HLPUSD After School Program 2026-2027
In case of an emergency and I cannot be reached, authorize, pursuant to the provisions of Section 258 of the California Code of Civil Procedure, any and all attention as may be deemed necessary by the physician/medical advisor in charge. I also realize that local law enforcement and paramedics may be called in certain circumstances in order to ensure emergency treatment. I understand and abide by the stated terms of this release. I understand that I am responsible for payment of emergency services.
Release for Exchange of Information with Regular Day School
I hereby * request and authorize an exchange of information between the regular day school staff and afterschool staff to support my student’s educational goals and progress. I approve the release of the following information: IEP, SST, 504, Behavior Intervention Plans, counselor communication etc.
Release for Permission to Participate in the Evaluative Survey
I agree do not agree* to allow my student to participate in any evaluative survey related to the Hacienda La Puente Unified School District’s After School Program.
Release for Permission to Photo, Video and Sound Record
I hereby release, discharge, and agree disagree* to hold harmless the HLPUSD After School Program and those acting under its permission from any liability to the extent permitted by law, for the preparation, distribution and use of photos, videos and/or sound recordings.
Acknowledge
Parent/Guardian Signature
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearToday's Date

Community Relations BP1311
CIVILITY

The district is committed to maintaining orderly educational and administrative processes in keeping schools and administrative offices free from disruptions and preventing unauthorized persons from entering school/district grounds. Members of the district staff will address parents/guardian and other members of the public with respect and expect the same in return.

This policy promotes mutual respect, civility and orderly conduct among district employees, parents/guardian and the public. This policy is not intended to deprive any person of his/her right of freedom of expression but only to maintain, to the extent possible and reasonable, a safe harassment-free workplace for our students of this district, as well as the community, the district encourages positive communication, and discourages volatile, hostile or aggressive actions. The district and the After School Program seeks your cooperation with this endeavor.

Legal References

EDUCATION CODE

32210 Willful disturbance of public school

44014 Assaults, required report

448101 Interference

44811 Disruptions

PENAL CODE

243.5 Assault on school property

415.5 Unlawful fighting on school grounds

626.8 Schools

627.7 Misdemeanors, punishment
Name of Parent/Guardian

First NameMiddle NameLast NameSuffix
Signature of Parent/Guardian

You can use your finger or mouse to sign
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Release of Liability

HLPUSD After School Program 2026-2027
In consideration of being allowed to participate in any capacity in the After School Program in the Hacienda La Puente Unified School District athletics/sports program, and related events and activities, the undersigned:

1.     Agree that the parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she should immediately advise his or her coach or supervisor of such condition(s) and refuse to participate.

2.     Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions, or negligence but the action, inaction, and negligence of others, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.

3.     Assume all the foregoing risks and accepts personal responsibility for the damages following such injury, permanent total disability or death.

4.     Release, waive, discharge and covenant not to sue HLPUSD, Champions, Del Haven Community Center or Boys & Girls Club of West San Gabriel Valley & Eastside and its affiliated clubs, their respective administrators, directors, agents and other employees of the organization, other members/participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessons or premises used to conduct the event, all of which are hereinafter referred to as “releases,” from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death and damage to property, caused or alleged to be caused in while or in part by the negligence of the releases or otherwise.
I HAVE READ THE ABOVE WAIVER AND RELEASE; UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT VOLUNTARILY.
Name of Participant:   First Name*   Last Name*
Name of Parent/Guardian:   First Name*   Last Name*
Parent/Guardian Relationship:   *
Signature of Parent/Guardian: Signature*
Date*
Address of Member/Participant:   Street Address*      City*   State*   Zip*
Telephone Number of Parent or Guardian:   Area Code*   Phone Number*

Authorization To Walk Home
Dear Parent or Guardian:

To authorize your high school student to walk home from the Hacienda La Puente Unified School District’s After School Program, this form must be signed and returned to the Site Director. Your child will not be allowed to leave campus unaccompanied unless and until this form has been received by HLPUSD’s After School Program Site Director.
My child, First Name* Last Name* , has permission to WALK HOME (walk off campus) from * . I am aware that once my child leaves the school campus, there is no adult supervision for them provided by the Hacienda La Puente Unified School District's After School Program staff. I have made my child aware that, for their safety, they are not allowed to loiter around the premises of the school or at any nearby businesses, and they must go directly to their after program destination.
By signing, you are agreeing to the following guidelines:
- Parent must contact the Site Director to have the student released prior to the end of program at 6:00pm.
- Calls or texts to your student to relay the message to the site director will NOT be accepted.
- You agree that ANY CHANGES from the above permission will be communicated (in writing) to the HLPUSD’s After School Program Site Director prior to changes being made.
- This authorization form will remain in effect unless and until you have notified the HLPUSD’s After School Program in writing that it has been rescinded.
Notes
Type NA if no notes to give to staff
Student's Name

First NameMiddle NameLast NameSuffix
School
Grade Level in 2026-2027 school year:
Student Grade Level
Parent/Guardian Name

First NameMiddle NameLast NameSuffix
Parent/Guardian Signature

You can use your finger or mouse to sign
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I give permission for my child to WALK HOME for the duration of the 2026-27 school year.
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Should be Empty:

Parent Agreement

Consent

Student Registration Form

Parent/Guardian Information

Emergency Contact Information

Doctor/Medical Information

Release For Emergency Treatment

Release for Exchange of Information with Regular Day School

Release for Permission to Participate in the Evaluative Survey

Release for Permission to Photo, Video and Sound Record

Community Relations BP1311

Release of Liability

I HAVE READ THE ABOVE WAIVER AND RELEASE; UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT VOLUNTARILY.

Authorization To Walk Home

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