Tutoring, Counseling, Connection

LCYC has provided after school programs for LaGrange County 3^rd-5^th grade students for more than a decade. Our programs occur on weekday afternoons from 3-5:30pm at different schools throughout the county. We offer a diverse range of programming including academic support, homework help, community speakers, mentoring, physical education, arts and culture enrichment and much more! After school programs have proven to have a positive influence in children’s lives and in the overall community. They give children a safe place to go to after school and offer extended learning opportunities outside the classroom. Registration forms are located on our website and available in school offices where our programs are located.

UPDATE: Due to the unforeseen circumstances of Covid-19 we are reworking our after school programming for the 2020-2021 school year. Please continue to check our website, find us on Facebook or email Jennifer for updates or questions on what programs we are going to be offering.

A tutor works with a student in an after-school program.

After School Program Signup

If you would like for your child to participate in the 2020/21 After School Program please complete the form below.

School District*
Student*
First Last
Grade Level for 2020/2021 School Year*
Student's Age*
Student's Date of Birth*
Student's Home Phone
Student's Cell Phone
Student's Address*
Street Address City State / Province / Region ZIP / Postal Code
Parent / Guardian*
First Last
Parent / Guardian Home Phone
Parent / Guardian Cell Phone
Emergency Contact*
First Last
Relation
Emergency Contact Home Phone
Emergency Contact Cell Phone
Allergies
Additional info that may be helpful
Child's most frequent mode of transport
Parent / Guardian Electronic Signature
General Compliance Signature
Picture Release Signature
Walking Consent Signature
By electronically inputting your signature in the upper categories you are giving consent to:
1. Acknowledgement that you consent to all the terms set forth by your School Cooperation and the LaGrange Communities Youth Centers, Inc. regarding the After School Program.
2. “The LaGrange Communities Youth Centers, Inc., volunteer, or any employee of and/or any employee at any locations, are hereby released and discharged liability or damages resulting from any accidental injury occurring to you child, and do hereby agree to release, indemnify, and hold harmless LCYC, Inc.for any and all claims, injuries or cause of action arising or occurring during program participation.”
3. Permission for your child to be photographed during activities at the LCYC After School Program. These pictures are to be used only for the purpose of the newspaper articles, brochures, and/or publicity directly related to the After School Program activities. Pictures may appear on the LCYC, Inc. Facebook page and the LCYC, Inc. website – However, NO NAMES will be used to identify students. Permission for you child to walk home from the LCYC, Inc.
4. After School Program, agreeing to contact the LCYC directly if request changes.
Please type N/A if any of these do not apply or if you do not give consent.
Your Email*
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

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