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Public School District Operated School-Age Child Care and Remote Learning Enrichment Center - REGISTRATION FORM

*Note: This Registration Form has been updated as of September 2020 due to COVID-19 to include a remote learning enrichment center option. Please refer to Frequently Asked Questions – Enrichment Centers Established by School Districts for Remote Learning as well as the DESE and Department of Early Education and Care (EEC) Joint Guidance on Care Options for Hybrid and Remote Learning Models documents for further details.

BASIC PROGRAM INFORMATION

*Please include the school at which the program takes place; and also any schools that send students to this program.
This question requires a valid email address.
This question requires a valid email address.

STUDENTS SERVED

Please indicate the estimated number of students served at each applicable grade-level.
Space Cell PKK123456789101112
School-Year
Summer

SCHEDULE OF OPERATION

Please provide the requested information for all that apply:
Space Cell # hours/ day# days/ week# of weeksTotal # of hours
School-Year (before school)
School-Year (after school)
School Year (remote learning)
School Vacation Weeks
Summer

PROGRAM FEATURES

Services/Activities: Which of the following are components of the program? (check all that apply)
Transportation: Please indicate how students travel to/from the program. (check all that apply)
Program Funding/Fees*: How is your program funded? (check all that apply) *Note: For remote learning enrichment centers, in instances where the school committee determines that a fee is necessary to cover program costs, DESE recommends that the school committee utilize a sliding fee scale based on family income, and any fees charged should reflect only the costs of the program.
*If parents/families pay fees, does your program offer a sliding scale and/or scholarships for families that cannot afford the program?
If available, you may upload a copy of your program flyer/handbook. (This is not required for registration.) Click Browse to find your file, click on the file, and then click Upload to begin upload process.
     Superintendent (Signature)*: _________________________________________________      
    
     Date*: _________________________
    

*Upon receipt of the PDF version of this submitted form, please sign, scan and email with the signature of the Superintendent to asost@mass.gov.