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Welcome to the Registration Page for Summer Arts for Learning at Goodnow. The program is being operated by Arts for Learning Maryland (formerly known as Young Audiences of Maryland) and is offered to students CURRENTLY finishing grades Pre K-7. Transportation for students is NOT provided.

NOTE: Applications are reviewed on a rolling basis, and registration is first come, first served. The program fills up quickly, so apply today!

For more information about the program click here.

Other (please explain from above)

Student Information

Please complete the registration for your first student. You will have the option of registering another student in the same family on the last page of the form.

1. Student First Name

2. Student Middle Name

3. Student Last Name

4. Student Nickname

5. Does your child have a Baltimore City Student ID Number.

Yes and I know it!Yes but I don't know it!My child is not a Baltimore City school student.This number can be located on your report card. If you can't locate your student's ID Number, it is highly recommended that you call their home school to request it, and then complete this registration form. Registration/enrollment is on a first come, first served basis and there are a limited number of slots.

Please enter the Baltimore City Student ID Number for this student.

This number can be located on your report card. If you can't locate your student's ID Number, it is highly recommended that you call their home school to request it, and then complete this registration form. Registration/enrollment is on a first come, first served basis and there are a limited number of slots.

6. Student Home Address

Address

City/Town

State/Province

ZIP/Postal Code

7. Student Date of Birth (MM/DD/YYYY):

8. What grade is the student CURRENTLY in?

9. What grade will the student be in NEXT school year (School Year 2022-2023)

10. Gender:

MaleFemaleMy student's gender is not listed

If not listed above, please enter your student's gender here:

11. What are your student's gender pronouns to be used in this space and program?

he/him/hisshe/her/hersthey/them/theirsMy Student's pronouns are not listed here:

If not listed above, please enter your student's gender pronouns here:

12. What is the student's ethnicity? OPTIONAL - We use this information for statistical purposes only.

Hispanic or LatinoNot Hispanic or Latino

14. What is the student's primary language?

EnglishSpanishOther (please specify)

Other Student Primary Language

15. This program will take place Monday through Friday between July 5th and August 12th 8:30AM - 4:30PM. Can your child commit to attending all days?

Yes. I can commit to my student attending Monday through Friday for the full 6 weeksIf not, please list any dates that they will miss and the reason for missingThis question is specific to planned absences like vacations. If a student is sick they are strongly encouraged to stay home.

Please list any dates that they will miss and the reason for missing:

16. Does this student have any of the following? (Please select all that apply):

An IEP (Individualized Education Plan)504 Plan or Behavioral Intervention Plan (BIP)Any other student need for reasonable accommodations (please explain in the comment box below)

Other need for reasonable accommodations

17. Does this student receive ESOL services as an English Language Learner?

YesNoI don't know

18. Is this student involved in Gifted and/or Advanced programs?

YesNoI don’t know

19. If your student attends a Baltimore City Public School, what school does this student currently attend? If your student does not attend a Baltimore City Public School please click the "I do not see my school listed" option.

This is a list of all Baltimore City Public Schools. Attendance at a school on this list does not guarantee eligibility for the program.

If you do not see this student's school on the list. Please type the school name.

20. Why should this student be accepted to the Goodnow Summer program? How do you hope they will benefit from the program?

21. What would you like us to know about your child both academically and in general? Please share how we can best support them.

Student Transportation Plan

1. My student will ARRIVE to the program by 8:30AM each day by (choose one):

2. My student will DEPART from the program at 4:30PM by (choose one):

Child's Medical Information

1. Is your child on any medication?

YesNo

If yes, please list the medications and any side effects below:

2. Are any medications to be taken during the program?

YesNo

If yes, please list the medications to be taken during the program as well as the time/s to be taken, the dosage and any other information staff needs to know.

3. Please list below any special limitations or concerns your child may have, such as dietary restrictions, allergies (including the reaction and treatment required should your child become exposed to the allergen), or chronic health conditions.

Parent/Guardian Information

You will have an opportunity to register more than one student in the same family at the end of the application as long as the parent/guardian information on this page applies to all students being registered.

Parent/Guardian #1 Contact Information

Parent/Guardian First Name

Parent/Guardian Last Name

Relationship to Student(s):

Home Phone (If N/A Please Leave Blank):

Cell Phone (Note: this number can be used to notify you of important program information):

Work Phone (If N/A Please Leave Blank):

Email Address:

Address

City/Town

State/Province

ZIP/Postal Code

What is the primary language spoken by this parent/guardian?

EnglishSpanishOther (please specify)

Other Parent Primary Language

Parent/Guardian #2 Contact Information

Parent/Guardian First Name

Parent/Guardian Last Name

Relationship to Student(s):

Home Phone (If N/A Please Leave Blank):

Cell Phone:

Work Phone (If N/A Please Leave Blank):

Email Address (If N/A Please Leave Blank):

Check here if the home address for this parent/guardian is the same as Parent/Guardian #1

Home Address Line 1

City/Town

State/Province

ZIP/Postal Code

Emergency Contact #1

At least one emergency contact is required. This person must be different from the parent/guardian listed on the previous page.

First name

Last Name

Relationship to Student(s):

Home Phone (If N/A Please Leave Blank):

Cell Phone:

Email (If N/A Please Leave Blank):

Is emergency contact #1 authorized to pick up the student?

YesNo

Emergency Contact #2

First Name

Last Name

Relationship to Student(s):

Home Phone (If N/A Please Leave Blank):

Cell Phone:

Email (If N/A Please Leave Blank):

4. Is emergency contact #2 authorized to pick up the student?

YesNo

I am the Parent/Guardian of

a minor child (the “Student”). Arts for Learning Maryland. (“Arts for Learning”) is the operator of Goodnow Summer Program 2022.

Goodnow Summer Program 2022 CONSENT, WAIVER AND RELEASE STATEMENT

By checking the CONSENT box below and signing this document, I agree and consent to all of the following terms and conditions:

1. I give permission to City Schools Employed nurses and the staff in the Goodnow Summer Program to administer basic first aid and/or CPR to my child and/or take the Student to a hospital to secure medical treatment when I cannot be reached, or when delay would be dangerous to my child's health. I also give permission to staff to administer medication in the event that a nurse is not available to do so.

2. I certify my understanding that I will receive policies and procedures and related information about the Goodnow Summer Program. Upon enrollment of my child in the Goodnow Summer Program, I agree to follow the policies and procedures described.

3. I give Arts for Learning Maryland, Inc. (“Arts for Learning”) permission to access and keep copies of my child's/children's academic record(s), including report cards, IEP's, standardized test scores and cumulative records. Arts for Learning will keep these data confidential and use them only for analysis and program planning. I understand that Arts for Learning may share data collected during the program, including attendance, demographics, and academic outcomes, with program funders and sponsoring organizations; however, any information shared will not specifically identify program participants. 4. I give Baltimore City Public Schools and Arts for Learning permission to contact me (using telephone, email, mail, SMS text message, or robo-call via telephone) using the contact information I provided about the status of enrollment, my child's attendance, upcoming events and programs, schedule changes and program updates.

5. I certify my understanding that I will be given a Field Trip Permission Form to authorize my child's participation in any field trip or other off-site activity planned by the program and that alternate care will not be provided should I choose not to grant such permission for the Student’s participation. Additionally, I acknowledge that the Student’s participation in Field Trips is at the sole discretion of the Arts for Learning Team.

6. I release Baltimore City Public Schools and Arts for Learning as an organization, as well as its employees, contractors, volunteers, and agents (collectively, the “Arts for Learning Team”) from any liability suit or claim for property damage or loss, or personal injury to the Student, except to the extent such claims arise directly from the gross negligence of Baltimore City Public Schools, Arts for Learning and/or the Arts for Learning Team. 7. Arts for Learning takes great care in capturing thoughtful, high-quality images of students’ incredible artwork, their pride, excitement, determination, friendship, and joy. I understand that the images, video, and materials collected over the course of the Goodnow Summer Program are vital for building awareness of the program in the community and for securing funding so that it can continue to grow and remain available at no cost to students. I give permission for the Student to be included in the documentation/promotion of Arts for Learning and its partners, including photographs, audio/visual/video recordings, interviews, reproductions of academic and artistic work, participation in surveys, and written quotations or descriptions of activities. I also understand that resulting materials may be exhibited before the community, fundraising, or other groups and individuals and/or included in media articles, partner publications, and Goodnow Summer Program funder promotional materials.

8. I certify that the Student will attend every day of the program except in the event of an emergency. I acknowledge that students who miss more than 3 days of the program may be removed so that their spot can be given to another student

9. I certify that the entered information is true and correct to the best of my knowledge.

BALTIMORE CITY SCHOOLS COVID GUIDELINES AND WAIVER

I understand and agree to comply with all the following requirements for my child’s participation in the In-Person Summer Arts and Learning Academy

My child will follow the Code of Student Conduct, as well as all rules for wearing a mask and social distancing, set forth in the City Schools Health and Safety Guide, which is grounded in science-based, expert guidance and real time experience from in-person operations in City Schools and across the United States and in other countries (https://www.baltimorecityschools.org/safety-procedures)
I will not send my child to the Goodnow Summer Program if they have symptoms of a COVID-19 like illness, have been diagnosed with COVID-19, are waiting for test results, or have been in close contact (within 6 feet for at least 15 minutes total over a 24 hour period) with anyone diagnosed with COVID-19 or suspected of having COVID-19 in the past 14 days. I also agree to report to City Schools that my child has a confirmed or suspected case of COVID-19.

COVID-19 Guidelines and Expectations Signs and Symptoms of COVID-19:
New onset cough, shortness of breath OR At least 2 of the following:

Fever of 100.4 or higher
chills
shivering
muscle pain
sore throat
headache
loss of sense of taste or smell
gastrointestinal symptoms (nausea, vomiting or diarrhea)

I will review symptoms with my child and monitor my child’s symptoms every day that my child attends the Goodnow Summer Program
If my child becomes ill during the Goodnow Summer Program, I will ensure they are picked up from school promptly and will follow-up with an authorized health care provider/health department and comply with recommended quarantine or isolation as directed. If my child is ill, I understand that a release to return to in-person activity from an authorized health care provider will be required.
I will ensure that a parent or guardian remains with my child until they complete their health screening. If my child does not pass the health screening, a parent or guardian will be there to take my child home.

Students must be free of fever without the use of fever reducing medications for the period of time directed by the Maryland Department of Health’s current guidelines. Please consult your health care provider or the Maryland Health Department (Dial 211) with specific questions about COVID-19.

If you need health insurance for your child, please visit: https://www.marylandhealthconnection.gov/ or call 1-855-642-8572.

If City Schools is able to provide rapid COVID-19 testing to participants in the Goodnow Summer Program, I consent to my child’s testing onsite by health professionals working in collaboration with City Schools and that tests results will be shared with the parent/guardian, City Schools, and the Baltimore City Health Department.

I understand that failure to comply with the above rules may require City Schools to take steps necessary to protect the health and safety of my child, as well as other students and staff.

I have reviewed information regarding COVID-19, including but not limited to these documents:

1. What you should know about COVID-19 to protect yourself and others;

2. What You Can do if You are at Higher Risk of Severe Illness from COVID-19

3. COVID-19 Frequently Asked Questions from the Maryland State Health Department

4. City Schools Health & Safety Guide

Based on my review of this information, I am aware that there is a risk of being exposed to COVID-19 by participating in the Goodnow Summer Program. I am also aware that exposure can occur either directly or indirectly, whether or not a mask is worn, and notwithstanding reasonable efforts by A4L, the host site and/or Baltimore City Public Schools to mitigate exposure.

I have considered my child’s and family’s personal health risk in the decision to attend the Goodnow Summer Program. I have independently evaluated and reviewed the risk of being exposed to or infected by COVID-19, and I have determined to allow my child to participate in the Goodnow Summer Program with full knowledge, acceptance, and assumption of all the above risks.

In the event that programming has to be transitioned to virtual as a result of any COVID-19 related scenario, I will:

1. Contact my child’s teacher with any questions or concerns;

2. Support my child by:

Establishing a physical space where my child can plug in and engage in virtual programming; and
Encouraging the completion of activities and assignments.

3. Ensure my child is engaging in virtual programming in a manner that reflects community values including:

Using the chat feature of Zoom for conversations only related to the lesson, and as instructed by teachers;
Refraining from posting any identifying information including their full names, phone numbers, email or home addresses, as well as, avoid posting or sharing of any website or link in the Zoom chat feature; and
Refraining from recording or capturing any image during delivery of programming.

THIS IS A CONSENT, WAIVER, AND RELEASE OF LEGAL RIGHTS. READ IT CAREFULLY AND BE CERTAIN YOU UNDERSTAND IT BEFORE SIGNING. PLEASE CHECK ONE OF THE BOXES BELOW, THEN SIGN YOUR NAME.

CONSENT: I have read this Consent and Release and agree and consent to the terms and conditions set forth in it. I agree that I and the Student, and all of our heirs, legal representatives and assigns, are and shall be legally bound by the terms in this Consent and Release, and understand that Arts for Learning will rely on my consent and agreement. NON-CONSENT: I do not agree or give my/our authorization or consent to the terms in this Consent and Release on behalf of the Student, AND HEREBY WITHDRAW MY APPLICATION IN THE PROGRAM.

By signing below, I represent and certify that I am the parent or guardian of the Student, at least eighteen (18) years of age, and fully competent and authorized to sign this Consent and Release.

Please sign this form digitally by typing your first and last name:

11. Do you have another student in the same family that you would like to register for the Goodnow Summer 2022 program? If you chose yes, a new application will open up. If you choose no, you will be done with the registration process.

YesNo