After School Program Registration

Breckenridge History after school program

Thank you for your interest in joining the Breckenridge History after school program! Our program will run throughout the fall semester on Wednesdays from end of school to 5:30 pm. The first session will be at Upper Blue Elementary School and run Sept. 4 to Oct. 30. Our next session will be at Silverthorne Elementary School starting Nov. 6 and the last program will be Dec. 18. Student snacks will be provided. Each week will cover different history topics from American Indians to gold mining and railroad history.

Each week students will enjoy an activity focused on the topic. Activities include traditional Ute games, gold panning, Origami animals, and much more. If you have any questions about the program or the following forms, please contact Marketing and Outreach Manager Susan Gilmore at susang@breckhistory.org or call 970-453-9767 ext. 3.

2024-25 Afterschool Forms for Participation

In order to officially register for Breckenridge History’s after school program, the following forms must be completed and signed by the student's guardian:

- Student Information
- Authorization and Release
- Release of Liability for Class Participation
- Behavior Contract (must also be signed by student)
- Cancellation Policy

Please read these forms carefully and provide all information requested

Student Information

Please fill out the following information for our records
If your child does not have insurance, please write N/A in this field
If your child does not have insurance, please write N/A in this field

Authorization and Release

The undersigned, the parent. Classes, camps, and other activities provided or sponsored by Breckenridge History, the after school program. The undersigned understands and acknowledges that the above-named minor(s) may suffer injury, sickness or other physical harm from participating in such activities. The undersigned further understands that the undersigned is responsible for all costs and charges for medical treatment that may result from such injury or sickness, or other damages that otherwise result, relate to, or arise from participation in the after school program.

The undersigned further understands and acknowledges that Breckenridge History will not allow the undersigned, the above-named minor, or immediate relatives thereof to participate in the after school program and activities without releasing and holding Breckenridge History harmless. The undersigned requests that Breckenridge History allow above-named minor to participate in the after school program and activities, and in consideration thereof, agrees to release and forever discharge Breckenridge History, its officers and directors, and their employees, agents, and parties volunteering on behalf of Breckenridge History from all actions, causes of action, or claims for damage of any kind growing out of or relating to any of the after school program and activities in which the undersigned or above-named minor or their immediate families participate. The undersigned acknowledges that this is a full and complete release of all injuries, sicknesses, and damages that the undersigned or above-named minor or their immediate families may sustain or incur as a result of participation in the after school program and activities.

The undersigned gives permission to Breckenridge History to use any photographs/pictures for print, broadcast, recording, internet, website, and all other promotional materials related to Breckenridge History taken or created during the after school program and activities which may include the undersigned or above-named minor or their immediate families in promotional materials.

By e-signing my name, I acknowledge that I have read and agree to the terms and conditions of the Breckenridge History’s Release of Liability for Class Participation

Behavior Contract & Absences

BEHAVIORAL GUIDELINES:

Breckenridge History believes that each student involved in our workshops is entitled to a positive experience. Breckenridge History wants all students to have fun and do their best. As part of this philosophy, all students are required to follow the behavioral standards described below...

- Students are expected to be respectful to the teachers, Breckenridge History Staff, parents, other students, and facility representatives.

- Appropriate language must be used at all times. Name-calling, profanity, bullying, and/or inappropriate actions will not be tolerated.

- Breckenridge History expects students to be respectful of property; therefore, any damage intentionally done to property will be repaired or the damaged elements replaced by the student responsible.

- Breckenridge History expects purity of self with one's own body; therefore, the use of illegal drugs, alcohol, or tobacco products is strictly prohibited while at a Breckenridge History activity.

- Breckenridge History expects students to dress modestly and appropriately, in a way that promotes a healthy environment and eliminates distractions. Overly tight or revealing clothing is not acceptable. Midriffs must be covered. Undergarments are not to be visible or exposed at any time. For student safety, closed-toed shoes must be worn at all times.

DISCIPLINE PROCEDURES (CONSEQUENCES):

- In response to the first incident, the Outreach Manager, Staff, and/or individual in charge of a Breckenridge History activity will talk with the student about his/her misbehavior.

- If misbehavior continues, the Outreach Manager will call the parent and explain the misbehavior of the student, as well as potential consequences of continued misbehavior.

- If misbehavior continues, the Outreach Manager will meet with the parent and student to discuss possible dismissal from Breckenridge History workshops and activities.

- Continued misbehavior will result in dismissal from Breckenridge History activities for the particular session.

- Parents and students should be aware that serious misbehavior will be documented and may affect participation in future Breckenridge History workshops and activities. In certain cases, misbehavior that Breckenridge History considers extreme and/or which threatens the wellbeing of others will result in immediate suspension and/or permanent expulsion from all Breckenridge History workshops and activities.

ABSENCES
•After two absences without prior notice, a student's spot can no longer be guaranteed for the remainder of the term.

In order to officially register for Breckenridge History workshops and classes, camps, or other events, this form must be signed stating that the participant/participant's guardian has read and agrees to follow the guidelines stated above. Doing so will also signify that participants/participants' guardians are aware that Breckenridge History strives to keep students and others safe and free from harms when reasonably possible, but that Breckenridge History cannot guarantee any person's safety, or that students will comply with these guidelines at all times.

PARENT: By e-signing my name, I acknowledge that I have read and agree to follow the guidelines stated in the Breckenridge History Behavior Contract. I have read and understand the consequences of failing to follow them. I am aware that Breckenridge History strives to keep students and others safe and free from harm when reasonably possible, but that Breckenridge History cannot guarantee any person's safety, or that students will comply with these guidelines at all times
STUDENT 1: By e-signing my name, I acknowledge that I have read and agree to follow the guidelines stated in the Breckenridge History Behavior Contract. I have read and understand the consequences of failing to follow them. I am aware that Breckenridge History strives to keep students and others safe and free from harm when reasonably possible, but that Breckenridge History cannot guarantee any person's safety, or that students will comply with these guidelines at all times
STUDENT 1: By e-signing my name, I acknowledge that I have read and agree to follow the guidelines stated in the Breckenridge History Behavior Contract. I have read and understand the consequences of failing to follow them. I am aware that Breckenridge History strives to keep students and others safe and free from harm when reasonably possible, but that Breckenridge History cannot guarantee any person's safety, or that students will comply with these guidelines at all times
STUDENT 1: By e-signing my name, I acknowledge that I have read and agree to follow the guidelines stated in the Breckenridge History Behavior Contract. I have read and understand the consequences of failing to follow them. I am aware that Breckenridge History strives to keep students and others safe and free from harm when reasonably possible, but that Breckenridge History cannot guarantee any person's safety, or that students will comply with these guidelines at all times