If there are additional email addresses for spouse/partner or other family member to which you would like program information sent, please enter them below. Otherwise, leave this section blank.

The Village Learning Place’s programs seek to create an inclusive and welcoming environment that helps youth of all abilities. Everyone is welcome to enroll. If your student needs to have special accommodations made to allow him/her to participate, we will be happy to work with you.

Does your child receive any special education services (IEP, 504, speech, etc.) at school or other supportive services? If yes, then please explain to allow our staff to help your child be happy and successful this summer.

Throughout the school year, volunteer opportunities will be shared with LINK families. VLP will use SignUpGenius online system to share and manage volunteer opportunities.

An adult or a family member that is 14 years old or older must be available by phone in case of emergency. Please complete the chart below for all individuals to whom you, the legal guardian, give permission to be contacted in case of an emergency.

If for any reason these individuals change, then please contact the Youth Programs Coordinator and the LINK Leaders Academic Youth Advocate.

Please answer the following questions. This information will be used to determine whether the benefits of this program are being made available to all people on a non-discriminatory basis. Further, the information being collected is a requirement by funders of this program, and part of our continued efforts to remain in compliance with their guidelines.

Remaining in compliance is the only way that we are allowed to effectively conduct this service and continue to provide this FREE program to you, your child(ren), and this community.

The Village Learning Place (VLP) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived from any public assistance program.


None of this information will be shared outside of our program. We report demographics in terms of numbers, and not attached to identifying information.

Thank you for your understanding. If you have feedback about how we can make this from more inclusive, please share it in the space provided at the end.

As the legal guardian of the student named in this application:

• to be photographed or videotaped by the VLP or its partners (e.g. Johns Hopkins/SABES, Single Carrot Theatre, Family League) for marketing, public relations, and educational purposes.
• speak on the phone or virtually meet with VLP staff

• give my child(ren) reading and math evaluations and assessments
• access school records, including test scores, attendance, behavior and suspension records, and applicable information concerning services my child(ren) receives such as IEP records, 504 plans, etc.
• conduct and have students complete program evaluations as pre-determined by program funders
• communicate with teachers or other school staff about academic performance and behavior
• check-in with me, the legal guardian, and my student via phone or on a secure online meeting platform

I release the Village Learning Place, Inc., its partner organizations, and employees from any and all claims or liabilities for any damages or injuries that may be sustained in connection with this program.

I understand that with my support, my youth must maintain a good attendance record, actively participate in all activities, and exhibit good behavior in order to remain in the program.

Respect for children, their unique personalities, and their feelings are important. We use restorative discipline in our programs to manage behavior. As your partner, it is our goal to assist your child in developing self-control and socially acceptable behavior.

The Academic Youth Advocate and Academics & Evaluation Coordinator will keep you informed of any behavioral problems concerning your child. Every effort will be made to resolve any problems that occur. However, if a child’s behavior does not meet LINK Leaders Summer expectations, then the child may be asked to leave the program.

All serious incidences, regardless of the outcome, will be noted in writing and kept as part of the child’s file.

Due to the structured pace of LINK Leaders, consistent weekly check-ins are required to ensure that your child will receive the maximum benefit from the program. LINK Leaders supports your child’s academic progress in school by providing fun academic and enrichment activities.

We understand that there may be issues out of your control; however, it is imperative that you remain in constant contact with the LINK program staff so that we are aware of your situation. If a leave of absence is necessary for any reason, then please be sure to inform the Teen Programs Coordinator and/or the Academic Youth Advocate.

Consistently missing weekly check-ins will be immediately addressed.

The goal of the LINK Leaders program is to provide a safe and fun environment for our students to learn and thrive. Our behavior plan is designed to ensure that each student is given that opportunity.

Some students need extra support and we address behavior issues by reminding students of the rules and by trying to find out more about why the student is behaving the way that they are. When the student does not respond to a warning to correct their actions, then they are pulled aside by a teacher to discuss the problem. The parent or caregiver should be notified in a phone call if students are struggling with specific behaviors and of what we are doing to help them.

Repeated or serious negative behaviors will be documented and followed by a specific course of action. This course is determined by the teacher and Youth Programs Coordinator, and can include but is not limited to restorative circles, removal from class, or suspension from program.

I understand that with my support, my child must follow all policies and procedures contained within this application and within the LINK Family Handbook. I hereby agree to follow all policies in this application, and I certify that all information in this application is true to the best of my knowledge.