Requirements of Program and Rules of Conduct. 1. Each student is required to have a Student Application completed, and then signed by the parent/guardian, in the presence of GXG trainer, at or before the first class. Every student will receive a opportunity to link with our support team, to generate a support plan. This will require the parent’s approval in the application. Once an initial application has been signed, and entered into the system, a home visit can be set up to have an assessment closed on, and support systems of mentoring engaged. This agreement can then l go into a folder, along with the student’s weekly training and homework review. This class review will require a parent’s signature, every week. This will allow us a means to maintain contact with the parent so that the status of the student remains steady. 2. Parents will be responsible to pick up and drop off each student. We are not responsible for the youth, while going to and from each service site, including conduct and issues of going straight home. While the student is at the center, the student must comply with the following sets of rules as well as the team trainer daily directions. The student may not come to the center early, or stay after, unless they have another agreement with that center, for another activity. 3. A student cannot invite any person(s) to accompany them, to include brothers and sisters. 4. Excessively Disruptive activity is not permitted. Each team trainer will decide what is Excessive. 5. No open drink(s) or food(s) shall be allowed in the training room. No illegal drugs, what so ever. No prescription drugs, (without parental verification). No tobacco products of any kind. No beverages containing alcohol are prohibited on property. These items are Grounds for direct suspension from program 6. While at the Learning Center, the Student must adhere to the Rules of Conduct. a. No Horseplaying; No Fighting; No Running; No Borrowing Without Permission; No Cussing; No Throwing Anything; No Temper-Tantrums; No Video Game Consoles permitted; Cell phones must remain off, and no texting. No spitting, or call names. b. The Student will receive respect from, and show respect to the Learning Center Staff, Volunteers, and Tutors c. The Student will sign-in & sign-out at the Student Log d. The Student will clean up his/her Work Station before leaving e. The Student may not deface/destroy/damage Learning Center property; Parents/Guardians will be notified. Charges may apply. f. Only (1) Student in the bathroom(s) at a time g. Proper bathroom etiquette is expected (i.e. washing hands, flushing of toilet, trash etc.) h. The Student must respect the other Students present, and no name calling is allowed. i. The Student must stay within permitted areas; Staff Only areas are prohibited unless authorized by a Staff Member. These Rules are to protect every Student from any accidents, bodily harm, and any other dangers. So please ensure that you, the Parent/Guardian, understand fully and convey to your child(ren) these Rules. By not adhering to the Rules of Conduct, the Student faces removal of himself/herself from this program. We at this group service maintain the right to cancel the acquired services provided to a student, if we feel they or the group is being disrupted, excessively. We are here to deal with disruptive behavior; however, excessive behavior isn’t permitted. If you have read and agree to these Rules of Conduct, please fill in and sign the application.
Release And Registration Form Student’s Information First Name _________________________   Last Name _________________________Age______       Primary Address _________________________________________ City ___________________                                      State _______ Zip Code _______________ Home Phone________________ Work Phone_______________________    Parent’s /Caregiver Name   ____________________________ Cell Phone ___________________ Medicaid Number: _________________________________________ SPECIFICS OF PROGRAM Our goal is to help each student have the basics to be able to learn to address their life challenges so they can have the ability to identify and access needed resources,  to successfully initiate a life plan,  to graduate, and get and keep a good job. Along with group services, we provide each student a life coach to help youth get engaged in an “age appropriate life plan”. We will help youth  become mindful of their behavior and begin to take responsibility. Parents may need helping hands and tools. Parent training is also available to help to identify and confront youth and family core behaviors in a realistic manner. ADMISSION CRITERA We will  serve all the youth who  qualify and are sent to these trainings,  without discrimination to race, religion, sex, national origin, disability, or age. a. Youth may qualify who are presently either behavioral challenged, truant, engaged in the extended court  system, guidance counselor admitted, at risk to fail school, drug involved, violence involved, and other similar circumstances b. We  will be focusing on giving additional youth a chance for help, rather then providing further assistance to youth who have already received support services,   ie: therapeutic mentoring, day treatment services, counseling services ect MEDICAL RELEASE In the event of an emergency or non-emergency situation,  I _______________hereby grant permission for any and all medical attention deemed necessary  to be administered to my child in the event of any accidental injury or illness, until as such time as I can be contacted.  This permission includes any and all needed medical attention and services, under the care of qualified medical personnel. I will not hold any of this program’s team, (and affiliated programs) responsible for my child’s injuries, and will want my child treated ASAP.  I ____will also not hold any of GXG/VGPP team and the program’s affiliates liable for any injury that doesn’t require emergency care, that my child may occur during this program. Student Insurance:________________ Policy #:___________________ Contact Info:________________________ Registration  for  services and liability Release (Please initial in the blanks.) I ___ request the services of VGPP and GXG to provide this gang reduction program with a  life coach. I understand that the life coach will be meeting with me (the care giver) at the start of the program. Therefore,  I ___ will set aside 30 minutes to go over the specifics of what I feel is needed to help my child.  I ___will work in cooperation with the life coach, as together, we can do much more to help my child succeed. Review of Services Selected: I want my child to receive these group services with a cooperative life coach. I feel that this program will help my child with behavior challenges and give them a solid chance to succeed in life, stay in home and not be drawn into the streets, courts or worse.  I commit to have my child at the appropriate meeting sites, on time, for the day or days that this program is assigned to them. Parent’s/Guardian’s Signature _____________________________   Date _________________
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