CSA Registration English | Charter Oak Cultural Center

Student Information

Student First Name *

Student Last Name *

Nickname

Grade *

Age *

School Attending *

Gender *

Preferred Pronouns

Street Address 1 *

Street Address 2

City *

State *

Zip *

Has your child attended City School of the Arts (previously Youth Arts Institute) before? *

Yes
No

If yes, how many years? *

Primary Guardian Contact Information

Parent or Guardian First Name *

Parent or Guardian Last Name *

Phone # *

Alternate Phone #

Email *

Preferred method of communication: *

Phone
Email

Secondary Guardian Contact Information

Parent or Guardian First Name *

Parent or Guardian Last Name *

Phone # *

Alternate Phone #

Registration Policies and Disclaimers

Read our policies and disclaimers below.

City School of the Arts Behavior Policy

It is our goal that all students enjoy themselves and are always safe when at our programs.
When any child displays behaviors that are disruptive to the teacher or other students, violent or uncooperative, staff may remove the child from the classroom to take a moment to resolve the issue through peaceful resolution and open communication.
If their behavior does not improve, the student may be asked to take a day off from the program and their parents/caregivers will be contacted.
If, after a day off, the behavior still does not improve, the student may be asked to discontinue attending the program.
Full parental communication will occur throughout these steps.

City School of the Arts Absence/Late Pick Up Policy (English)

I understand that I must call (860-310-2589) or email amandan@charteroakcenter.org to report the absence in order for it to be considered an excused absence.
Children must be picked up promptly at the end of class. If my child has more than two unexcused absences or is picked up late, I understand that he/she may be removed from the enrollment list to make room for those on the waiting list.
For the health and safety of our CSA families, we ask that parents drop off and pick their child up at the ground level red side door and do not enter the building.

COVID-19 Disclaimer for Registration

I will notify Charter Oak (860-310-2589) immediately, and keep my child out of CSA programming, if anyone in my household has been exposed to COVID-19 or is feeling unwell.
I understand that Charter Oak is not liable if my child or anyone in my household should contract COVID-19.

Photo Release

I hereby assign and grant Charter Oak Cultural Center and partnership organizations the right and permission to use and publish the photographs/film/video/electronic representations and/or sound recordings made during my child’s participation in Charter Oak Cultural Center’s youth programming. I hereby release Charter Oak Cultural Center from any and all liability from such use and promotion. I hereby authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage and/or distribution of said photographs/film/video/electronic representations and/or sound recordings without limitation at the discretion of Charter Oak Cultural Center and partnership organizations. I specifically waive any right to any compensation I may have for any of the foregoing.

I understand and agree to all of City School of the Arts's policies and disclaimers listed above: *

Yes, I understand

First Name *

Last Name *

Today's Date *

Confidentiality

All answers will be kept strictly confidential. Charter Oak’s mission is to do the work of social justice through the arts. Our free programming is designed to help those most in need, and we therefore consider household income when we assess eligibility for our classes. We welcome all families to apply. We will get back to you as soon as possible about the status of your application.

Please Note: This registration is good for one full school year. You are responsible for updating staff of any necessary changes to the information on this form.

Confidential Income Verification Form

Your participation will help the Charter Oak Cultural Center obtain additional funding which will be used to keep our programs for your children free of charge. ALL ANSWERS ARE REQUIRED.

Head of Household First Name *

Head of Household Last Name *

Child First Name *

Child Last Name *

Child Date of Birth *

City of Residence *

Child Gender *

Female
Male
Other

Is Child Hispanic or Latino? *

Yes
No

Child Race (Please select one): *

Number of persons currently living in household *

Annual Family Income $ *

Please select the box for your annual gross income as reported on your 2022 tax returns. Charter Oak has the right to ask for proof of income.

Which of the following is your family receiving? *

Other (fill in)

Are you a single female head of household? *

Yes
No

Are you employed? *

Yes
No

Indicate Source of Income: *

Class Selection Form

Please select your first, second, and third class choices. Consult our current class schedule for updated classes.

Because there is a waiting list for our program…

• Please only register your child if they can attend the program every week.
• Please make sure that your child is interested in the subject that you are registering them for.

Note: Requesting a class is not a guarantee that a child will be placed in a class. We cannot guarantee enrollment in any class to any family. No student is guaranteed placement in more than one class.

First Choice *

HACYO List Instrument & Years Played *

Choose one of the following *

Guitar
Rap
Visual Art

Second Choice

HACYO List Instrument & Years Played *

Choose one of the following *

Guitar
Rap
Visual Art

Third Choice

HACYO List Instrument & Years Played *

Choose one of the following *

Guitar
Rap
Visual Art

Special Considerations

Is there anything you would like the staff/teachers to know about your preferred classes?

Does your child have any allergies?

Is there anything you would like the staff/teachers to know about your child?

Would you or your child like to have a complimentary confidential conversation with one of our licensed counselors? *

Yes
No

Charter Oak Cultural Center City School of the Arts Student Registration

2023 Fall

Student Information

Primary Guardian Contact Information

Secondary Guardian Contact Information

Registration Policies and Disclaimers

City School of the Arts Behavior Policy

City School of the Arts Absence/Late Pick Up Policy (English)

COVID-19 Disclaimer for Registration

Photo Release

Confidentiality

Confidential Income Verification Form

Class Selection Form

Special Considerations

Charter Oak Cultural Center City School of the Arts Student Registration

2023 Fall

Student Information

Primary Guardian Contact Information

Secondary Guardian Contact Information

Registration Policies and Disclaimers

City School of the Arts Behavior Policy

City School of the Arts Absence/Late Pick Up Policy (English)

COVID-19 Disclaimer for Registration

Photo Release

Confidentiality

Confidential Income Verification Form

Class Selection Form

Special Considerations

Youth Arts Institute Behavior Policy (English)

Youth Arts Institute Behavior Policy (English)

Youth Arts Institute Absence/Late Pick Up Policy (English)

COVID-19 Disclaimer for Registration

Youth Arts Institute Absence/Late Pick Up Policy (English)

Photo Release (English)