2024-2025 Expanded Learning Enrollment Request
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Mandarin Chinese (Simplified characters): 如果你在电脑上，右击此表格的任何地方并选择翻译以便翻译成你选择的语言。如果你在手机上，点击3个点并选择翻译以便翻译成你选择的语言。

Tagalog (Filipino): Kung nasa computer ka, mag-right click saanmang parte ng form na ito at piliin ang translate para isalin sa wika ng iyong pagpili. Kung nasa telepono ka, i-click ang 3 mga tuldok at piliin ang translate para isalin sa wika ng iyong pagpili. Kung nasa computer ka, mag-right click saanmang parte ng form na ito at piliin ang translate para isalin sa wika ng iyong pagpili. Kung nasa telepono ka, i-click ang 3 mga tuldok at piliin ang translate para isalin sa wika ng iyong pagpili.

Vietnamese (Tiếng Việt): Nếu bạn đang sử dụng máy tính, hãy nhấp chuột phải vào bất kỳ đâu trên biểu mẫu này và chọn dịch để dịch sang ngôn ngữ bạn chọn. Nếu bạn đang sử dụng điện thoại, hãy nhấp vào 3 chấm và chọn dịch để dịch sang ngôn ngữ bạn chọn. Nếu bạn đang sử dụng máy tính, hãy nhấp chuột phải vào bất kỳ đâu trên biểu mẫu này và chọn dịch để dịch sang ngôn ngữ bạn chọn. Nếu bạn đang sử dụng điện thoại, hãy nhấp vào 3 chấm và chọn dịch để dịch sang ngôn ngữ bạn chọn.

Korean (한국어): 컴퓨터에서 이용중이라면, 이 양식의 아무 곳에서나 마우스 오른쪽 버튼을 클릭하고 번역을 선택하여 원하는 언어로 번역하십시오. 휴대폰에서 이용중이라면, 3개의 점을 클릭하고 번역을 선택하여 원하는 언어로 번역하십시오. 컴퓨터에서 이용중이라면, 이 양식의 아무 곳에서나 마우스 오른쪽 버튼을 클릭하고 번역을 선택하여 원하는 언어로 번역하십시오. 휴대폰에서 이용중이라면, 3개의 점을 클릭하고 번역을 선택하여 원하는 언어로 번역하십시오.
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Enrollment Form Instructions
  • One form for each student is required.
  • Forms with multiple students, or incomplete forms, will not be accepted.
  • Once your student is approved, you will receive your child's start date and program details via email.
  • Additionally, before starting the program, you will need to agree to and sign the Expanded Learning Program Policies.
Student Information
ONLY 1 student per form.
Student First Name
 *
Student Last Name
 *
Student Gender
 *
Student Date of Birth
 *
MM
/
DD
/
YYYY
Student School
 *
Student Grade
 *
Requested Start Date
 *
First day of school is Thursday, August 15, 2024.
MM
/
DD
/
YYYY
Enrollment History *
My child attended the Expanded Learning program during the 2023-2024 School Year.
Eligibility Status
 *
My child is eligible to attend for free.
SCHEDULE FOR FEE-WAIVED STUDENTS
LOMITA PARK
  • Scheduled Days: Students are required to attend all days of the week.
  • Before School Hours: Students are required to arrive by 7:30 AM if attending Before School.
  • After School Hours: Students are required to stay until 5:30 PM if attending After School.
ALL OTHER LOCATIONS
  • Scheduled Days: Students can attend 1 - 5 days.
  • Program Hours: Students can arrive or be picked up at any time.
  • Consistency: For those selecting a schedule of fewer than 5 days per week, it is required that students attend on the same days each week. For instance, if a student is enrolled for Tuesday and Thursday, these are the specific days they should attend every week.
SCHEDULE FOR FEE-PAYING STUDENTS
SCHEDULES
  • Scheduled Days: Students can enroll in 3 or 5 days. There is a 2 day option for Middle School only.
  • Consistency: For those selecting a schedule of fewer than 5 days per week, it is required that students attend on the same days each week. For instance, if a student is enrolled for Tuesday, Wednesday, and Thursday, these are the specific days they should attend every week.
TUITION

GRADES TK-5 ONLY | 7:00 - 8:15 AM
  • AM ONLY 5 DAYS $505
  • AM ADD-ON 5 DAYS $95
TK-KINDER | PICK-UP BY 3:00 PM
  • 5 DAYS $595 + AM ADD-ON $690
  • 3 DAYS $390 + AM ADD-ON $485​
TK-KINDER | PICK-UP BY 6:00 PM
  • 5 DAYS $1,040 + AM ADD-ON $1,135
  • 3 DAYS $820 + AM ADD-ON $915​
GRADES 1-5 | PICK-UP BY 6:00 PM
  • 5 DAYS $910 + AM ADD-ON $1,005
  • 3 DAYS $720 + AM ADD-ON $815
GRADES 6-8 | PICK-UP BY 6:00 PM
  • 5 DAYS $770 
  • 3 DAYS $510 
  • 2 DAYS $400 
BEFORE SCHOOL
 *
Program Hours: 
  • Green Hills: 7:00-8:15 AM
  • Lomita Park : 6:45-8:15 AM
  • Meadows: 7:00-8:15 AM
  • Spring Valley: 7:00-8:15 AM
  • Taylor: No Before School Program
Lomita Park: Must select all 5 days.
Yes
No
Monday
Tuesday
Wednesday
Thursday
Friday
AFTER SCHOOL
 *
Indicate the days your child will attend each week. (Lomita Park must attend a 5 days)

Program Hours:
All Locations - after School until 6:00 PM

Lomita Park: Must select all 5 days.
Yes
No
Monday
Tuesday
Wednesday
Thursday
Friday
Preferred Language for Communication
 *
Student Allergies
 *
In order to take the necessary precautions, we request that you provide as much detail as possible about your child's allergies.
  • Type of Allergy: Specify the type of allergy/allergies your child has (e.g., food allergies, drug allergies, environmental allergies, etc.). If they have more than one allergy, please list all of them separately.
  • Severity of Allergy: Indicate the severity of each allergy, if possible. For example, does the allergy cause a mild rash, or could it potentially result in a life-threatening reaction like anaphylaxis?
  • Symptoms Experienced: Describe the symptoms your child usually experiences during an allergic reaction. This information will help our staff to quickly recognize and respond to an allergic reaction.
Student Medication
 *
Please provide detailed information about any medication your child may require while participating in our program. This includes medication for allergies, chronic conditions, or any other medical needs.
  • Medication Name: Please provide the name(s) of any medication your child is currently taking.
  • Condition Treated: Please briefly describe what each medication is used for. This will help us understand the purpose of each medication.
  • Administration Instructions: Please provide detailed instructions on how and when the medication should be administered. This should include information on dosage, timing, and any specific steps we should follow.
  • Storage Requirements: Are there any special storage requirements for the medication? For example, does it need to be refrigerated or kept away from sunlight?
  • Expiration Date: If applicable, please provide the expiration date of any medication your child will be bringing to the program.
Student Special Diet
 *
We strive to accommodate the individual dietary needs of all students participating in our after-school program. If your child follows a special diet due to allergies, religious beliefs, personal choice, or a medical condition, please check all that apply below. 
Required
Student Special Needs
 *
If your child has any special needs or accommodations related to a physical, learning, behavioral, or emotional disability, please provide detailed information below.
  • Current Accommodations: Please provide information about the accommodations or modifications currently in place at your child's regular school, if any. This could be anything from an IEP (Individualized Education Program), a 504 plan, or other accommodations.
  • Additional Information: If there are additional details or instructions related to your child's special needs, please provide them here. This might include communication preferences, strategies that have been effective in other settings, ongoing supportive therapies, or considerations to help avoid discomfort or distress.
Parent 1/Guardian 1 Information
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Relationship to Student *
Parent/Guardian Email *
Parent/Guardian Cell Phone
 *
Street Address
 *
City
 *
State
 *
Zip
 *
Student lives with Parent 1/Guardian 1
 *
Parent 2/Guardian 2 Information
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Relationship to Student
Parent/Guardian Email
Parent/Guardian Cell Phone
Student lives with Parent 2/Guardian 2
Clear selection
Authorized Pick Ups & Emergency Contacts
Only list people below that you authorize Happy Hall to release your student to and contact in case of an emergency. This information will be used to create a unique pin that authorizes pick-up of this student.
#1 First Name
#1 Last Name
#1 Relationship to Student
#1 Cell Phone
#2 First Name
#2 Last Name
#2 Relationship to Student
#2 Cell Phone
#3 First Name
#3 Last Name
#3 Relationship to Student
#3 Cell Phone
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