• After-School Plus (A+)Program Eligibility

  • Eligibility: K-6 public elementary school latchkey children
    In order to qualify for the A+ Program, children must first be qualified as latchkey. Your child is considered latchkey when you (parent/s or guardian/s) are working during the hours of A+ operations, attending school, or engaged in a job training program. The program hours are from after school to 5:30 P.M. on regular school days. The program will not operate during school vacations, state holidays, weekends, Teacher Institute Day, Teachers’ work day and school half days.

  • Parents must submit of proof of Eligibility in order to complete the registration.

    • Employed parents:
      • Most recent pay stub with hours worked indicated
      • If you are not able to submit a pay stub: a letter from your employer indicating days & times worked (may be a sample schedule if hours vary) will be accepted.
    • Self-employed/independent contractor parents:
      • If you do NOT receive a W-2 form at the end of the calendar year from you employer, or you receive a 1099 form from the company you work with, additional documents will be required.
      • GE Tax license AND Previous year's tax return (1040) with Schedule C OR a voided business check/business bank statement with the company name
      • Uber/Lfyt/food delivery drivers or are consider as independent contractors
      • If the business is new or you are unable to provide the required documents, eligibility may be denied until these conditions can be met.
    • Parents/legal guardians attending school:
      • School Schedule on official school letterhead with the school's name, name of the student and course schedule with date and time.
      • Online courses with no designated schedule (self-pace courses) may not qualify your family for the program.
    • Parents in DHS Job Training:
      • DHS_728 First to work approval letter.

  • I understand that my registration will be reviewed and that my family must first qualify to be eligible for the A+ program before my child/ren can be enrolled. Additional documents may be required based on my employment, school schedule or job-training status.

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  • After-School Plus (A+) Program Registration Form

  • After-School Plus (A+) Program Registration Form

    Child(ren) information

  • If you are registering more than 3 children into the A+ program. Please complete this registration for the first 3 children and then start another registration after you complete this one. 

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  • EMERGENCY CONTACTS: In case child listed becomes ill or is injured at school and I cannot be contacted, the school authorities have my permission to contact and release my child to the custody of one of the following. Emergency contacts should be someone other than child's parent.

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  • List below adult invididual(s) authorized to pick up your child from the facility and their phone numbers. Authorized pick up must be at least 18 years old and able to provide a valid ID upon pick up. (The child will not be released to any individual not listed below)

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  • After-School Plus (A+) Program Registration Form

    Parent/Guardian information
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    • Acceptable forms of proof of eligibility 
      • Employed parents:
        • Most recent paystubs
          • Must include your name, employer's name
          • Hours work and/or the pay period
          • Pay period must be within 30 days to verify that its current
      • Self-employed/independent contractors: 
        • GE Tax License (mandatory) AND one of the following:
          • Previous year's tax return (1040) with Schedule C OR
          • Voided business check/business bank statement with the company name
        • If the business is new or you are unable to provide the required documents, eligibility may be denied until these contions can be met. 
      • Parents/Legal Guardians attending school:
        • School schedule on official school letterhead with the school's name, name of the student and course schedule with date and time.
        • Online courses with no designated schedule(self-paced courses) does not qualify your family for the program. 
      • Parents in DHS Job Training: 
        • DHS_728, First to work approval letter.
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    • Acceptable forms of proof of employment 
      • Employed parents:
        • Most recent paystubs
          • Must include your name, employer's name
          • Hours work and/or the pay period
          • Pay period must be within 30 days to verify that its current
      • Self-employed/independend contractors: 
        • GE Tax License AND previous year's tax return (1040) with Schedule C or voided business check/business bank statement with the company name
        • If the business is new or you are unable to provide the required documents, eligibility may be denied until these contions can be met. 
      • Parents/Legal Guardians attending school:
        • School schedule on official school letterhead with the school's name, name of the student and course schedule with date and time.
        • Online courses with no designated scheudle (self-pace courses) may not qualify your family for the program. 
      • Parents in DHS Job Training: 
        • DHS_728, First to work approval letter.
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  • After-School Plus (A+) Program Registration Form

    Registration Agreement

  • PARENT/LEGAL GUARDIAN’S RESPONSIBILITIES AND BILLING PROCEDURES

  • Please check each of the following to indicate that you have read, understand, and agree with each item.

    Please note that each checkbox will be initaled on your registration form. 

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  • YMCA Waiver and Release of Liability

  • In consideration of my membership and being able to use the Young Men’s Christian Association of Honolulu
    (YMCA) facilities and equipment, and/or allowing any of my minor children (hereinafter referred to as “minor children”), for whom I am responsible, to use the facilities and equipment or enroll in YMCA activities or programs, I, on behalf of myself and/or my minor children, hereby release and covenant not to sue the YMCA, its owners, employees, instructors, or agents (hereinafter collectively referred to as “YMCA”), from and all present and future claims, resulting from ordinary negligence on the part of the YMCA or others listed for loss, damage, or theft of personal property, personal injury, or death, arising from my and/or my minor children’s use of the facilities and equipment of the YMCA and/or engaging in any YMCA activities or any activities incidental thereto, wherever, whenever, or however the same occur. I, on behalf of myself and/or my minor children, hereby voluntarily waive any and all claims resulting from negligence, both present and future, that may be made by me, my family, estate, heirs, or assigns.
    Further, I, on behalf of myself and/or my minor children, am aware that YMCA activities, both in-person and virtual, may range from various cardiovascular activities (i.e., aerobics, bicycles, steppers or racquetball) to the strenuous exertion of strength training (i.e., free weights, weight machines). I understand that these and other physical activities, both in person at the YMCA and through virtual participation, involve certain risks, including but not limited to death, serious neck, and spinal injuries resulting in complete or partial paralysis, heart attacks, illness, and injury to bones, joints, or muscles. I am voluntarily participating in YMCA activities and/or allowing my minor children to participate in YMCA activities or programs, with full knowledge of the dangers involved, and hereby agree, on behalf of myself and/or my minor children, to accept and assume any and all inherent risks of property damage, personal injury, or death.
    This Waiver and Release of Liability Agreement shall be effective and binding upon my heirs, next-of-kin, executors, administrators, assigns, and representatives in the event of my death or incapacity. This Agreement shall be governed by and interpreted solely in accordance with the laws of the State of Hawaii and no other jurisdiction. Any litigation involving the parties to this Agreement shall be brought solely within the State of Hawaii. I agree that if any portion of this Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.
    I, on behalf of myself and/or my minor children, further agree to hold harmless, indemnify and defend the YMCA and others listed for any and all claims arising as a result of my engaging in club activities or any activities incidental thereto, where ever, whenever, or however the same occurs. I have read this form and fully understand that by signing this form, I am giving up any and all legal rights and/or remedies that may be available to me and/or my minor children for the ordinary negligence of the YMCA or any parties listed above.


    CODE OF CONDUCT
    The YMCA is committed to providing a safe and welcoming environment for all members and guests. To promote safety and comfort for all, all individuals are asked to act appropriately at all times when in YMCA programs. Our values are honesty, respect, responsibility, caring, and diversity. We expect persons using the YMCA to act maturely, behave responsibly, and respect the rights and dignity of others. The following Code of Conduct outlines prohibited action, but the actions listed below are not an all-inclusive list of behaviors considered inappropriate in our facilities and programs.

    • Using or possessing alcohol or illegal chemicals on YMCA property or in YMCA vehicles.
    • Smoking/tobacco use or e-cigarettes/vapor cigarettes use on YMCA property.
    • Carrying or concealing a weapon or any device or object that may be used as a weapon.
    • Harassment or intimidation by words, gestures, body language, or any type of menacing or unwelcome behavior.
    • Physical contact with another person in an angry, aggressive, or threatening way.
    • Verbally abusive behavior, including angry or vulgar language, swearing, name-calling, or shouting.
    • Sexually explicit conversation or behavior; any sexual contact with another person.
    • Inappropriate, immodest, or sexually revealing attire.
    • Theft or behavior that results in the destruction or loss of property.
    • Loitering within or on the grounds of the YMCA.
    • Use of electronic devices that are capable of taking photos and/or videos within locker rooms and restrooms. Use of any electronic device capable of taking photos and/or videos in the exercise facility is only acceptable when the device is used as a video/ music player (not as a recorder). All other use is prohibited.
    • In addition, the YMCA reserves the right to deny access to any person who has been accused or convicted of any crime involving sexual abuse, is or has been a registered sex offender, has ever been convicted of any offense relating to the use, sale possession, or transportation of narcotics or habit forming and/or dangerous drugs, or is presently or habitually under the influence of dangerous drugs or chemicals, narcotics, or intoxicating beverages.

    PHOTO / VIDEO / STORY RELEASE

    I am 18 years of age or older and grant the YMCA, National Council of Young Men’s Christian Associations of the United States of America and its chartered YMCA member associations in the United States, and collaborating third parties permission in perpetuity to use my and those of my minor children and persons listed on this registration form; image, voice, and personal story in photographs, videos, social media, artwork, profiles and all forms of promotional materials and venues without limitation or obligation to provide compensation for the purposes of promotion or interpreting YMCA programs. I release YMCA, National Council of Young Men’s Christian Associations of the United States of America, and its chartered YMCA member associations in the United States, and collaborating third parties from any and all claims, causes of action, and liability arising out of any use of my, and those of my minor children and persons listed on this registration form; images or likeness.

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  • Application for Subsidized Monthly Fee (A+ Program)

  • Note: Application for each household if there is joint custody

    If you are currently receiving financial assistance from Department of Human Services (FTW) Program, you must provide the A+ Program with Form DHS 728 from the FTW Program office.

     

    MONTHLY INCOME OF PARENT/LEGAL GUARDIAN LIVING IN HOUSEHOLD

    To figure/convert to monthly income: Weekly income x 4.33, Income every 2 weeks x 2.15, Twice a month income x 2

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    • List of Acceptable Income Documentation  
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    • The information on this form and the attached documentation may be used to assist the determination of eligibility for the After-School Plus (A+) Program’s subsidized monthly fee. A+ Program staff may verify all the information on this form and the attached documentation. I give up my rights to confidentiality for this purpose only. I certify that I am the parent/legal guardian of the child(ren) for whom application is being made. I also certify that all of the above information is true and correct and all income is reported. I understand that deliberate misrepresentation of the information may subject me to prosecution under applicable state and federal laws. If any information has been falsified, I understand that this may result in a loss or reduction of benefits, legal claims, and dismissal of my child(ren) from the After-School Plus (A+) Program.

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  • IMPORTANT: Submission of your registration does NOT guarantee acceptance into the A+ program.

    Your registration will be reviewed in the order that was received and you will be notified via email in regards to your status. 

    Additonal documents may be required, please make sure you check your email for any emails from us. If any required document is missing or insufficent, it will delay your registration. 

    Please click on the green submit button when you are ready to submit. 

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