21st Century Registration Form

 2018-19 After-School 21st CCLC Teacher Help/Enrichment Registration                               Liberty Middle School        August 27-Nov. 1, 2018   

Student Name:  ____________________________________________   Grade:   ______

Homeroom Teacher:  ___________________ Parent Signature __________________

Contact Phone # ____________________________________________

Emergency Contact Name:  ________________________________ Emergency Phone #:  __________________

Medical Information (include food allergies): ______________________________________________________

Parent’s e-mail: ______________________________________________________________________________

Yes____ No_____ My child’s photo can be shown in the paper/website

Yes ____No_____ My child may watch the following movies while at the Public library enrichment time.   Cross out any non-acceptable movies: Shrek (PG), Nightmare before Christmas (PG)

**The after school program is a student commitment to attend each registered class.                             
 Students wanting to attend any enrichment class, including Thursday’s enrichment classes, must also attend at least one Teacher Help class on Mon, Tue. or Wed. If a student does not attend on M, Tue. or Wed, but comes Thursday, they will spend Thurs. time doing homework.  The only exceptions will be dr. appointments or being sick.

Parents:   The instructional support/enrichment program is provided free and sponsored by the 21st Century grant.  The program is offered from 3:30-6:00 pm on Monday, through Thursday.  Participating students will stay at school after normal afternoon dismissal, reporting to the cafeteria when called at 3:35.  A snack will be given to each after-school participant, at 4:00 they will report to their designated teacher help area. 

Class Registration:  Students must enroll in one teacher help time in order to attend any enrichment timePlease list selected instructional classes and enrichment activities below (options shown on back)

Student’s choices: Please list- 
Teacher help class name 4-5pm   Enrichment choice class name 5-6pm

Monday:          ______________________________            ________________________

Tuesday:          ______________________________            ______________________

Wednesday:            _________________________            ______________________

Thursday:            _________________________            _____________________

*5pm bus:  Monday-Wednesday only to Vista Foods for those not able to stay until 6.

*6 pm buses: Following are the only stops approved for the 21st Century bus.  You must choose from this list:

 (Montvale/Thaxton Bus Route)    (Vista/Powderhorn/Auto Zone)            (Big Island Bus Route)

Raintree (6:05)                                    AutoZone (6:00)                      Otterville Methodist Church (6:00)
 Thaxton Market (6:15)                      Powderhorn (6:10)                 Millstone Restaurant (6:05)              
Montvale Elementary (6:20)         Vista Foods (6:15)         Big Island Elementary School(6:15)            

(Exceptions are possible if a student lives directly on routes-check with Mrs. Slingerland)

***The following information is needed from all students. Please note that the 21st Century bus will not wait for parents/guardians at the stops.  Please be on time at drop spots.

____My child will ride the bus at 6pm and should be dropped off at (circle drop off location listed above)

____My child will ride the bus to Vista Foods at 5:00 for pick up or to walk home. (pick-up----walk)

____My child will be a car rider and picked up at LMS at 5:00

____My child will be a car rider and be picked up at LMS at 6 pm.

All students are dismissed from LMS, not the enrichment locations.

Parents must notify Mrs. Slingerland beforehand if plans change.

21st Century Afterschool Programs - Fall Session -LMS

 After School Teacher time: Mon.-Wed., (4:00-4:50pm)

Students may attend 1, 2, 3 or 4 days a week-write choice/s on front page.




Daily news-reading practice Mr. MacDougall

Harry Potter read/activities Mr. MacDougall

Kahoot! Mr. MacDougall

Science grades 6

Ms. Phillips

History-grade 6 Mr. King

Science-grade 7&8

Ms. Phillips

Math-grade 8

Mrs. Bond

Math-grade 7 Mrs. Wagner-Brown

Math-grade 6 Ms. Moore

Learn to Code-extra practice Mr. Booth/Ms. Bell

Homework Help

Ms. Bell

Dimension U (math and English reinforcement) Mr. Bryant

Homework Help

Mr. Bryant


Homework Help

Mr. Booth

Enrichment classes: 5pm-5:45pm.   ***Students must attend a 4:00-5:00 teacher help class in order to participate in any enrichment class. (students cannot come just on Thursdays)*** All enrichment dismissals will be at LMS unless otherwise arranged with Mrs. Slingerland. Students are transported by bus to and from enrichment locations.  You can choose one per day for the session. Write choice on front page.




Thursday (2 hrs., 4-8:45)

Quiddich-play the game Harry Potter plays! Mr. MacDougall (limit 25)

Origami- What different shapes/animals can you create? Mr. MacDougall

Chess club- learn the fine art of playing Chess- Mr. MacDougall (limit 10)

YMCA-  swimming- 15 min. lesson, 45 min. free swim. Mr. Bryant/Mrs. Markham FULL

Giant games- corn hole, giant connect four, giant Jenga, more.- Mr. Bryant FULL

Snack Time fun-learn how to make healthy, easy snacks. Ms. Bell (limit 10) FULL

Getting Fit-indoor/outdoor activities. Mr. Bryant

Scrapbook creations- save your favorite memories in a scrapbook designed by you. Mrs. Wagner-Brown

All about moving- get physical with dance, exercise, etc.-Ms. Bell

Board games-including electric UNO, Life, Clue, clay. Mrs. Wagner-Brown

Lego creations: Use your imagination to create with Lego bricks-Mr. Booth (12)

Public Library- go to the public lib for movies, crafts and other activities.


Photography- learn photo techniques, use your photos in unique ways. Mr. King. (10)


Artistic creations- expand your creativeness with art projects! Ms. Meadows

Students may also attend a half hour MORNING session any day during the week…to get help on homework, class projects, math, reading, etc. Times are 7:55-8:25, Mon – Fri.  Mr. Bryant, rm 112, or Mr. MacDougall, rm 215.  No registration needed…just come in!                    

Registration forms due by Wed., Aug. 22. Students may join at any time but it is best if they begin at the start of the program. Forms can be sent back with students, emailed or FAXed, 586-4957.  If you have questions or concerns, please contact Mrs. Slingerland at LMS (586-7735) or sslingerland@bedford.k12.va.us    Confirmation forms to be sent home after registration forms are received, usually on Thursdays.

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