Quest Center Registration Form

Participant Information
Participant Name	Social Security Number
	Male ☐	Female	☐
	
Grade	School District
	
Home Address
	City
	
Parent/Guardian Name
	
Cell
	Home
	Email
	
Remind App:
Please indicate if you can be contacted via the Remind App with information and updates relevant to the Quest Center.
☐Yes ☐No
If you select yes, please indicate your notification preference. ☐Phone
☐Email

Emergency Contacts

Name
	Relationship
	Phone
	
Name
	Relationship
	Phone
	
Name
	Relationship
	Phone

Medical Information
Any known allergies/treatment: Yes     ☐               No     ☐

Any known medical conditions: Yes	☐	No	☐
	List:

List:
	
Emergency Medical Release

If emergency care is necessary and I cannot be contacted, Iauthorize the Quest Center staff to act on my behalf. I hereby grant the Quest Center program permission to have my child receive emergency medical attention.
	
Parent/Guardian Signature
	Date

Medical Information

Primary Care Physician
	Phone Number
	Address
	
Dentist
	Phone Number
	Address

Transportation

Notes:
	Drop Off/Pick Up	☐

By whom?

Relationship?
	Walk	☐

With whom?

Relationship?
	
People authorized to pick up: Adults will be asked to show ID.

			

Policy Agreement
Behavior
Students are expected to follow the behavioral expectationsset by the Quest Center. If student(s) cannot follow these behavioral guidelines, the program will contact their parents and may ask the student(s) to leave the Quest Center program for the remainder of theday.
Repeated or severe violations of the behavioral expectations may result in the student not being able to participate in the Quest Center program.
	
I have read and agree to the above behavioral policy
	
Parent/Guardian Signature
	Date

Field Trip Permission

Your child may be invited on a field trip as partof the Quest Center program. Before a field trip, you will receive detailed information about the proposed excursion. By signing below, yougive
the Quest Center program permission to transport your child to and from any field tripopportunity.
	
Parent/Guardian Signature
	Date

Quest Center 2250 Cherry Avenue Steubenville, Ohio 43952 740.381.7150

HOURS OF OPERATION

Quest for Success begins on Tuesday, October 13, 2020 from 7:30 PM- 6:00PM 7:30AM – 2:00 PM Academic and enrichment activities at the Quest Center

2:00 PM- 6:00 PM Homework help, computers, art & crafts, reading, math, health/nutrition, and service learning at the Remote Locations:

OVYN Sycamore Center and the Jefferson County ESC.

Below is an example of the weekly schedule for the 2020-2021 school

year: Monday:
7:30AM – 2:00PM Character Education Academics
Life Skills

Tuesday:

7:30AM – 2:00PM On-Track Tuesday Academics
Life Skills

Wednesday: 7:30AM – 2:00PM On-Track Wednesday Academics
Life Skills

Thursday

7:30AM – 2:00PM

2:00PM – 6:00PM Online Tutoring- JCESC
Whiz Kids Math Skills – Sycamore Center

2:00PM – 6:00PM Online Tutoring - JCESC N/A – Sycamore Center

2:00PM – 6:00PM Online Tutoring – JCESC
Project Home/Auto Repair, Craft Class, Life Support Young Entrepreneurs/Financial Literacy, Chess Club & Hip-Hop

2:00PM – 6:00PM

Sycamore Center

On-Track Thursday Academics
Life Skills

Friday

7:30AM – 2:00PM Culinary Arts Academics
Life Skills

Online Tutoring - JCESC Home/Auto Repair, Drama/Acting Art Class, Knitting

2:00PM – 6:00PM Cooking Class, Jobs for Life
Martial Arts, Computer Lab open

Sycamore Center

Sycamore Center