RSU73 2023-2024 After School Program Application

1. 2023-2024 After School Program RSU73

  • The 21st Century Kids of Southern F.R.A.N.K.L.I.N. provides an after school program opportunity to K-8 students who attend Spruce Mountain Primary, Spruce Mountain Elementary, Spruce Mountain Middle Schools, homeschool, and private schools within the district.

    The program will run 4 days a week (Monday through Thursday) beginning September 11th, 2023 until a date to be determined in May, depending on snow days.

    Program Hours by School:

    SMMS, SMES & SMPS runs Monday-Thursday from dismissal until 4:15pm.

    Parents/guardians picking up students must pick up by 4:30pm at each school.

    Students are offered Tutoring, Homework Help, and engaging Enrichment Activities.

    Parents who complete an application prior to August 21st, 2023 will receive an “application received” confirmation email by August 25th, 2023. Applications completed after August 21st will be confirmed via email within 5 business days.

    After you submit an application successfully, you will receive an online confirmation of your submission. You are highly encouraged to take a screen shot of that confirmation for your own records. If you do not receive an email confirmation as described above, please contact the Program Coordinator, Milissa Cousins, by email at

    When you receive an email confirmation of your application, you will also receive attachments with further details about the program and a pdf copy of the After School Program calendar.

    Transportation may be provided after the program to pre-designated stops identified by the school district.

  • MM slash DD slash YYYY
    21st Century staff are not allowed to walk children home. Expectations for students' behavior on the after school program bus is the same as it is for the regular bus. RSU 73 Transportation Department's drivers and Director have sole discretion regarding consequences for any student whose behavior does not meet expectations. If a student loses their is after school program bus privileges, in most cases they are still allowed to attend the after school program, however, they will need to picked up by a parent, caregiver or other authorized adult.
  • Sign up for the Late Bus for students who wish to participate in the Spruce Mountain After School Program. You must fill out the information and designate the drop off point your child will be using. Please indicate the stop your child will be using and sign below. If you have questions or concerns about the bus stops listed, or would like to discuss alternative stops, please contact the RSU 73 Transportation Department at (207) 897-1121. The 21st Century Staff is not authorized to approve stops that deviate from the provided bus routes/stops list. Only the transportation department may grant approvals.

    The Late Bus will run Monday through Thursday on days there is Spruce Mountain After School Programming scheduled. If the bus run is cancelled due to weather or unforeseen circumstances, there will be an announcement made to the students and to parents/caregivers.

    Additional Bussing Information:

    SMMS: Busses load at 4:25pm. Parents need to be at bus stops by 4:35pm.

    SMES: Busses load at 4:30pm-4:35pm. Parents need to be at bus stops by 4:40pm.

    SMPS: Busses load at 4:15pm. Parents need to be at bus stops by 4:40pm.

  • Please describe the special education supports your child receives.
  • This program is intended for students who do not have additional educational supports. If your child receives 1:1 Educational Support from the district please know that this 1:1 support does not extend to the after school program. The program is not able to provide 1:1 support, however, parent/guardians may make their own arrangements for 1:1 support for the after school program. If you’d like to provide your own 1:1 support please make arrangements and consult with Milissa Cousins at 207-491-9842 or
  • Please list any student medical conditions, needs, medications, allergies, diagnosis that we need to be aware of.
  • Contact Information for Parents, Guardians, and Emergency Contacts

    You have the opportunity to input information for up to 4 contacts. In each contact, you will need to tell us whether that contact is a parent/guardian, emergency contact, etc. Three contacts are required, one is optional.
  • Any Additional Information?

    If there's anything else you'd like us to know, please do so below.
  • Example: additional authorized pick ups, child likes/dislikes, etc.
  • Parent/Guardian Release and Liability Form

    Please read and sign the standard releases and permission forms that are required to attend the summer program. Thank you. If you do not agree, please mark below the release which you do not agree with.
    I authorize the 21st Century Kids of Southern F.R.A.N.K.L.I.N. After School Program and the 21st Century Kids of Southern F.R.A.N.K.L.I.N. After School Program Staff to arrange for transportation in case of accident or acute illness of the participant. It is understood that every effort will be made to contact the parents or other priority person before treatment is given but that treatment will not be withheld if a parent cannot be reached. In the event it is not possible to receive instruction for the participant’s care, consent is given to any EMS or licensed physician for treatment. I allow the EMS staff and/or physician to administer medication and to perform necessary treatment for the preservation of the participant’s health and well-being. I understand that any cost incurred for treatment of sudden illness or accident shall be paid by me. This authorization and consent for treatment is given to the 21st Century Kids of Southern F.R.A.N.K.L.I.N. After School Program and in conjunction with any authorized event. If you do not agree, this will affect your child's acceptance into the program.
    I hereby assume full responsibility for any risk of illness, bodily injury, death, or property damage and/or while using the premises or any facilities or equipment hereon. I understand that this program includes physical activity and I also understand that any program or sport that includes such activity carries with it an inherent risk of physical injury. I further agree to hold harmless the 21st Century Kids of Southern F.R.A.N.K.L.I.N. After School Program, their partners, directors, officers, employees, agents, and volunteers from any and all claims that may result from any action for damages, included but not limited, to such claims that may result from injury or death, accident or otherwise, during or arising in any way from said activity. I acknowledge that this General Release of Liability of the 21st Century Kids of Southern F.R.A.N.K.L.I.N. After School Program, its partners is binding on me and my heirs, personal representatives, and successors. If you do not agree, this will affect your child's acceptance into the program.
    As your child is enrolled in the 21st Century Kids of Southern F.R.A.N.K.L.I.N. After School Program, funded by Maine Dept. of Education through funding from the US Dept. of Education our use of this funding requires that we report certain results to the Maine DOE & U.S. DOE including free and reduced lunch status, special services, academic progress, student MEDMS (school identifier) number, attendance, discipline, behavior, surveys, activity participation, and classroom performance. In addition to compliance with reporting requirements, use of this data assists program managers to make informed decisions about program adjustments and improvements, matching students with needs, program sustainability, and program replication in other sites. Our reporting of positive student results may increase our chances of securing continued and additional funding to operate this program. All information collected will be restricted and used solely for serving student needs and approved program evaluation purposes. If you do not agree, this will affect your child's acceptance into the program.
    I hereby consent to the use of my child’s name, likeness and speech in any audio tape, video tape, film or photograph made in any 21st Century Kids of Southern F.R.A.N.K.L.I.N. After School Program activity for the business or publicity purposes of the program and its partners. Publicity may include posts on our “21st Century Kids of Franklin” Facebook Page (@21stcenturyfranklincounty). We encourage you all to “like” us on Facebook to get the latest updates regarding the program. I understand that any participation offers no remuneration and that my child’s name, likeness, and speech may be edited, produced, recorded for distribution throughout the United States and abroad. I expressly release the 21st Century Kids of Southern F.R.A.N.K.L.I.N. After School Program and its licensees, assignees, affiliates and successors from any privacy, defamation, or other partners have arising out of broadcast, exhibition, publication, or promotion of this program.
    I hereby consent to allow my child to walk home from their designated bus stop unaccompanied by a parent, caregiver or other authorized adult. I realize there is potential risk for the child in walking home alone and release RSU 73 and the Franklin County Children's Task Force's 21st Century After School Program from any legal responsibility or liability for any harm that may result to my child during the act of walking home unaccompanied from the designated bus stop.
  • Parent/Guardian Signature

  • MM slash DD slash YYYY
Skip to content