APPLICATION FORM GRAVITY

Child Information

Submission of this application does not guarantee enrollment in the program.

Your Name(Required)

First Name Last Name

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I agree that I am the child's parent/guardian and can legally complete this application

Click the Add Child button to add your child. If more than one child, please click the Add Child button to add additional children.

Children Details

Child's Legal First Name	Birth Date	Select the programs you want to apply for	Actions

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Completion of the Child Information Section

Thank you for submitting this information. Please review prior to moving to the next section. Only the child’s legal parent or guardian can legally complete this application.

Household/Guardian Information

Submission of this application does not guarantee enrollment in the program. Students must stay in LA’s BEST during the hours of operation.

Your Name(Required)

First Name Last Name

Address(Required)

Street Address Address Line 2 City State ZIP Code

If your child is experiencing homelessness, please use the school's address as the child's address.

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Is this the same address as all the children listed?(Required)

Yes

No. (If not, please provide the different addresses for each child.)

Email Address(Required)

Confirm Email Address(Required)

Your Primary phone number(Required)

Primary phone type(Required)

It’s okay to text me confirmation of this application to this number. I understand data rates may apply.

Your Secondary phone number(Required)

Secondary phone type(Required)

It’s okay to text me confirmation of this application to this number. I understand data rates may apply.

Check here if you would like to receive information from LA's BEST about events and other news and updates.

Completion of the Household/Guardian Information Section

Thank you for submitting this information. Please review prior to moving to the next section. If you need to add another child, please go to section 1 by clicking the circle with the number 1 at the top or bottom of this page. Only the child’s legal parent or guardian can legally complete this application.

Confirmation

Submission of this application does not guarantee enrollment in the program.

The following information applies to all children included in this application. You must answer all of the following questions.

AUTHORIZED RELEASE. I authorize my child to be released to the individuals included in this application at the close of each day and in case of emergency. I understand students must be signed out by an authorized adult who is 18 years or older, and listed in this application(Required)

I read and understand the information as it applies to all children listed in this application.

I agree

EMERGENCY MEDICAL ATTENTION. In case of emergency, I authorize my child to receive medical care. I understand the school district is not responsible for any costs incurred for emergency treatment.(Required)

I read and understand the information as it applies to all children listed in this application.

EMERGENCY MEDICAL ATTENTION. I also understand the school district is not responsible for any medical treatment received or transportation of my child.(Required)

I agree

I don't agree

CONSENT FOR PROGRAM EVALUATION. I give consent for the disclosure of personally identifiable information from my child's education records under the Family Educational Rights and Privacy Act .(Required)

I read and understand the information as it applies to all children listed in this application.

CONSENT FOR PROGRAM EVALUATION. I allow for the Los Angeles Unified School District to disclose such information only to the extent and for the duration necessary for my child to participate in LA's BEST.(Required)

I agree

I don't agree

RELEASE FOR PHOTOGRAPH AND VIDEO. I give my permission for my child to be filmed and/or photographed.(Required)

I read and understand the information as it applies to all children listed in this application.

RELEASE FOR PHOTOGRAPH AND VIDEO. I understand that all film and photos are the sole property of LA's BEST, and may be used in displays to the public, to publicize the program, or for printed material published by and/or for the benefit of LA's BEST. I understand that all proceeds will be used for LA's BEST programs.(Required)

I agree

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PLEASE READ ALL CONTENT IN THE BOX BELOW AND CHECK THE BOX TO AGREE.(Required)

LA’s BEST Parent/Guardian Agreement

Our role is to create environments where youth can discover their own interests and talents, learn skills that help them successfully navigate today’s world and grow into their true, whole selves. It is encouraged that you review safety practices, policies, and procedures found in the LAUSD Parent Student handbook provided to you by LAUSD. The LA’s BEST Parent/Legal Guardian Agreement outlines some of the policies and procedures that guide a safe and supportive campus life. Please thoroughly read through this document to identify how we can collaborate to best support your student.

___ LA’s BEST Application:

Each child must have an application form on file with the names and phone numbers of, at minimum, three adults, 18 years or older, who are authorized to pick up the child. Your child will only be released to the adults you have authorized on the application form. It is important that this form is frequently updated. Only parents/legal guardians may update information in-person with the Site Coordinator. Application information cannot be altered over the phone or by a third party.

___ Parent / Legal Guardian Engagement:

Quarterly parent/legal guardian meetings will be scheduled in person or zoom. These meetings will provide space to connect with staff and receive programmatic updates.
LA’s BEST is committed to providing exceptional customer service to parents / legal guardians, community members. Please connect in person verbally with your Site Coordinator or the Traveling Staff regarding any concerns or additional support needed.

___ Program Hours:

The program hours of operation are from school dismissal bell to no later than 6:00pm. Students are expected to remain for the full duration of programming per grant requirements.

___ Student Sign In / Out:

Children will be signed into the LA’s BEST program by staff daily. To ensure student safety, reinforce to your children that they are to go directly to the LA’s BEST designated sign-in area at the end of the school day. All children must be signed out at the end of the day no later than 6:00pm by a parent / legal guardian or authorized adult, 18 years of age or older, who is authorized on the application form. Children will not be released to those under 18 years of age or persons not listed on the application form. All adults listed on the application form may be required to present a valid identification (ex.California ID, license or passport) before a child is released.
On a yearly basis, all parents /legal guardians must complete an Early Release Policy Acknowledgement form for each child enrolled in LA’s BEST. Upon signing out a child before 6:00pm, the authorized adult will need to select an appropriate early release code from the designated Early Release Code box on the attendance sheet to indicate the reasoning for leaving early.
Staff will not release a child under the following circumstances:

○ The parent / legal guardian or authorized adult verbally or physically poses a risk to anyone on campus.

○ Person is not an authorized adult on the application and / or is under the age of 18.

○ A court order has been provided to the program by the custodial parent / legal guardian to restrict access by the non-custodial adult. All court orders are to be shared with the school administrator and the LA’s BEST Site Coordinator. A hard copy of the current court order must be filed with LA’s BEST and the school’s main office.

___ Visitors To School Campuses and Locked Campuses:

Learn and follow the school wide behavioral expectations.
Visitors DO NOT have the right to:

○ Willfully interfere with the discipline, order, or conduct in any school classroom or activity with the intent to disrupt, obstruct, or inflict damage to property or bodily injury upon any person.

○ Disrupt instructional time, extra-curricular activities, cause disorder, or otherwise disrupt the normal operations of the school (ie, converse with students, etc.).

___ Student Attendance and Attendance Records:

LA’s BEST is a free After School Education and Safety and 21st Century Community Learning Centers grant funded program. Per grant expectations, children are required to attend Monday through Friday from school dismissal bell to 6:00pm. Children may be dismissed from the program for excessive unexcused absences in order to provide the opportunity of programming engagement for children who need the program on a daily basis. If your child is going to be absent, notify the Site Coordinator as soon as possible.
Children absent from the regular school day may not attend LA’s BEST afterschool. ● Parent/legal guardians can request student attendance information through the LA’s BEST Operations Office with the “Data Request Form” which can be provided by the Site Coordinator. Please allow at least two weeks when requesting student information. Student information will be released only to parents / legal guardians. Parents / legal guardians must provide an I.D. to receive documents. ___ Health and Wellness:
Parent/ legal guardians will be notified in the event a child becomes ill during the program. Arrangements are to be made by a parent/legal guardian or authorized adult to have the child picked up.
Parents/ legal guardians are to include on the application form any food allergies or other medical conditions that might affect their child’s participation in the program. LA’s BEST staff are not permitted to dispense or administer medication to students unless cleared and trained by LAUSD. ___ Student Code of Conduct:
Before consequences are given, students will be supported in learning the skills necessary to practice, meet expectations, and contribute to positive school culture and climate. LA’s BEST follows all LAUSD discipline policies outlined in the LAUSD Parent/Student Handbook. Breaks will be determined in collaboration by the school administrator and the LA’s BEST Operations office.
Personal items of value (cell phones, handheld devices, tablets / ipads, electronic games, laptops, jewelry, etc.) should not be brought to school since loss, theft, or damage is possible. Also, such items can be distracting to the programming environment. The District is not responsible for lost or stolen items.

___ Support Systems and Resources:

LA’s BEST in partnership with the School Mental Health (SMH) and Student Health and Human Services offers a range of mental health services and supports to help children, youth, and families become better equipped to thrive and live successfully. For additional information, call Student Health and Human Services, School Mental Health at 213 241-3841 or visit https://achieve.lausd.net/smh. School Mental Health Crisis Counseling and Intervention Services staff are available for consultation during the school year, Monday through Friday from 8:00 am – 4:30 pm.

Need Additional Support?

Please connect in person verbally with your Site Coordinator or the Traveling Staff regarding any concerns or additional support needed. If further explanation is required feel free to contact the LA’s BEST Operations Office at 213-745-1900 ext. 0.
Questions, concerns, and/or feedback may also be submitted via the LA’s BEST website at www.lasbest.org. We welcome your input and hope to hear from you!

Site Information:

Site Coordinator Name:
LA’s BEST Site Office #:
School Main Office #:

It is encouraged that you review safety practices, policies, and procedures found in the LAUSD Parent Student handbook provided to you by LAUSD. The LA’s BEST Parent/Legal Guardian Agreement outlines some of the policies and procedures that guide a safe and supportive campus life. As a confirmation that you have thoroughly reviewed, and initialed next to each agreement, please sign and return this sheet of the 2024 – 2025 LA’s BEST Parent / Legal Guardian Agreement. We thank you for your future support, and look forward to collaborating in partnership with you to maintain a safe and quality program.

I read and understand the information. I understand that in order for my child(ren) to be a participant in LA’s BEST, they are required to attend during all hours of operation.

I agree

PLEASE READ ALL CONTENT IN THE BOX BELOW AND CHECK THE BOX TO AGREE.(Required)

A Fact Sheet for Youth Sports Parents

This sheet has information to help protect your children or teens from Sudden Cardiac Arrest

Why do heart conditions that put kids at risk go undetected?

While a youth may display no warning signs of a heart condition, studies do show that symptoms are typically present but go unrecognized, unreported, missed or misdiagnosed.

Symptoms can be misinterpreted as typical in active youth.

Protect Your Kid’s Heart
Educate yourself about sudden cardiac arrest, talk with your kids about warning signs, and create a culture of prevention in your youth’s sports organization.
Know the warning signs
Document your family’s heart health history as some conditions can be inherited
If symptoms/risk factors present, ask your doctor for follow-up heart/genetic testing
Don’t just “check the box” on health history forms—ask your youth how they feel
Take a cardiac risk assessment with your youth each season
Encourage youth to speak up if any of the symptoms are present
Check in with your coach to see if they’ve noticed any warning signs
Active youth should be shaping up, not breaking down
As a parent on the sidelines, know the cardiac chain of survival
Be sure your school and sports organizations comply with state law to have administrators, coaches and officials trained to respond to a cardiac emergency
Help fund an onsite AED

Fainting is often mistakenly attributed to stress, heat, or lack of food or water

Youth experiencing symptoms regularly don’t recognize them as unusual – it’s their normal
Symptoms are not shared with an adult because youth are embarrassed they can’t keep up

Youth mistakenly think they’re out of shape and just need to train harder

Youth (or their parents) don’t want to jeopardize playing time
Youth ignore symptoms thinking they’ll just go away
Adults assume youth are OK and just “check the box” on health forms without asking them

Medical practitioners and parents alike often miss warning signs
Families don’t know or don’t report heart health history or warning signs to their medical practitioner

Well-child exams and sports physicals do not check for conditions that can put youth at risk
Stethoscopes are not a comprehensive diagnostic test for heart conditions

What happens if my child has warning signs or risk factors?

● State law requires youth who faint or exhibit other cardio-related symptoms to be re-cleared to play by a licensed medical practitioner.
● Ask your health care provider for diagnostic or genetic testing to rule out a possible heart condition.
Electrocardiograms (ECG or EKG) record the electrical activity of the heart. ECGs have been shown to detect a majority of heart conditions more effectively than physical and health history alone. Echocardiograms (ECHO) capture a live picture of the heart.
● Your youth should be seen by a health care provider who is experienced in evaluating cardiovascular (heart) conditions.
● Follow your providers instructions for recommended activity limitations until testing is complete.

What if my youth is diagnosed with a heart condition that puts them at risk?

There are many precautionary steps that can be taken to prevent the onset of SCA including activity modifications, medication, surgical treatments, or implanting a pacemaker and/or implantable cardioverter defibrillator (ICD). Your practitioner should discuss the treatment options with you and any recommended activity modifications while undergoing treatment. In many cases, the abnormality can be corrected and youth can return to normal activity.

What is Sudden Cardiac Arrest?

Sudden Cardiac Arrest (SCA) is a life-threatening emergency that occurs when the heart suddenly stops beating. It strikes people of all ages who may seem to be healthy, even children and teens. When SCA happens, the person collapses and doesn’t respond or breathe normally. They may gasp or shake as if having a seizure, but their heart has stopped. SCA leads to death in minutes if the person does not get help right away. Survival depends on people nearby calling 911, starting CPR, and using an automated external defibrillator (AED) as soon as possible.

RECOGNIZE THE WARNING SIGNS & RISK FACTORS

Ask Your Coach and Consult Your
Doctor if These Conditions are
Present in Your Youth
Potential Indicators That SCA May Occur
Fainting or seizure, especially during or right after exercise
Fainting repeatedly or with excitement or startle
Excessive shortness of breath during exercise
Racing or fluttering heart palpitations or irregular heartbeat
Repeated dizziness or lightheadedness
Chest pain or discomfort with exercise
Excessive, unexpected fatigue during or after exercise

How COMMON is SCA?

As a leading cause of death in the U.S., most people are surprised to learn that SCA is also the #1 killer of student athletes and the leading cause of death on school campuses. Studies show that 1 in 300 youth has an undetected heart condition that puts them at risk.

FAINTING
IS THE #1 SYMPTOM
OF A HEART CONDITION

What CAUSES SCA?

SCA occurs because of a malfunction in the heart’s electrical system or structure. The malfunction is caused by an abnormality the person is born with, and may have inherited, or a condition that develops as young hearts grow. A virus in the heart or a hard blow to the chest can also cause a malfunction that can lead to SCA.

Factors That Increase the Risk of SCA

Family history of known heart abnormalities or sudden death before age 50
Specific family history of Long QT Syndrome, Brugada Syndrome, Hypertrophic Cardiomyopathy, or Arrhythmogenic Right Ventricular Dysplasia (ARVD)
Family members with known unexplained fainting, seizures, drowning or near drowning or car accidents
Family members with known structural heart abnormality, repaired or unrepaired
Use of drugs, such as cocaine, inhalants, “recreational” drugs, excessive energy drinks, diet pills or performance-enhancing supplements

Cardiac Chain of Survival

Their life depends on your quick action!
CPR can triple the chance of survival.
Start immediately and use the onsite AED.

KeepTheirHeartInTheGame.org A Fact Sheet for Youth Sports Parents. This sheet has information to help protect your children or teens from Sudden Cardiac Arrest To learn more, go to KeepTheirHeartInTheGame.org. Get free tools to help create a culture of prevention at home, in school, on the field and at the doctor’s office. Discuss the warning signs of a possible heart condition with your child or teen and have each person sign below.
Detach this section below and return to your sports organization/LA’s BEST. Keep the fact sheet to use at your kids’ games and practices to help protect them from Sudden Cardiac Arrest.

While missing a game may be inconvenient, it would be a tragedy to lose a young athlete because warning signs were
unrecognized or because sports communities were not prepared to respond to a cardiac emergency.

I learned about warning signs and talked with my parent or coach about what to do if I have any symptoms. I have read this fact sheet on sudden cardiac arrest prevention with my youth and talked about what to do if they experience any warning signs, and what to do should we witness a cardiac arrest.

I read and understand the information. I understand that in order for my child(ren) to be a participant in LA’s BEST, they are required to attend during all hours of operation.

I agree

IMPORTANT

You will receive an email or text confirming your application submission. LA’s BEST will notify you regarding the status of your child(ren) placement.

Untitled(Required)

I agree that I am the child's parent/guardian and can legally complete this application

Contact the Site Coordinator at the location where you applied between 2:00 PM and 6:00 PM to check the status of your child's enrollment.

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Language

Please fill out the application below for LA's BEST

Child Information

Click the Add Child button to add your child. If more than one child, please click the Add Child button to add additional children.

Completion of the Child Information Section

Household/Guardian Information

Completion of the Household/Guardian Information Section

Confirmation

The following information applies to all children included in this application. You must answer all of the following questions.

A Fact Sheet for Youth Sports Parents

IMPORTANT

Contact the Site Coordinator at the location where you applied between 2:00 PM and 6:00 PM to check the status of your child's enrollment.