After School Clubs Instructor Form Please fill out all the required fields below. Please send any questions to: email@example.com. WJHS After School Clubs Instructor FormThank you for offering to run an After School Club for our WJHS students. This form is for anyone wishing to host an After School Club at WJHS. Please fill out all of the details below so we can set up your club. If you have any issues/questions with the form, please email firstname.lastname@example.org. The form cannot be submitted until the items marked "mandatory" are completed. When selecting your dates, please refer to the D39 school calendar. There will be no clubs over school breaks or on days with no school or half days. YOUR CONTACT INFORMATIONName(Required) First Last Email(Required) I am.....(Required) a WJHS employee not a WJHS employee CLUB INFORMATIONClub Name(Required) Club Description(Required)Please limit to 50-70 words.Club Capacity(Required)Please enter the maximum number of students this club can accommodate.Day of the Week(Required) Please enter the day of the week this club will run. Note: WJHS teachers can't host on Wednesdays due to staff meetingsTime of Club(Required) 3:30-4:30pm Other Start Date(Required) Week commencing 1/10/22 Other Number of Sessions(Required) 8 Other End Date(Required) Week commencing 3/14/22 Other No Club Dates(Required) N/A Other Please detail any dates where your club will not meet.Club Expenses(Required) I will not have expenses for my club I will have expenses (please list below) Estimated Club Expenses Note: Please get prior approval before incurring more expenses than listed above, since they are rolled into your club fee.ROOM REQUESTWJHS Teachers, please list your room number if club will be held in your classroom. Outside vendors, check the type of room needed, or if a classroom, check “Need room Assigned”Please check one....(Required) I have a classroom (please enter room number below) I need a classroom assigned Auditorium Other Other Room Requests Please detail any additional room request details, including multiple room requirements, open space needs. Also include any need for chairs, sound equipment etc.REGISTRATIONPlease check one....(Required) I am an outside vendor and will set up my own registration and payments I am an outside vendor and would like the PTO to assist with registration, not payments I am a teacher and need the PTO to set up registration and payments I am a teacher with a free club and only need the PTO to set up registration STIPENDSTeachers, please note the stipend rates are as follows: $80/hr for clubs with 18 or more students $70/hr for 6–17 students $50/hr for lunchtime clubs We submit your stipend request to our treasurer 2 weeks prior to last club date.Please check one....(Required) Please send my check to my WJHS mailbox Please send my check to my home address Please add your home address here. OUTSIDE VENDORSPer Illinois and D39 Covid guidelines, all individuals who work within our schools, including all contractors and third-party vendors, who regularly work with students within our buildings, are required to submit proof of vaccination for Covid-19. Please submit your proof of vaccination to the D39 Human Resources Department. This information will be maintained as confidential and accessible only by our human resources department, our school administrators and our school nurses.All instructors for my club have submitted proof of vaccination Yes No Please copy and paste this URL to submit vaccination information: https://docs.google.com/forms/d/e/1FAIpQLSctMKY1lfCMA98aDgoEmhXm0Av4IoUnU8By24QESliS2xzoJA/viewformPer D39, all outside vendors must also submit a Certificate of Liability Insurance, naming the district as the Certificate Holder, Wilmette School District #39 615 Locust Road Wilmette, IL 60091 I emailed my COI to email@example.com ADDITIONAL INFORMATIONPlease add any additional information below.PLEASE NOTE:If your club doesn’t meet the minimum number of registrants one week prior to club start date (normally 6 students, depending on expenses), your club will be cancelled. So please promote your club in class. The PTO will promote your club as follows: In our Weekly Highlights newsletter, on the WJHS Parents Facebook page, on our PTO website, and with in-school announcements. After registration, the PTO ASC chair will send you a roster and a sample email reminder to send the parents the Friday before club starts. If you have any further questions, please contact clubs@WJHSPTO.com. Thank you!