After School Program – APPLICATION PROCESS

After School Program application will NOT be accepted until ALL of the below items are submitted.

1. Fill out the Online Application Form, click the button below.
2. Due with Application (non-refundable): $10 registration fee
   • Pay Online HERE -or- Pay in Person -or- Pay by Mail 
3. Household Information – number of individuals living in household and proof of income for every member of the household
4. Parent Notice Form – print, complete, sign & return (click HERE). Copies available at LUM if you are not able to print it.
5. What you need to submit with your application and registration:
   • Online Application Form – Completed, click button below
   • Children’s names, date of birth, grade, school, teachers’ names
   • Medical information – medication and allergy information; Immunization Record – current year
   • Educational needs information; Individualized Education Plan (IEP), if applicable
   • Emergency contact information
   • Read and agree to the Discipline/Guidance Policy
   • Payment, if not paid online

If you have additional questions, please email or call Kristi Hogue (khogue@lumserve.org | 765-423-2691).

Important After School Program Information may be found HERE

• Includes important information for students & parents
  — dates, open house, fees, forms & more
• OPEN HOUSE: Tours of the LUM Ray Ewry Youth Center (525 N 4th Street, Lafayette, IN) may be arranged by emailing Kristi Hogue at khogue@lumserve.org.

Who’s eligible for the After School Program:

• Elementary aged children – Kindergarten through 8th grade
• Students attending the following schools:
  • Lafayette School Corporation — all schools
  • West Lafayette Community School Corporation — all schools
  • Lafayette Christian School and St. James Lutheran School
  • Paramount Schools of Excellence
  • Tippecanoe School Corporation — not offered at this time
• Limited to 60 children

Contact information:

Kristi Hogue
Email: khogue@lumserve.org
Phone: 765-423-2691

BEFORE YOU BEGIN — Please review the application first and be sure that you have all of the information you need before filling out the form. You will NOT be able to save your work and return to this form at a later time.

When you have the information you need — fill out the registration form below.

When the registration form is completed and you’re ready — click SUBMIT.
IMPORTANT — Stay on this page until the form is done processing — otherwise, it may not go through. You will receive an email confirming that LUM has received your registration when it is submitted properly. When typing information into this form, please do NOT use only lower case or upper case letter.

After School Program – Important Information, click HERE
After School Program – main page, click HERE

No LUM Program applicant shall suffer discrimination due to his/her race, religion, national origin, gender, age, marital status, physical handicap, sexual orientation, political association or belief, or union affiliation or activity.

Here are some “frequently asked questions” about LUM financial assistance — and the answers.

Q: What do I need to bring with me for rent, utility, or prescription assistance?
A: Depends on what you need help with, but generally a photo ID, a copy of your current lease (or mortgage payment book), the most recent utility bill that shows “disconnect notice,” your HIP/MDWise statement, the information of which pharmacy your medications are ready for pick-up.

Q: Does my utility bill need to be a disconnect notice?
A: Yes. Exceptions to this are if you have a deposit, payment agreement, or budget billing showing on your current bill.

Q: Will you help with an eviction?
A: Many times real eviction court dates come with a hefty amount owed. We may or may not be able to help you because our funding is so small or we’ll require you to already have paid a significant portion of the amount owed.

Q: Do you help with phone cards?
A: No. We do not help with phone cards. If you are receiving TANF/SNAP, you should qualify for a government phone and that is what we recommend you seek since it’s free of charge to you.

Q: Do you help with cable TV/internet bills?
A: No. This is not something we are able to assist with.

Q: Will you help with CityBus tokens or Greyhound trips?
A: No. This is not something we can generally assist with. In extremely rare and unique situations, it may be possible.

Q: What do you help with?
A: We help with utilities after you receive a disconnect notification (but please come see us before you are actually disconnected!) or in other situations like payment agreements, deposits, or budget billing. We offer small amounts for rent/mortgage. We’ll help with most prescription drugs, including prescription glasses. We’ll help pay your annual HIP premium.

Q: Besides financial assistance, is there anything else you do?
A: Yes! Our program also helps to resource you with other avenues for assistance and by guiding you to other areas where you may qualify for varying types of help to improve your situation. This includes things like: referrals, a current “Now Hiring List” for area employers, information about government programs, etc.

Go back to main LUM Financial Assistance Program page, click HERE.

In addition to the services & programs offered by LUM — here is a list of resources you may also find helpful:

• 211 Help: Connect2Help – call/dial 211
• Addiction – Drug Rehab | Alcoholics Anonymous | Gambling |
• Childcare & Daycare
• Christmas Assistance – Salvation Army | Red Cross | United Way |
• Churches
• Clothing
• Community Gardens
• Crisis Intervention – Crisis Center
• Education
• Employment
• Energy Assistance
• Financial Assistance
  – Area IV Energy Assistance Program
  – Salvation Army, call 765-742-0006 for appointment
  – Tippecanoe Township Trustees – Website | Township Map (PDF) | 
  – Faith Presbyterian Emergency Aid Program
• Financial Planning
• Food
  – Assistance Programs
  – Food Pantries’ Information (listed by county)
  – Community Gardens
  – Education Classes
• Health Care
• Health Insurance
• Housing
• Legal Services – General | Immigration |
• Mental Health
• Parenting
• Rape Survivor Advocacy
• Recipes
• Religion
• Salvation Army, call 765-742-0006 for appointment
• Senior Center
• Shelter – Emergency | Day | Family |
• Social Services
• Suicide Prevention/Intervention
• Tax Assistance
• Tippecanoe Township Trustees – Website |  Map (PDF) | 
• Transportation – City Bus | Senior Center | LCP |

You may also check the Bauer Family Resources’ Community Resource Guide:

• Community Resource Guide 2017 (PDF)
• Guia de Recursos de la Comunidad 2016 (PDF)

DISCLAIMER – Lafayette Urban Ministry does not examine, determine, warrant or endorse the information listed above. Use of this list is voluntary and will not result in any liability against LUM. In no event shall LUM be liable for damages to any user of this list for the voluntary selection of any professional, for the services provided by any agencies, companies and individuals listed above, or for any other damages which may occur. Furthermore, it is important to understand that this directory is simply a list of agencies, professionals or businesses, and no recommendations, guarantees or endorsements are made regarding the quality of service you might expect from any of the professionals or businesses listed. Understand also that inclusion or omission of particular professionals, businesses, organizations, or services does not imply a recommendation, or lack of, by LUM.

for Waiver and Release, Assumption of Risks & Indemnification

HANGING ROCK CHRISTIAN ASSEMBLY, INC.
6988 SOUTH STATE ROAD 263
WEST LEBANON, INDIANA 47991
765-893-4581

NOTICE: This document affects your legal rights, please read carefully. Handwritten changes to this document are not permitted and will not be honored. This Agreement constitutes the entire Agreement and shall not be modified except via written document, executed by both parties. If any portion of this Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

I, the  Participant and the Parent/Legal Guardian of participant, being above the age of 18, agree as follows:

I acknowledge and understand that certain camping activities, including but not limited to: skating, skateboarding, paintball, ropes courses, archery, marksmanship, water sports, horses, zip line, rappelling, rock wall, swimming, ATV and dirt bikes are hazardous and dangerous activities that require strenuous exercise and varying degrees of skill and experience. I understand that these activities can result in serious injury to the person and damage to property and I voluntarily assume any and all risks of loss, damage or injury while on the premises.

I acknowledge that there are risks, hazards and dangers of personal injury, death and disability inherent in entering camp grounds and participating in, or viewing camp activities. I am aware that the usual risks, hazards and dangers of personal injury, death and disability increase when using certain camping equipment and when other persons, whether of the same or different level or experience or skill, are using the same facilities and equipment.

In consideration for my participation, or for the participation of my child or the minor for whom I represent that I am legal guardian, I hereby release and forever discharge Hanging Rock Christian Assembly, INC. and their servants, employees, officers, directors, trustees and all other persons or entities acting on their behalf (collectively referred to as “HRCA”), from any and all claims, actions, damages, liabilities, costs or expenses and attorney fees which are related to, arise out of, or are in any way connected to my child’s, or the minor for whom I represent that I am legal guardian’s viewing or participation in any camping activities. By signing this Agreement, it is my intention to waive any rights to sue or seek damages from HRCA; except where injury, death or disability results from HRCA gross negligence.

I further agree to indemnify, hold harmless and defend HRCA against any and all claims for damages, costs, expenses or attorneys fees brought by any third party in connection with or arising out of my, or the above-listed participant’s involvement or participation. This Agreement shall be effective and binding upon my marital community, estate, heirs, agents, personal representatives and assigns.

I accept responsibility of medical coverage while at Hanging Rock. Hanging Rock does not carry camper/guest/participant insurance.

Emergency Consent: Participant may receive emergency and/or routine medical care from a physician or emergency facility if I am incapacitated (if participant), or cannot be reached in an emergency (if parent/guardian).

I hereby certify that I am over 18 years of age; I have carefully read the foregoing and acknowledge that I understand and agree to all the terms and conditions. I have had the opportunity to ask any and all questions regarding this Agreement and the effect of the same. I am aware that by signing this Agreement, I assume all risks and waive and release certain substantial rights that I have or possess.

{As required by the State of Indiana – Provider name: Lafayette Urban Ministry}

It is very important that a child’s development is nurtured through caring, patience and understanding.  However, while caring for your children, we may have to respond to your child’s misbehavior.  Hitting, kicking, spitting, hostile verbal behavior and other behaviors which will hurt another child are not permitted.

In response to these behaviors, we will not use:

• Threats or bribes
• Physical punishment, even if requested by the parent
• Deprive your child of food or other basic needs
• Humiliation or isolation

In response to misbehavior, we will:

• Respect your child
• Establish clear rules
• Be consistent in enforcing rules
• Use positive language to explain desired behavior
• Speak calmly while bending down to your child’s eye level
• Give clear choices
• Redirect your child to a new activity
• Move your child to a time-out area for no longer than one minute per year of your child’s age, if necessary

If your child’s behavior is very disruptive or harmful to him/herself or other children, we will discuss the issue with you privately.  If the situation can be resolved, the child may remain enrolled.  If we are unable to resolve the issue, you may be asked to make other child care arrangements.

Please also see the other LUM behavior management documents in your registration packet.  If you have any questions do not hesitate to ask.

As a parent, you may have some concerns or wish to offer suggestions.  We may modify the above plan with agreed upon suggestions. Additional techniques to be used with my child and suggestions may be emailed to Kristi Hogue (khogue@lumserve.org).

Your LUM Camp registration will NOT be accepted without a letter to your child included.

Each camper will be given a letter from their family while at LUM Camp. The children love the letters from home — and it really helps make their time at camp happy and positive. Thanks in advance for writing a thoughtful letter to your child.

Here are some requirements and helpful tips:

• Letter MUST be…
  • Hand-written
  • Written as if they are at LUM Camp NOW
• Be positive
  • Focus on the positive experience of attending LUM Camp
  • Happy letters of encouragement
  • No bad news
• Be creative
  • Use colorful paper, pens
  • Add stickers — draw a picture
  • Write a letter from the family pet

Topic Ideas

• Sample sentences
  • “I bet you’re having a wonderful time at camp!”
  • “I can’t wait to hear about all the fun things you’ve done at camp this week”
  • Like swimming, climbing the wall, riding a horse, arts & crafts, hiking
  • “I look forward to hearing about all the new friends you’ve made at camp this week.”
• Funny
  • Include a funny story — it can even be true
  • Joke of the Day — click HERE
  • Riddles — click HERE
• Educational
  • Include a topic of interest — or specific topic
  • Word of the day — click HERE
  • Trivia — click HERE
• Spiritual — Bible verse of the day — click HERE

LUM Camp Registration form, click HERE
LUM Camp – How to Register, click HERE
LUM Camp Important Information, click HERE
LUM Camp – Behavior Expectations, click HERE
HRCA Agreement, click HERE