21st Century Community Learning Center Registration 2015-2016


Welcome to AYS’ online registration. For program contact information, hours of operation, and other pertinent details, please read your school district’s General Information Sheet. Please also review our Parent Handbook that outlines important policies and procedures, including AYS’ Behavior Management Policy (pg. 12-14).

This registration form is for families recommended for AYS’ 21st Century Community Learning Centers (21st CCLC) only. Attendance is at NO COST for children who meet at least one of the following criteria:

  • C or below/non-mastery in Language Arts, Math or Reading
  • Did not pass ISTEP
  • English as a Second Language (ESL status designated by school district)
  • Free or reduced lunch or book rental

Additional documentation that can be uploaded or completed online (if applicable):

  1. Plan of Care form for any special health or behavior concern. Paper/PDF copy or online form.
  2. Medication Consent forms – Required for all over-the-counter medication. All prescription medication must be in a bottle with original prescription, name of child and dosage instructions listed on the container. (Paper/PDF copy signed by medical professional required for all early childhood programs and the John Strange and Stony Creek licensed school-age sites by the State of Indiana. All other programs: Paper/PDF copy or online form.)
  3. Custody Agreement

This form will allow you to register up to five children.

Thank you for choosing AYS for your family. After all the steps are completed, you will receive confirmation within two business days. Please contact the AYS director at your school to inquire about immediate openings. This online application is not a guarantee of space availability at the site for which you are registering or qualification for 21st CCLC funding. We will update this form frequently to indicate sites on a waiting list.

  1. The first three pages will cover these areas:
    a) School, Parent/Guardian Information, Emergency contacts
    b) AYS Enrollment Terms
    c) Your child(ren)’s health information
  2. You will be directed to the Procare login page. Procare is the childcare database AYS uses to safely manage all of your family’s information.
    Here you will:
    d) Create your family’s account
    e) Enter your contact information
    f) Enter information about your child(ren) (be sure to click “Add Child” here)

Call (317) 283-3817 if you have any problems with or questions about completing this application.

If you would prefer to complete a paper registration, you may download and print the registration packet here.

Download and print Plan of Care and Medication Permission forms (if applicable).

ADD-ADHD PDF or online form
Allergies PDF or online form
Asthma PDF or online form
Autism PDF or online form
Diabetes PDF or online form
Seizure PDF or online form
Hearing or Visual Impairment PDF or online form
Learning Disability PDF or online form
Physical Disability PDF or online form
Other Special Needs Generic PDF or online form
Non-prescription Consent PDF or online form
Prescription Consent (NO online form available. Medical professional signature required.)

Please mail all completed forms, registration fee, and first week’s deposit (per child) to:

AYS, Inc.
Attn: Registration
4755 Kingsway Dr., Suite 300
Indianapolis, IN 46205