Good Afternoon Parents,

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1 Good Afternoon Parents, Thank You for looking into the Calvary Christian Mentor Program, we appreciate the opportunity to serve you and your family for the duration of summer break. Though this is a pilot program, if we find that we have succesfully filled a need, we will keep it running year round. This program was created so that students in the 5 th, 6 th and 7 th grades will have a safe place to come to during the summer months. A place where they can be encouraged to learn and grow into the young adults that God wants them to become. They will have the opportunity to explore our community and participate in different activities that will encourage an active and safe lifestyle. As they begin to help the younger children with projects, they will be learning how to have a servant s heart, but also, through our Bible studies and daily devotions, they will learn how to become solid leaders in our community. I am currently looking into different professional fields that allow job shadowing. Police, attorneys, doctors, judges, aircraft pilots and many more. I feel that if a student can become more familiar with the line of profession that they are interested in, it could help them make wiser decisions for their future. Remember, this is a pilot program and with any new program, there are going to be some kinks. Please pray that God will speak, we will listen and our children will prosper. If you should ever have any questions or concerns, please feel free to contact me at anytime. I look forward to the joy of serving you and the students here at the Calvary Christian Mentor Program. In HIS Service, Mrs. La Donna Skupowski Director of Calvary Christian Mentor Program School Office (208) Message Phone Jeremiah 29v11 For I know the thoughts that I think toward you, says the LORD, thought of peace and not of evil, to give you a future and a hope

2 Mentor Program Calvary Christian is pleased to offer a mentoring program for students between the ages of 12 and 16 years of age. The students will meet in the Pre-School Building, room 100. This is a pilot program and if successful, we will continue to offer it throughout the school year as well. Our policies are outlined below. Self Discipline and Discipline Policies With tweens and teens, there are bound to be disagreements and confrontations, though, uncomfortable for all involved, if handle correctly, each student will learn: 1. How to correctly and effectively communicate their feelings 2. How to set and maintain personal boundaries 3. How to respect the feelings and boundaries of others 4. How to recognize and stand up to peer pressure The program director will handle the discipline and will notify the parents if any disciplinary actions that are needed. Disciplinary Actions: 1. The assigned staff to the group, will sit down with the offending student(s) to discuss the problem and come up with a suitable solution for all involved. 2. The program director will sit down with the offending student(s) and come up with a suitable solution for all involved. The program director will call the parents and inform them of the situation. 3. The offending student(s) will miss the daily outing and will call their parents to notify them of their change in plans and why they had to change their plans. 4. The program director, the parents and the offending student(s) will have a meeting to discuss a suitable solution for all involved. 5. The offending student(s) will be suspended from the program for a full day. (No Refunds) 6. The offending student(s) will be suspended from the program for a full week. (No Refunds) 7. Contract Termination! (No Refunds) Name calling, malicious or abusive words/actions, obscene or obnoxious behavior, harassment of any king and physical violence will not be tolerated and are grounds for instant contract termination! (No Refunds) Drop Off/Pick Up We only release students to parents or other adults designated on the Authorized Pick-Up section of the registration form in the students file. It is our policy to ask all unfamiliar adults for photo identification. Families must keep us updated on current addresses, phone numbers, emergency contacts, and adults authorized to pick up their students. This information is critical for the safety and well-being of every student and must be in writing. Please inform us of any custody and/or visitation restrictions and provide us with the appropriate documentation. Drop-Ins Daily drop-ins are not available due to student-teacher ratios. Summer Hours of Operation The normal operating hours are 7 am 6 pm Monday through Friday. The program will be available to the 5 th, 6 th and 7 th graders June 1 st - August 17 th The program will NOT be available Monday, May 28 th, and Wednesday, July 4 th. Illness (see school handbook) In the event that your student becomes ill, you will be contacted and will need to make other arrangements for care. A student who has been ill, must be free from fever, diarrhea and/or vomiting for at least 24 hours before returning to the mentor program.

3 Mentor Program Immunizations A current copy of your student s immunization records (or a signed letter of exemption) must be on file with the Calvary Christian Mentor program. Late Pick-Up Fee A $25 late fee per student will be charged in increments of 10 minutes, starting at 6:00 pm. Medication Procedures The Calvary Christian Mentor Program may not give any medication to students without proper authorization from parents, and only within the guidelines of the Medication Administration Policy. PLEASE BE SURE TO SIGN THE MEDICAL RELEASE FORM. Program Requirements Students enrolled must be able to follow simple instructions and maintain a respectful attitude with staff and fellow students. The students will have the opportunity to decide, as a group, as to what activity the group will do for that day. Each student is required to help with any project that the staff assigns them for the morning and afternoon. Bible studies and scripture memorization will be part of the curriculum. Each student must bring their own healthy snack and lunch each day, NO PEANUT OR NUT PRODUCTS OF ANY KIND ALLOWED. Tuition Policies/Billing The Mentor Program is provided at a monthly rate, which is outlined below specifically designed for your student s summer schedule. An Activity fee of $120 is due with enrollment, which will be used for supplies and field trips. The program is offered on a prepay basis that will be charged to you monthly. Payments are due between the 1 st and 5 th of each month. You will be charged a late fee in the amount of $20.00 if the account is not paid in full. There will be a $20.00 charge for all checks returned because of insufficient funds. If tuition is not paid and arrangements have not been made, your student(s) enrollment for Mentor Program will be terminated. We budget on anticipated enrollment and therefore will not issue a refund of tuition if your student is unexpectedly absent. Should your student(s) normal date of attendance fall on a holiday or in-service day, regular payments are still expected. Tuition rates are as follows: Supply and Field Trip Fee Tuition 3 Days $120 $250/month 4 Days $120 $275/month 5 Days $120 $300/month Staffing is determined by the registration sheets. If your student is registered and you have prepaid, the space for your student will be kept available. Your schedule for the Mentor Program will be a commitment for the entire summer. A written notification must be given to the Program Director at least two weeks in advance of a student s withdrawal, and tuition will be paid for those two weeks, regardless if the student is in attendance. We reserve the right to change policies at any time we deem necessary in order to keep our program updated. Parents will be given a two week notice prior to implementation.

4 Mentor Program Registration 2012 Supply and Field Trip Fee Tuition 3 Days $120 $250/month 4 Days $120 $275/month 5 Days $120 $300/month Monday Tuesday Wednesday Thursday Friday Estimated Time of Drop-Off Estimated Time of Pick-Up Student s Name M F (Last) (First) (Middle) (Goes By/Nickname) Address Zip Phone (Street) (City) Age Birth date Grade Has your student personally received Jesus Christ as their personal Savior? Yes No Lives with: Mother Father Both Other: FAMILY INFORMATION Father/Guardian s Name Father s Address Cell City State Zip Phone Employer/School Work Phone Employer Address City Zip Religious Preference Church Currently Attending Have you personally received Jesus Christ as your personal Lord and Savior? Yes No Mother/Guardian s Name Mother s Address Cell City State Zip Phone Employer/School Work Phone Employer Address City Zip Religious Preference Church Currently Attending Have you personally received Jesus Christ as your personal Lord and Savior? Yes No

5 Mentor Program Student Release Form Calvary Christian Mentor Program will not release students to any person other than those listed on this form without prior written notification from the child s parent/guardian and proper identification. Please list the people authorized to pick up your student(s) from the Mentor Program in the spaces below: Person(s) authorized to pick up student(s) Name Phone Relationship Person(s) NOT authorized to pick up child/children Calvary Christian Mentor Program Statement of Parent/Guardian and Student I have been given a copy of the Parent Paperwork and I have read the financial policies and am aware of the terms and conditions of enrollment, which together with this Registration Form shall constitute a binding agreement between Calvary Christian Mentor Program and the undersigned. I understand it is my responsibility that all fees for the selected plan are paid in advance by the beginning of each month. I understand that I will be charged the normal monthly rate as stated under the tuition policy. I agree to pay any outstanding charges the following month. This contract may be terminated by either parent/guardian or provider by giving a two week written notice. I hereby, give permission to Calvary Christian Mentor Program staff to secure medical help, including ambulance or emergency of the closest hospital, in the event of an emergency. I agree that Calvary Christian Mentor Program will not be held responsible in case of sickness and/or injury to my child while in the care facility or in transit to and from the care facility except when it is the direct result of the care giver s negligence. Signature of Father/Guardian: Date: Signature of Mother/Guardian: Date:

6 Mentor Program Transportation Release Form Dear Parent, Please complete and return form to a staff member of the C.C.M.P. We must have a completed and signed form in order for your student (s) to attend the field trips for this program. This transportation release form will be in effect for the duration of the Calvary Christian Mentor Program. If the form is not completed and submitted, your Student will not be permitted to attend our field trips, and you will need to find alternative care. Student(s) MY STUDENT(S), NAMED ABOVE, HAS MY PERMISSION TO ATTEND THE CALVARY CHRISTIAN MENTOR PROGRAM FIELD TRIPS. I REALIZE THAT IF MY STUDENT IS NOT DROPPED OFF AT THE SITE BY THE TIME THE BUS LEAVES, THAT MY STUDENT WILL BE STAYING WITH THE SUMMER CARE PROGRAM FOR THE DURATION OF THE FIELD TRIP TIME PERIOD. Parent s Signature Date Father s Work Phone Father s Cell Phone Mother s Work Phone Mother s Cell Phone Psalm 121 v 8 The LORD keeps watch over you as you come and go, both now and evermore

7 Mentor Program Medical Release Form Students Name Male Female Last First Allergies (List food/drug/insect) N / A Allergy/ Asthma medications: Name Dosage Other medications (name, dosage, reason taking) Of the above medications, please list any / and all needed at school Name Dosage Time Name Dosage Time DOCTOR S NAME PHONE DENTIST S NAME PHONE PERSON AUTHORIZED TO MAKE MEDICAL DECISIONS IF PARENTS CANNOT BE REACHED Name Phone Address Relationship to child In the event my student(s) become(s) ill or sustains injury while in the care of C.C.M.P and is unable to reach us, I, the undersigned parent or legal guardian of the student(s) listed above, give my permission to those in charge to take whatever steps are necessary. Consent is given to any licensed physician or dentist to perform such emergency procedures deemed necessary to treat the emergency. I give consent for my child to receive emergency treatment (first aid and/or C.P.R) by any qualified C.C.M.P staff member. In case of an emergency, we will call 911 and you will be contacted immediately. I also give my permission for my student(s) to be transported by ambulance to an emergency center for treatment. In case of emergency, and if emergency transportation is needed, I agree to pay all costs of transportation and medical care. C.C.M.P cannot give any medication to students without proper authorization from parents, and only within the guidelines of the Medication Administration Policy. All prescribed medications, must be in their original container, with the prescribing doctors name, number, name of medication, dosage, route and how many daily doses prescribed. Parent s Signature Date

8 Mentor Program Student Contract I will, to the best of my ability, be respectful of the feelings and boundaries of the staff and my fellow students. I will speak with the staff and fellow students with the same kindness that I want to be spoken to. I will participate in the daily devotions and bible studies without complaint. I will help my team to make the daily activity decisions and I will learn to compromise when needed. When on campus or on an outing, I will conduct myself with a manner that will glorify the Lord and not bring an embarrassment to myself, my fellow students or the program. I will behave in a manner that will not belittle or make light of a fellow student and their opinions. I understand that if there is a problem with the staff or a fellow student, the following will take place: 1. I can, with a calm and respectful tone, talk to the person that there is a problem with and come up with a suitable solution for all involved. 2. If there is still a problem, the students, with a calm and respectful tone, may speak with a staff member to come up with a suitable solution for all involved. 3. If the issue continues to be unresolved, the program director will sit down with the student(s) and come up with a suitable solution for all involved. Name calling, malicious or abusive words/actions, obscene or obnoxious behavior, harassment of any king or physical violence will not be tolerated and are grounds for immediate contract termination! (No Refunds) Student Signature Date Psalm 25: 4 5 Show me Your ways, O LORD; Teach me Your paths. Lead me in Your truth and teach me, For You are the God of my salvation

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