C.A.R.E.S. PROGRAM, 2018 FEBRUARY VACATION REGISTRATION Registration Deadline Tuesday January 9, 2018

Transcription

1 C.A.R.E.S. PROGRAM, 2018 FEBRUARY VACATION REGISTRATION Registration Deadline Tuesday January 9, 2018 For Office Use Only: Received on / / Registration Fee & Tuition Paid: December 1, 2017 Enrollment and field trip participation is open to all WPS children in grades K-5 and will be granted on a first come first serve basis. Your C.A.R.E.S. account must be in good standing to enroll in vacation programs. We will accommodate as many children as our staffing allows, maintaining a safe 1:10 ratio at all times. We hope that this will include everyone interested. HOURS: The program will be available from 7:00AM to 5:45PM. Please fill out information below: Child s Name: Home Phone: School: Grade: M F Parent/Guardian: Parent/Guardian: Cell Phone: Work Phone: Cell Phone: Work Phone: Home Address: (required): (required): Child lives with: Both Parents Mom Dad Other Alternate Pick-up/Emergency contact (REQUIRED). You must provide at least one local contact in order to participate. Contacts will be added to the list of existing contacts that are in the database if you are a returning family unless otherwise noted. Name: Phone: Name: Phone: Note: Are there any parental (or other) pick-up restrictions that we need to be aware of? YES NO If yes, please provide appropriate legal documents Name of Child s Physician: Phone: Allergies: EPI Pen: Yes NO Medical or Behavior Alert: Does your child take any medications? Yes No If yes, you will need to provide CARES staff with orders and meds. (Please do not assume that we already know this information.) Child may may not receive Non-Aspirin/Ibuprofen after consultation with the School Nurse. In case of accident, illness or other emergency, the staff at the C.A.R.E.S. program will try to locate immediately the parent or person responsible for the child. In the event of an emergency requiring immediate attention, if neither you nor the person(s) you designate can be reached, the C.A.R.E.S. nurse or C.A.R.E.S. staff will institute emergency procedures. If you do not wish to authorize hospital treatment you may cross out the following paragraph before signing below. In the event of an EMERGENCY during which neither I, nor my spouse, nor the person(s) I have designated above can be reached, I hereby give permission to the staff of the nearest medical facility to administer an anesthetic and perform such emergency procedures as may be necessary to aid my child. Parent or Guardian Signature: (Initial) I give permission for my child's medical information to be disclosed to Wilmington C.A.R.E.S. personnel, as needed. You must provide a protocol and any necessary medications with current doctor s orders. Note: There may not be a nurse on site for all hours of operation. However, much of our staff is also trained and certified in First Aid and CPR. Does your child have any needs other than medical? (PLEASE NOTE that CARES IS NOT AWARE of any IEP s or 504 plans that your child has for school unless you provide that information directly to us). Yes No If yes, please explain on back of form. Notice of Non-Discrimination All educational and non-academic programs, activities and employment opportunities at Wilmington Public Schools are offered without regard to race, color, sex, religion, national origin, ethnicity, sexual orientation, gender identity, homelessness, age and/or disability, and any other class or characteristic protected by law.

2 WILMINGTON PUBLIC SCHOOLS 2018 C.A.R.E.S. FEBRUARY VACATION PROGRAM WILL TAKE PLACE AT THE WOBURN STREET SCHOOL February Vacation Program will be held at the Woburn St. School, 227 Woburn Street. There will be staff located at the main entrance in the morning for sign in. We will guide you from there. Please use the front door. There is a pin pad located there. We will have full access to the library/computer lab, the gym, B level classrooms, and the playground area where we will offer activities that are fun for all. Please wear or bring sneakers every day! REGISTRATION AND PAYMENT INFO: Completed registration forms, permission slips, registration fee and tuition must be received by this office (320 Salem St.) no later than the end of business on Tuesday, January 9, Forms and payments can be either mailed or dropped off. Drop box/mailbox is located in the back of the building of the North Intermediate School. There is a $20.00 registration fee per child and a 20% tuition discount for siblings. Discount does NOT apply to field trip or registration fees. Please make check payable to WPS C.A.R.E.S. Enrollment, Tuition & Fees: Please check off ONE choice for each day. Tuesday 2/20/18 NO FIELD TRIP Onsite Only/No FT $43.00 Wednesday 2/21/18 Celebration Kingdom GRADE K-2 ONLY Daily cost w/ft $56.00 Wednesday 2/21/18 MVP GRADE 3 5 ONLY Daily cost w/ft $66.00 Onsite Only/No FT $43.00 Onsite Only/No FT $43.00 Thursday 2/22/18 Knucklebones ALL GRADES Daily cost w/ft $48.00 Onsite Only/No FT $43.00 Friday 2/23/18 Chunky s ALL GRADES Daily cost w/ft $64.00 Onsite Only/No FT $43.00 FIELD TRIP NOTES: + Registration Fee: $20.00 Total Cost: Wednesday February 21 Gr. K-2 Celebration Kingdom: Located on West St. in Wilmington. Grades K-2 will spend 2 hours there in the bouncy house, race around the dragon track, climb the magical obstacle course and jump in the birthday cake bounce house. Each child attending this trip must pass in a completed waiver form with their vacation enrollment forms. Forms can be downloaded at LUNCH AT WOB.ST after trip. Wednesday February 21 Gr. 3-5 MVP: Children will be playing laser tag, receiving 20 tokens for games and 2 slices of pizza and a drink for lunch on Wednesday at MVP Pavilion in Tewksbury. Thursday February 22 All Gr. Knucklebones: Knucklebones provides a diverse quantity of high end athletic equipment, we are proud to bring active entertainment and fun directly to you! Please remember to wear sneakers this day. There will be 3 one hour sessions (K-1, 2-3, 4-5) Check out their website at / Friday February 23 All Gr. Chunky s: We will all be attending an afternoon movie on Friday. We do not know which one as of yet, but they will be offering a PG movie. We will let you know the movie title when we receive it. Each child will also receive 2 slices of pizza, a drink, and a Hoodsie cup, which are peanut safe. **Field trips are subject to change. If this should happen, you will be given as much notice as possible. If your child intends to take advantage of the field trips, all field trip fees must be paid at the time of registration. We are sorry, but we cannot add children to any field trip at the last minute. If there are less than 10 children requesting NOT to attend any field trip, parents will need to either reconsider the trip or find alternate care as we will not be able to provide coverage at the site for such a small number of children. Staff will be needed on the trip. You will be notified if this is the case.

3 WILMINGTON PUBLIC SCHOOLS 2018 C.A.R.E.S. FEBRUARY VACATION PROGRAM WILL TAKE PLACE AT THE WOBURN STREET SCHOOL TRANSPORTATION PERMISSION: Transportation will be by bus supplied by North Reading Transportation unless otherwise noted. I give permission for my child to be transported to the field trip locations by the Wilmington Public Schools C.A.R.E.S. Program. I release the Wilmington Public Schools C.A.R.E.S. Program from all liability while transporting my child. Parent Signature Date: PERMISSION TO ATTEND EVENT: The undersigned gives permission for my son/daughter, to attend events with the Wilmington Public Schools C.A.R.E.S. Program during vacation. The undersigned releases the Wilmington Public Schools C.A.R.E.S. Program and its employees from any liability for any injury incurred by my son/daughter on this trip which is caused in whole or in part by some condition in or at the premises visited, and/or is the result of any actions by a person not employed by Wilmington Public Schools C.A.R.E.S. Program. Parent Signature Date ACTIVITY PERMISSION: PICTURES: I give my permission for my child s picture to be taken (At times students are recognized in newsletters and on our website and will NOT be identified by name). SLEDDING: I give my child permission to go sledding at C.A.R.E.S. and I will provide a helmet and snow gear. PG MOVIE: I give my child permission to watch a PG movie at C.A.R.E.S.: FACE PAINTING: I give my child permission to have their face painted at C.A.R.E.S.: TEMPORARY TATTOOS: I give my child permission to have temporary tattoos at C.A.R.E.S.: NAIL POLISH: I give my child permission to have their nails done at C.A.R.E.S.: 1, 2, 3: Parents must provide all food and drinks for your children. That includes 1 lunch, 2 snacks and 3 drinks. Please be sure your child eats breakfast before coming to the program in the morning as well. We will not have access to a kitchen, so please be sure to provide all utensils needed and no food in need of warming up.

4 CELEBRATION KINGDOM, LLC WAIVER FORM In consideration of being allowed to enter the play area and/or participate in any parties or programs at Celebration Kingdom LLC, the undersigned on his/her own behalf and on behalf of the minor(s) identified below, acknowledges, appreciates and agrees that. I willingly agree to comply with the stated and customary terms, rules and conditions for participation. In addition, if I observe any hazard during my participation I will bring it to the attention of the nearest official immediately, and I understand that the risk of injury can be significant, including the potential for paralysis and even death, and while particular rules, equipment and personal discipline reduce the risk, the risk does still exist, and I knowingly and freely assume all risks both known and unknown, even if arising from the negligence of other participants. I assume full responsibility for all participants listed below. Further, I agree to assume liability for all medical costs, attorney fees, and all other damages resulting from injury to myself and the undersigned participants, and I, for myself and on behalf of my heirs, assign personal representatives and next of kin, hereby hold harmless Celebration Kingdom LLC, agents, employees, other participants and sponsoring agencies with respect to any and all injury, disability, death, or loss or damage to person or property to the fullest extent of the law, and by signing below for my children and/or children in my care or spouse, I agree to the above conditions, should I decide to participate. Participant(s) 1 D.O.B / / Participant(s) 2 D.O.B / / Address/Street: City State Zip: Parent/Guardian Signature Date Printed Name Emergency Contact if dropping off (Events & birthday parties) Home Mobile We occasionally take photos for our WEB site. Please check there if you do NOT want your child s picture used. PLEASE PRINT YOUR ADDRESS TO RECEIVE NOTICES AND SPECIAL OFFERS: address:

5