Welcome to the YMCA Great Escape Before & After School Program

Size: px

Start display at page:

Download "Welcome to the YMCA Great Escape Before & After School Program"

Edmund Marsh
5 years ago
Views:

Welcome to the YMCA Great Escape Before & After School Program 2016-2017 The YMCA Great Escape Program is designed to offer well-supervised, safe, quality care for school age children.

1 Welcome to the YMCA Great Escape Before & After School Program The YMCA Great Escape Program is designed to offer well-supervised, safe, quality care for school age children. Our program is set up to accommodate both working and non-working parents. It offers children an opportunity to grow and develop in an enriching, multi-choice, encouraging, and pressure-free environment. In a semi-structured setting, our program will help children to: Grow personally and increase self-esteem Clarify issues Improve relationships and parent involvement Appreciate diversity Become better leaders and supporters Develop specific skills HAVE FUN State licensed Serving Stevens Point & Plover public schools Grades K-6 The Stevens Point Area YMCA is a non-profit, charitable organization that is dedicated to the development of the whole person: Spirit, Mind and Body. No child is ever denied membership or participation due to financial need. Important Registration Information All forms, including immunization records, must be complete at the time of registration. All forms must be completed and submitted a minimum of three working days prior to the requested start date. Physician/Dentist information must include the street address, and phone number. A $15 registration fee is due at the time of registration. Register before August 1st and the $15 registration fee will be waived. Payments are due on the 15 th of each month prior to attendance. A voided check and signed bank draft agreement are required at the time of registration for the bank draft option. The first draft will be August 15 th, 2016 and the last draft will be April 15 th, Bank draft is not available for families receiving assistance. The first month s payment is due at the time of registration for all other payment options. Complete the special activities sheet if your child will be attending activities such as breakfast, Big Brothers/Big Sisters, Boy/Girl Scouts, clubs, or sports in conjunction with Great Escape. It is the parents responsibility to let their child s school/teacher know when they will be attending Great Escape. All Registration forms must be received by 6PM Friday, August 26, 2016, for your child to start on the first day of school. Variable schedules will not be accepted until August 15th.

GREAT ESCAPE Child s Name: Age: M or F Birth Date: Start Date: School: Grade for 16-17 School Year: Before School Care After School Care Variable 6:30-8:45am 3:35-6:00pm * Schedules accepted 1 month

sessions/week $168 $198 5 sessions/week $145 $170 4 sessions/week $120 $140 3 sessions/week $93 $108 2 sessions/week $62 $72 1 session /week $32 $37 Add a Session $8.50/session $9.

3 GREAT ESCAPE Child s Name: Age: M or F Birth Date: Start Date: School: Grade for School Year: Before School Care After School Care Variable 6:30-8:45am 3:35-6:00pm * Schedules accepted 1 month prior M T W R F M T W R F Schedule: Monthly Tuition: YMCA Member Monthly Tuition: Non-Member 10 sessions/week $260 $310 9 sessions/week $243 $288 8 sessions/week $216 $256 7 sessions/week $196 $231 6 sessions/week $168 $198 5 sessions/week $145 $170 4 sessions/week $120 $140 3 sessions/week $93 $108 2 sessions/week $62 $72 1 session /week $32 $37 Add a Session $8.50/session $9.75/session Full Days: 6:30 am 6:00 pm Member Rate: $29/day General Public: $37/day DAYS OFF PROGRAM required. Pre-registration is lunch. Children should bring swimsuit, towel, and a registration. Payment is due in full at time of provided. Held at the YMCA, Transportation is NOT days. Two week notice is required for a refund or to transfer ($5 cancellation fee applies) Mon Oct 24 Fri Dec 23 Mon Jan 2 Tue Mar 21 Fri Oct 28 Mon Dec 26 Fri Jan 20 Wed Mar 22 Mon Oct 31 Tue Dec 27 Mon Jan 23 Thu Mar 23 Mon Nov 14 Wed Dec 28 Fri Feb 24 Fri Mar 24 Wed Nov 23 Thu Dec 29 Mon Feb 27 Fri Apr 14 Fri Nov 25 Fri Dec 30 Mon Mar 20 Mon Apr 17 Mon Dec 12 *as of 6/21/16 CONTINUED ON BACK SIDE

4 SNOW DAYS OFF AT THE YMCA YES NO Member Rate: $59 General Public: $72 6:30 am to 6:00 pm One time fee reserves a spot for your child for any and all FULL-DAY cancellations due to winter weather. Registration is required at least 1 business day prior to the snow day announcement. Payment is due in full at the time of registration. Fee is non-refundable unless the YMCA is able to fill reserved spot prior to snow day. *A $5 cancellation fee will apply. Children should bring a lunch and outdoor clothes if the temperature is above 0. Tuition Payment Agreement Registration Packet: A completed registration packet is required at time of registration for each school year. All registration forms must be complete. Parents are responsible for notifying the Child Development Office in writing of any changes in your child s registration information, including emergency contact and pick up information. Registration Fee: There is a non-refundable $15 registration fee per child due at the time of registration. Fee will be waived if registration is complete by August 1st. Payments: To simplify payments, Great Escape payments have been divided into 9 equal payments. Although specific dates included in each period may vary from month to month, the payments are equal amounts and are due the 15 th of each month prior to attendance for 9 months. Payment Schedule: The first payment is due at the time of registration, and the final payment is due April 15 th, Payment Options: You may make payments by bank draft, credit card draft, cash, check, or credit card. You may mail or drop off your payments at the YMCA, 1000 Division St., Stevens Point, WI 54481; or call with credit card information. Please put your child s name on all correspondence. Bank/credit card draft is not available for families who receive assistance paying for the Great Escape program. Late Fees: Payments not received by the 15 th of each month prior to attendance will be assessed a late fee of $ A $20.00 fee will be assessed for returned checks. Overtime: Children must be picked up by the closing time of 6:00 pm or an overtime fee of $5.00 per15 minutes will be charged. Chronic tardiness may be grounds for termination. Schedule Changes and Terminations: All cancellations and schedule changes must be received in writing 2 weeks prior to the change, and are limited to 2 per year. After 2 changes, a $10 fee per change will be charged. Notify the Child Development Office by one of the following methods: mail your notice to 1000 Division St., Stevens Point, WI 54481, fax it to , it to childdevelopment@spymca.org, or drop it off directly at the YMCA. Additions to the schedule will be made based on availability. All refunds are subject to a $5 cancellation fee. Add a Session: If you need to add a session, you must call the Child Development Office prior to your child attending the Great Escape Program and get approval. Each added session must be paid for in advance. Switching one session for another is not allowed. Variable schedules will be accepted no earlier than 1st of the month prior. Financial Assistance: If you receive financial assistance you are responsible for knowing all co-payments. If your child is registered for Great Escape, Days Off, or Snow Days and does not attend, you will be responsible for the full tuition amount as we will not receive funding if your child is not in attendance. I understand and agree to the terms of the tuition fees/schedule policy explained in the Parent Handbook and Tuition Agreement. I understand that I am responsible to meet the payment due dates regardless of my child s attendance. In addition, I understand that an authorized person will sign my child in at the morning session of Great Escape and sign them out in the afternoon session. The child will walk to class after being released from the morning session of Great Escape and in the afternoon, will walk from class to Great Escape and be signed in by a YMCA staff member. Parent or Guardian Signature Date

5 Stevens Point Area YMCA - Child Care/Preschool/Great Escape PARENT/GUARDIAN CONSENT and WAIVER & RELEASE OF LIABILITY Initial Section #1: REASONABLE ACCOMMODATIONS CLAUSE: Children with special needs or challenges will be accepted provided that "reasonable accommodations" can be made for their participation in the program and/or the child's participation does not require an inordinate amount of staff time that would not allow for the safety and welfare of the other children in the program. I understand that if my child requires an unusual amount of one-on-one attention, whether due to special needs or behavior, my child may be removed from the program. (Does not apply to School District programs including 4 year old Kindergarten.) Initial Section #2: MEDICAL RELEASE: In the event I cannot be reached, I give consent for YMCA staff to act in my behalf in granting permission for my child to receive emergency treatment. I agree that I will be responsible for the payment of all medical services rendered. Initial Section #3: RELEASE FROM LIABILITY: I understand that all reasonable safety precautions are taken by the YMCA in the operation of its facility, equipment, and programs. However, participants and parents of children must recognize and accept that there are inherent risks when choosing to participate in any YMCA program; risks that could cause sickness, injury or death. I agree that my child's participation in the YMCA programs shall be undertaken at his/her sole risk, and that the YMCA, its directors, employees, volunteers, and agents shall not be liable for any claims, injuries, damages, losses, diseases, wrongful death, actions or causes of action whatsoever, to my child or his/her property, arising out of or connected to participation in this program or any other YMCA program. I agree to hold harmless and indemnify the YMCA, its directors, employees, volunteers, and agents from any and all liabilities and claims resulting from participation in this program. Initial Section #4: MEDIA RELEASE: I give my permission for my child to appear in media approved by the YMCA and for the YMCA to use photographs and video of my child for promotional purposes and social media. Initial Section #5: FIELD TRIP PERMISSION: I give permission for my child to participate in walking, parent driver, bus and YMCA Van field trips. I understand that details will be sent home in advance and that these trips are dependent on weather conditions. Initial Section #6: SUNSCREEN/REPELLANT: I give permission for my child use sunscreen (NO-AD SPF30) and insect repellent (OFF Skintastic with 5% DEET) provided by the YMCA and/or the brands listed here (to be provided by me) and for my child to receive application assistance as needed. Sunscreen SPF Insect Repellent DEET% Initial Section #7: PARENT HANDBOOK: I have received the YMCA Child Care, Preschool or Great Escape Parent Handbook, which includes necessary program information for my child/ren and me. I have read the information and agree to abide by the policies and procedures therein. I also understand that a copy of the Policies Manual and DCF 251 licensing manual are available to me on the parent table. Initial Section #8: PETS: I have been informed of the pets in the center and their degree of contact with my child. I will be informed by the YMCA if pets are added prior to the pet s addition to the center. Initial Section #9: RESPONSIBILITY STATEMENT: I understand that the YMCA s responsibility for my child begins after s/he has entered the program area and has been signed in and ends when s/he leaves the program area and is signed out. I understand that I and/or an authorized adult must sign my child/ren in and out. Initial Section #10: PARTICIPANT ENROLLMENT ACCEPTANCE: I hereby apply for a reservation for my child as a program participant. I agree to pay the total fee on or before the payment due date. Failure to pay by the due date may forfeit my application and deposit. Furthermore, if my child is forced to leave the program due to illness, injury, or inappropriate behavior a refund may not be available. Children must be picked up by the identified program closing time or I understand that an overtime fee of $5 for every additional 15 minutes will be charged. YMCA membership must be valid at the time of registration and maintained through the program dates to receive member rates. (Does not apply to School District programs including 4 year old Kindergarten.) Initial Section #11: SCHEDULE INFORMATION: I understand that I am responsible for notifying the YMCA Child Development Office in writing any changes in my child s schedule, and to inform the staff of any extra curricular activities that may affect my child s attendance. I understand that schedule cancellations, changes and transfers may result in fee charges (see current registration for details). Initial to others. Section #12: DAILY SHEET: I give my permission to have my child s daily sheet information posted in the classroom and visible Initial Section #13: INFORMATION RELEASE: I authorize the Stevens Point Area YMCA and my child s past and present school to exchange and share information related to my child including: YMCA reports, behavior plans, school psychological evaluations, social work reports, IEP s and related evaluations/reports. Initial Section #14: ACCURATE/COMPLETE INFORMATION: I hereby state that all information I have provided is accurate and complete. I understand that it is my responsibility and required by licensing to provide any changes/updates regarding emergency and health information to the YMCA. I have carefully read and initialed each of the above parent/guardian consent sections. I fully understand that by signing this form I have given my parent/guardian consent for my child on all sections contained within. / / Child s Name Please Print Parent/Guardian Signature Date Form Rev. 11/2016 PM

9 Stevens Point Area YMCA Child Care/Day Camp Health History and Care Form FULLY COMPLETE ALL SECTIONS of this REQUIRED Health and Care Form and return to: Stevens Point Area YMCA, Child Development Office, 1000 Division Street, Stevens Point, WI (715) First Day of Attendance: Participant Name Birth Date Age M F Street Address Street City State Zip Home Phone School Grade Height Weight Parent/Guardian Name Home Address Parent/Guardian Name Home Address City State Zip City State Zip Place of Employment and Phone # Cell Ph. Home Ph. Cell Service Provider (for ER txt) Where Reachable While Child is in Care: Place of Employment and Phone # Cell Ph. Home Ph. Cell Service Provider (for ER txt) Where Reachable While Child is in Care: Please Indicate any Custody Issues Emergency Contacts (other than Parent/Guardian) and Persons Authorized to Pick Up Child. Emergency Contact Name Relationship to Child Place of Employment and Phone # Cell Ph. Home Ph. Cell Service Provider (for ER txt) Emergency Contact Name Relationship to Child Place of Employment and Phone # Cell Ph. Home Ph. Cell Service Provider (for ER txt) Where Reachable While Child is in Care: Where Reachable While Child is in Care: Participant Physician Phone Dr. Name/Facility Office Address Participant Dentist Dr. Name/Facility Office Address Phone Insurance Information: Is Participant covered by family medical/hospital insurance? YES NO Carrier or Plan Name Member ID # Group # Carrier Address & Phone # Name of Insured Relationship to Participant Emergency Treatment Authorization: In the event I cannot be reached in an emergency, I authorize the YMCA staff to transport to and/or secure from any licensed hospital, physician and/or medical personnel any emergency care or treatment deemed necessary for my child. I agree that I will be responsible for the payment of any and all medical services rendered. Signature of Parent/Guardian OVER Date

10 Participant Name Birth Date Age M F HEALTH CONDITIONS: (Check any that apply to the participant and explain below, include severity.) Sleepwalking Frequent Ear Infections Skin Problems Cerebral Palsy/Motor Bed-wetting Heart Defect/Disease Joint/Bone Problems Picky Eater Athlete s Foot High Blood Pressure Head/Neck/Back Injuries Vegetarian Warts Diabetes Epilepsy/Convulsions/Seizures Allergies Eating Disorder Frequent Headaches Visual Impairment/Glasses... Asthma Diarrhea/Constipation Indigestion Hearing Impairment/Aids... Other Abnormal Menstruation Sinus Trouble Speech Impairment Other Homesickness Frequent Nose Bleeds Learning Disability Doesn t Swim (describe) Bleeding Clotting Disorder ADD or ADHD Does participant have a Nightmares Fainting/Dizziness Cognitive Disability School IEP? If yes please Exercise Induced Difficulties Emotional/Behavior Disorder Chronic Illness/Condition provide a copy. Give details including triggers, signs/symptoms, care procedures and when to call parent and/or 911 for any conditions checked above: Identify any YMCA staff that you have given specialized instructions/training to: ALLERGIES Describe reaction/symptoms, management instructions and when to call parent or 911. Medications (list) Foods (list) Insects, Animals, Plants MEDICATIONS (Please name and describe reason for taking.) Medication Name Dosage (tabs & mg) Times Taken Reason for Taking Will participant medication need to be taken during this program? Yes No Maybe If yes or maybe a Authorization to Administer Medication form must be completed. All Medications are required to be in original containers and be clearly labeled. List and describe any other participant Health Conditions/Disorders/Impairments/Diseases/Illnesses/Major Surgeries/ Special Needs and indicate if there are any Restrictions: * A copy of participant s immunization records or provided form must be attached. I hereby state that the information I have provided is accurate and complete. I understand that it is my responsibility to provide any changes/updates regarding emergency and health information to the YMCA. I further understand that failure to provide accurate, complete, and updated information may jeopardize my child s participation in this program. Participant Name - Please Print Signature of Parent/Guardian Date Review dates: Form Rev. 11/2016 PM

U.S. Martial Arts Academy SUMMER CAMP 2015

U.S. Martial Arts Academy SUMMER CAMP 2015 3430 Oak Road Vineland, NJ 08361 Hours of operation 7:30am-5:30pm (Monday-Friday) Dates of Operation: Monday June 22nd thru Friday August 28th CLOSED WEEK OF