Holy Name of Jesus Catholic School. Henderson, KY Extended Care Program Form Parent(s) Name. Home Address

Transcription

1 Holy Name of Jesus Catholic School nd Street Henderson, KY Extended Care Program Form Parent(s) Name Home Address Home Phone Mother s Cell Father s Cell Mother s Place of Employment Phone Father s Place of Employment Phone Student s Name Grade Age Mid- Morning 11:00 to 3:00 Full Time 11:00 to 5:30 (4 yrs old) After School Program 3:00 to 5:30 Days of the Week My Child(ren) will be checked out of the Holy Name School Extended Care Program by one of the following people: Name Phone:

2 If for some reason, the people listed as the designated sign out person are unable to come for my child, I will send written permission for another designated sign out person to pick the child(ren) up. I understand that pick up changes can be made by phone only in the case of an emergency. The Extended Care Program personnel may check the authenticity of the phone message by calling the telephone number listed for the student s parent/guardian. Your designated person must bring proper ID to be checked by Extended Care personnel. Student s Name Special Medical/Allergy Problems Doctor to be called in case of Emergency Phone Number If a student signs into the Extended Care Program at 2:50 and leaves before 3:15, you will not be billed for Extended Care services that day. However, if the student has had a snack and drink, their lunch account will be charged $1.00. ALL EXTENDED CARE ACCOUNTS MUST BE PAID IN FULL BY THE 5 TH OF THE MONTH OR SERVICES CAN BE DENIED. Signature of Parent: Date: Signature of Parent: Date:

3 Holy Name of Jesus Catholic School nd Street Henderson, KY Parent Permission Form I hereby authorize the Holy Name Catholic Elementary School Extended Care Director of director of designee to obtain emergency medical care for my child(ren) named on the Extended Care registration form. I hereby grant permission for my child(ren) to use all of the play equipment, participate in all school sponsored extra curriculum activities. In case of emergency I hereby grant permission for the Director or director designee to take the following action: 1. Parents will be notified and their instructions followed. 2. Should a life threatening situation arise the 911 procedure will be activated first and parents notified as soon as possible. 3. In the event parents cannot be reached, the Director or director designee will determine whether 911 emergency procedures should be followed or first aid administered at location. 4. In the event parents cannot be reached and the Director or director designee determines the need to transport to a hospital, an emergency vehicle will be called. Under no circumstances will the school provide emergency transportation. 5. The child s medical history and authorization for emergency medical care will be made available to the emergency personnel. 6. Any expenses incurred under any of the above will be borne by the child s family. 7. The school will not be responsible for anything that may happen as a result of false information given at the time of enrollment, and/or failure to update student s information in writing. Parent Emergency Phone Number or Persons to contact in case of emergency (other then parent): Name: Number: Name: Number: Name: Number: Parent/Guardian: Date:

4 Holy Name Extended Care Handbook Holy Name Catholic School Mission Statement: Holy Name is a Catholic School providing an environment for a quality education based on the Gospel message, which fosters service to the community. Holy Name Extended Care s Goal: The goal of Holy Name s Extended Care Program is to provide a safe environment after school. The program is designed to enable social development and academic achievement of students participating in the program. The Objectives of Our Program: 1. Developing good after school study habits through homework and homework assistance. 2. Provide opportunities for students to interact socially with other students through structured and non structured activities. 3. Using our resources wisely by recycling bottle caps, Capri-sun pouches, chip bags for the good of our school. Licensed: Holy Name School Extended Care program is licensed by the Kentucky Department of Human Resources. The program is STARS rated at level 2. The program seeks quality standards beyond the requirements for facility licensure. Student to Caregiver ratio: 3 to 4 years: 12/1 staff ratio 5 to 7 years: 15/1 staff ratio 7 years +: 25/1 staff ratio Hours of Operation & Rates: Monday - Friday when school is in session. 11:00 to 3:15 Pre-School includes lunch for $ :00 to 5:30 Pre-School includes lunch and afternoon snack and drink for $ :00 to 5:30 K 8 th includes a snack and milk $7.50 for 1 Child $13.00 for 2 Children $18.00 for 3 Children Billing: Valerie Beckert, School Accountant, sends monthly statements that indicate the amount owed for Extended Care services to each family. The payments are due on the 5 th of each month. Failure to stay current will result in your child not being accepted into the Extended Care program. Student Guidelines: 1. Opened to ALL students attending Holy Name Catholic School. 2. Follow ALL the school rules as stated in the Holy Name Handbook. 3. Follow ALL directions of those in authority. 4. Students shall remain in designated Extended Care areas and should never be in other parts of the school. Designated areas include the Extended Care room, the Gym, the Cafeteria, and the Computer Lab in the 300 hallway. 5. Students are not allowed in school bleachers or in the school kitchen. 6. Students will clean up after themselves when eating. 7. ALL food/drink must remain in the cafeteria. 8. Students will not leave the program until their parent or designated person on their permission form have signed them out.

5 Providing Lunch For Pre-School Students: Our Extended Care program provides lunch for ALL students who attend after Pre-School. We are required to provide 5 components of food to each student. This includes students who bring their lunch from home. We must make sure the lunch includes milk, protein (meat, cheese, peanut butter, etc.), bread, fruit, and vegetable. ALL lunches must have the 5 components list in order to be a qualified meal. If you pack you child s lunch, please make sure you meet the requirements listed. If your child s lunch does not have 5 components, the cafeteria must provide the missing components. This is a STATE REGULATION. Snacks Provided After School: Snacks are provided for Extended Care through our Cafeteria. On our sign-in sheet, we keep a record of your child s snack and milk. According to STATE REGULATIONS, a snack includes 2 of the following components: milk, protein (meat, cheese, peanut butter, etc.) bread, fruit, and vegetable. If a student signs into Extended Care Program at 2:50 and leaves before 3:15, you will not be charged for Extended Care services that day. However, if the student has had a snack and drink, their lunch account will be charged $1.00. After School: 1. Students may change from their uniform into appropriate play clothing. We strongly recommend that you write the student s name in ALL clothing. We are not responsible for lost clothing. 2. A homework classroom is provided for those students who wish to attend and quietly work on their homework. 3. Students bringing video games to the program will be responsible for their games. ALL games must be rated E and must be appropriate by Catholic School Standards. 4. Students are responsible for any items brought from home. Extended Care is NOT responsible for lost items. 5. It is prohibited by law to show/view movies rented by individuals. In the event that a legal video shown, it must be rated G and meet guidelines appropriate with the teachings of the Catholic Church. Discipline: (Page 14 and 15 of the HNS Student Handbook) As in society, all disciplinary offenses at Holy Name Extended Care are not created equal. A student s age, physical, mental and emotional condition will govern the Extended Care Teacher s response as will any previous record of behavior/discipline problems and the nature of the offense. It is impossible to list all inappropriate behavior and serious offenses. Some examples are the following: 1. Chewing gum, drinks, and food violations at all times in all areas. 2. Dress code violations. 3. Cafeteria misbehavior. 4. Restroom misbehavior. 5. Hallway wanderings and/or misbehavior. 6. Disrespect to a teacher, staff member and/or another student. CONSEQUENCES for offenses (levied at the discretion of the teacher and/or administrator.)these may include but are not limited to the following: 1. Conduct notice. 2. Supervised isolation. 3. Conference of teacher, student, and administrator. 4. Detention after school hours. 5. Saturday school. Partial list of serious offenses for which a student may receive more serious consequences: 1. Fighting or instigating a fight. 2. Having fireworks at school or using them. 3. Any type of abuse. 4. Possession of any dangerous object or weapon, any controlled substance, tobacco products, alcoholic beverages, unacceptable or vulgar magazines and/or pictures. 5. Stealing 6. Extortion.

6 7. Blatant disrespect toward any adult or child within the school. 8. Repeated violation of school rules. 9. Throwing objects. 10. Willful destruction or defacing of school property or the property of others. CONSEQUENCES for the above offenses: (determined by the administrator.) These may include but are not limited to the following: 1. Conference with parent/guardian and student. 2. Guidance referral to counselor or priest. 3. Suspension in or out of school (work assigned must be completed during suspension.) 4. Repairing or replacing damaged items. 5. Afternoon detention. 6. Denial of participation in extracurricular activities. 7. Expulsion. Pick-Up: Parents are asked to come into the school and sign out students each afternoon. A late fee of $5.00 will be assessed for the initial five (5) minutes after the ending time and $1.00 for each additional minute. These fees cover the cost of the caregivers who stay with late pick-up. Medical Condition: Extended Care Director will be notified in writing of any student who has a medical condition. Informing the school nurse or the administration does not relieve the parents of also notifying the Extended Care Director. Application: Only students registered/accepted at Holy Name School may enroll in our Extended Care Program. If a student is enrolled in 3 year old Pre-School or 4 year old Pre-K 3 days a week, they are only allowed to attend the days they attend school. Requirements for entering Pre-School & Pre- K Extended Care Students entering our 3 year old & 4 year old Pre-School program will need: 1. Hepatitis B shot. 2. Kentucky immunization Certificate (up to date and on a Kentucky form). 3. Copy of student s State Birth Certificate. 4. Child must be 3 by July 1 st. (3 year old pre-school) 5. Child must be completely potty trained and able to take care of personal needs. He/she must be able to tell us that he/she needs to go to the bathroom and must be able to clean himself/herself. 6. Second dose of MMR. (4 year old Pre-K) 7. Child must be 4 by October 1 st. (4 year old Pre-K) To insure the Health and Safety of all children at Holy name School, only those students who have obtained the above will be allowed entrance into the school at the beginning of the school year. Thank You for your cooperation in this matter.

7 September 8, 2010 Re: After School Care and Students in Athletic Programs Dear Parents of Athletes: Students who participate in athletics often want or need to stay after school until their sporting event begins or the bus arrives to pick them up to transport them to an event. This has been an annual challenge for the school and the challenge grows each year. The supervision of all students after school is imperative and it is not an option to have your child be on the school grounds and not be supervised by their coach or extended care personnel. The number of students staying after school and waiting for an athletic event is growing and placing larger demands on our extended care personnel. Any student who stays after school until their sporting event occurs will be charged $7.50 a day regardless of the time spent with the extended care personnel. The school will not permit students to leave the school building without supervision to eat at local food establishments and return to school. As principal, I am very concerned about the safety of our students who are unsupervised during that time. However, part of the cost ($7.50 per day) will include pizzas being ordered for the athletes by Mrs. Beth Probus. Students in the school after 3:15 p.m. will be sent to extended care and parents will be billed for the services. Parents will need to make alternative decisions about child care if they do not wish to send their child to extended care. I am very appreciative of Mrs. Probus for offering to order the pizzas for the students and to all parents for understanding the safety issues and supporting the school in our decision to keep the athletes supervised after school. Sincerely in Christ, Sandy Fleming Principal