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Immaculate Heart of Mary After-School Care 2011-2012
(click here for pdf version of letter/form) |
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I IHM AFTER-SCHOOL CARE PROGRAM 2011-2012 Dear IHM Parents, Welcome to the 2011-2012 School year! The IHM After-School Care Program operates every day that school is in session for a complete day and is open to any IHM student in grades Kindergarten through 6. The hours are from 3:00 until 6:00. Please print and complete the Registration Form and Medical Form and send them to IHM c/o Anne Jones, with the $35.00 Registration Fee made out to IHM School. In order to prepare, I need these before the start of school on August 24th. The following rates are in effect for this school year: Full-time (4 or 5 days per week): $210.00 per month for one child and $345.00 per month for two children. Part-time (3 days per week or less): $163.00 per month for one child and $273.00 per month for two children. We also take children on an hourly basis and for emergency situations: $7 per hour, per child. August/September will be billed as one month. May/June will also be billed as one month. Full and Part-time payments are due on the first Thursday of the month. Hourly students will be billed at the end of each month. Please send your payment with the payment slip to school to my attention. You will receive the payment slips after August 24th. NOTE: It is imperative that your child(ren) be picked up by 6:00. If your child is not picked up by 6:00, there will be a charge of $1.00 per minute past 6:00 and it must be paid in cash at that time. In an emergency, please have someone else pick up your child(ren) if at all possible. You will need to inform us if someone other than a parent will be picking up your child(ren). On days you plan to use After-School Care, please tell your child(ren) to meet the After-Care staff in the Gym at 3:00. You will pick your child up in one of the second grade classrooms. I am looking forward to caring for your children. Sincerely, Anne Jones Coordinator IHM After-School Care Program
AFTER-SCHOOL CARE RULES AND SCHEDULE
AFTER-SCHOOL CARE DISCIPLINE POLICY
Being disrespectful to the staff Harassment of another child Physical assault Refusing to follow the rules Running away from the group Stealing Destroying another student’s property
AFTER-SCHOOL CARE PROGRAM 2011-2012
REGISTRATION FORM
Family Name: ______________________________________
Child(ren) who will be enrolled in the program.
Name: ____________________________________________ Grade/Homeroom: ______
Name: ____________________________________________ Grade/Homeroom: ______
Name: ____________________________________________ Grade/Homeroom: ______
He/She/They will be: ___ Full-Time ___ Part-time ___ Hourly
Please mail this form along with a check - payable to IHM School in the amount of $35.00 to the address below:
Anne Jones IHM School 7800 Beechmont Ave. Cincinnati, OH 45255
I/We have read the policies of the Immaculate Heart of Mary After-School Care Program and agree to abide by them.
____________________________________ Signature (Parent) ____________________________________ Signature (Parent)
____________________________________ Signature (Child) ____________________________________ Signature (Child) ____________________________________ Signature (Child)
____________________________________ Date
IMMACULATE HEART of MARY AFTER-SCHOOL CARE MEDICAL FORM
STUDENT’S NAME:___________________________________
EMERGENCY NAMES AND NUMBERS WHERE YOU OR PERSON YOU DESIGNATE MAY BE REACHED DURING AFTER-SCHOOL CARE HOURS:
NAME: NUMBERS: 1.____________________________________________________________________________
2.____________________________________________________________________________
PART I OR II MUST BE COMPLETED: PART I: TO GRANT CONSENT
In the event reasonable attempts to contact me at _____________(phone) or ________________(other parent or guardian) at _____________(phone) have been unsuccessful, I hereby give consent for:
1.) The administration of any treatment deemed necessary by Dr._________________________(preferred physician) at _____________(phone) or, Dr._________________________(preferred dentist) at _____________(phone) or, in the event the designated preferred practitioner is not available, by another licensed physician or dentist; and2.) The transfer of the child to________________________________(preferred hospital) or any hospital reasonably accessible.
This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained before surgery is performed.
FACT’S CONCERNING THE CHILD’S MEDICAL HISTORY INCLUDING ALLERGIES, MEDICATIONS AND ANY PHYSICAL CONDITIONS WHICH THE PHYSICIAN AND SCHOOL SHOULD BE INFORMED OF:___________________________________________ _________________________________________________________________________________________________________
________________________________________ ______________________________ Signature of Parent or Guardian Date
PART II: REFUSAL TO CONSENT (do not complete part II if you completed part I)
I do not give my consent for emergency medical treatment of my child. In the event of any illness or injury requiring treatment, I wish the school authorities to take no action or to:_______ ______________________________________________________________________________
________________________________________ ______________________________ Signature of Parent or Guardian Date
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