After School & More
Participation Agreement
In
consideration of the benefits from the After School and More
Program, which will be caring for my child while providing
educational and recreational programs, I agree to my or my child’s
participation in the activities as follows:
Voluntary
I understand
that this program is voluntary and that my child is not obligated
to participate in it. However, if my child elects to
participate, then he or she must be present for the program or
programs selected at the time the after school programs begin and
not leave until the conclusion of the after school activities for
that day with the exception of the after school supervision pick up
time arranged with the parent.
Release
I
understand a written release may be required before my child may be
allowed to participate in certain of the program’s
activities.
Medical Conditions and
Emergency Situations
I understand
if my child has a health problem, that I must inform the instructor
or site coordinator of the nature of the problem before my child
may participate in any activity. The After School & More
program reserves the right to require a medical release before
allowing a child with a health problem to participate in activities
of the program.
In the event
of illness or injury to my child and if I cannot be immediately
contacted by telephone, then I do hereby authorize any and all
necessary medical and surgical treatment that may be necessary and
appropriate for my child, including hospitalization and
transportation by an ambulance to the hospital if that is deemed
necessary or appropriate. I understand that all such expenses
for medical and surgical treatment will be my
responsibility.
Field Trip
Participation
My child
has my permission to attend all local field trips, excursions or
movies (G & PG only) with the After School & More
Program. I understand that advance notice will be given for
all field trips, excursions or movies, and will include date, time
of departure, return time at the program site, and film title and
rating. If my child arrives late for a field trip and the
group has departed, I assume full responsibility for my
child. I understand he/she may be unsupervised at the program
site, and may need to walk home. I release USD#487 from any
liability should this occur.
Internet
After School
& More and USD #487 provide access for students to state-of-the
art computer technology and the World Wide Web via the
Internet. It is a privilege to have access to these
extraordinary resources and therefore, all users must agree that
they will comply with the Unified School District #487 Internet
User guidelines. Users will agree to use the Internet for
only lawful and school related purposes and contact host sites,
which are considered to be appropriate at school. For a copy
of the Unified School District No. 487 Internet guidelines, please
contact After School & More at 258-3234.
Behavior
and Expectations:
My child and
I understand that all policies and procedures of the Board of
Education for USD #487 must be adhered to during all After School
& More program activities both on school property or in
alternate locations (field trips). I acknowledge that if my
child does not abide by the rules established by the After School
& More Program, my child or I may no longer be eligible to
participate in the program.
In the event
of a behavioral problem with my child, I understand that a
disciplinary incident report will be sent home with my child that
day. For my child to return to the program the next day, I
agree to sign and return the report acknowledging the
incident. After the receipt of the third disciplinary
incident report, I understand that my child will not be allowed to
attend the program for the next 5 consecutive school days.
Not withstanding this disciplinary procedure, After School &
More reserves the right to expel a student at any time who engages
in disruptive behavior or behavior that is harmful to himself or
others without the necessity of having received three disciplinary
incident reports.
Fees:
I
understand that the fees for these programs are one dollar a day
per child which will allow my child to participate in the before or
after school program. I may request a waiver of fees upon
submission of the request to the site coordinator of After School
& More.
Drop
Off/Pick-Up: I understand that the After School & More
Program, USD #487 and the City of Herington are not responsible for
children who walk to and from the program site. I agree to
arrange for the safe return of my child to my home from the After
School & More program site by:
__1. Pick
him/her up after the program ends not later than 6:00
pm.
__2. Allow
him/her to walk home alone or with a friend
__3. Allow
him/her to be picked up by a relative or
friend_____________________________________________
phone________________.
Your child
will only be released to the individuals named above unless
indicated by the parent/guardian by signed letter or phone
call. Please note that the proper identification will be
required to release your child. Prompt pick up is
imperative!
__4.
Arrange transportation with the school district at 5:00 pm
only.
I have read
the foregoing and fully understand and agree to the contents
thereof.
________________________________
________________________________
Parent/Guardian
Signature
Child’s Signature
____________________
Date
