After School and More Participation Agreement

by Chris Trapp

September 17, 2008

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.