North Star
Boys & Girls Club School Site Program
The Boys & Girls Clubs of Delaware School Site Child Care Programs were designed to form a partnership with schools in the New Castle County area. These programs enhance the lives of the children we serve by developing their values, skills, and self-esteem. Our club members have the opportunity to develop physical, social, personal, and educational skills while participating in our programs.
General Information:
o The Boys & Girls Clubs of Delaware School Site Program at North Star Elementary School operates for the length of the school year. A Summer Fun Program is available to students from kindergarten all the way through the completion of eighth grade.
o Club members will have the opportunity to participate in National Boys & Girls Club programs as well as other activities, which include: Project Learn/Homework Time, C.A.T.C.H., arts, and daily outdoor recreation.
o A nutritious snack will be provided each day after school.
o We strive to maintain a staff-to-child ratio of 1:15. Staff is experienced in childcare, and receives on-going training throughout their employment.
o In addition to being well trained, our staff is certified in First Aid, CPR and our supervisors are certified in medication administration.
Program Information:
o Our Before Care opens at 6:30 a.m. and not a minute before. It closes at the beginning of the school day, 8:35 am.
o The After Care program runs from 3:35 p.m. and closes at 6:00 p.m.
o We offer ON SITE care on district half days, and care on in-service days.
o Children must become a member of the Fraim Boys & Girls Clubs in Elsmere. The annual membership fee is $15.00/year/child, and is due at the time of registration.
o Casual care is available to families who choose to use our program on an occasional basis. Children must still become Boys & Girls Club members.
o In order for your child to receive care, he/she must have all paperwork in to us a minimum of 24 to 48 hours PRIOR to the day care is to begin.
Program Fees:
o Program Fees vary from year-to-year. Generally, we increase our tuition between $2.00 and $5.00 each year.
o POC is accepted. POC site ID: 1710343700.
Weekly Fees:
o AM PM care: $102.00 per week per child.
o AM care only: $77.00 per week per child.
o PM care only: $79.00 per week per child.
o We offer a third child discount of 50% off. Unfortunately, there is no discount on the second child.
Casual Care Fees: (Anything over 3 days is considered a full week of care.)
o $25.00 per visit for Before care per day per child
o $30.00 per visit for After care per day per child
o $35.00 per visit for half day care (AM and PM care on the same day) per child.
o $40.00 per visit for full day care per day per child.
** Field trip fees are not included in the price of tuition
Payment Methods:
o CASH, MONEY ORDERS, CHECK or ELECTRONIC FUNDS TRANSFER (EFT) from a checking account are the accepted forms of payment.
Registration Methods:
o Parents may drop forms off in the office at North Star Elementary or in the cafeteria during program hours.
o Parents may also mail their registration to:
Boys & Girls Clubs of Delaware
North Star Elementary School
1340 Little Baltimore Rd.
Hockessin, DE 19707
Attn: Brittney Moore
If you have any questions or concerns, please do not hesitate to call us at:
(302) 463-6188.
You can also email the Site Director, Brittney Moore, at
Enrollment Agreement:
School Year 2015-2016
Child’s Name ______Parent/Guardian ______
Address: ______
Phone Number: ______Date: ______
Grade: ______Teacher: ______
My child listed above will be attending the Boys & Girls Clubs of Delaware School Site Program for the 2015-2016.
___Before Care ONLY $77/week (with care for full days off being an extra $15/day)
___ After Care ONLY $79/week (with care for full days off being an extra $15/day)
___Before & After care $102/week
___ Purchase of Care (parent is responsible for copay)
ü Membership fee of $15 is due at time of enrollment. Purchases of Care families are NOT required to pay the $15 membership fee.
ü Before school program hours are from 6:30am until the start of the school day. After care program hours are from 3:30pm until 6:00 p.m. Transportation to the program, in the morning, and from the program, in the afternoon, is provided by the parent.
ü Parents that arrive after contracted pick up time will be charged a late fee of $1.00 per minute per child. A cash payment will be due before the child may return to the program. If your child is not picked up and no communication has been made with the program director 30 minutes after your contracted pick-up time, the authorities will be notified for assistance.
ü Tuition payments are accepted through electronic funds transfer, check, cash, or money order and are due on the Friday prior to the next week’s care. We do not refund or credit tuition for illnesses, absences, or unannounced vacations. Any returned checks or electronic funds transfer will get an additional $25 charge. Once one check is returned, you no longer have the option to use that payment method.
ü Withdrawals from the program require one week written notice.
ü Vacations require a one-week written notice. If notice is not received, you will still be expected to pay your full week tuition.
ü The Boys & Girls Club will provide care on days the school is closed, including most weather related closings. A schedule will be given out with the location of care on the days school is closed.
ü The program will be CLOSED for the following holidays: Labor Day, Thanksgiving (11/26 + 11/27), Christmas (12/24 +12/25), New Year’s Day (12/31 +1/1) Martin Luther King Jr. Day, Good Friday, Memorial Day, and Fourth of July. Tuition for weeks where program is closed for only one day is due in full.
ü Boys & Girls Club of DE hold the right to terminate enrollment for failure to follow policies and procedures
Parent/Guardian Signature Director’s Signature Date
(Both Parents MUST sign)
______
______
Tuition Payment Form
Child(ren)’s Name(s):______
Mother/Guardian’s Name:______
Father/Guardian’s Name:______
Person Responsible for Payment:______
How are you planning on making payments?
____CASH
____CHECK
____MONEY ORDER
____ELECTRONIC FUNDS TRANSFER (EFT)
***For EFT Parents (Our preferred method of payment)
· Do we have your account on file? YES NO (If no, please attached a voided check.)
· What is the amount you are authorizing us to debit from your account every Thursday? ______(ex. $77, $79, $102, etc)
· Do you have a schedule that differs than a normal week to week schedule or do you have a different day you prefer to have your account debited on? YES or NO For example, do you pay on a particular day for the entire month? Do you pay bi-monthly? Or do you have a particular situation for payment? If so please let us know. Please include the DATE, AMOUNT, and any other necessary information.
______
______.
· Will you be including the $15 membership fee with your first week tuition? YES or NO
If no, how will you be paying for membership?______
Did you pay it with your summer camp registration?______
FEES FOR 2015-2016 SCHOOL YEAR ARE AS FOLLOWS:
WEEKLY FEES:
Before Care: $77/week
After Care: $79/week
Before & After care: $102/week
Parent/Guardian Signature ______Date ______
Boys & Clubs of Delaware School Site Program
REGISTRATION INFORMATION
Please complete the registration form:
Type of care needed: _____ Before ____ After ____ Casual Care
Child’s Name: ______Date of Admission: ______
Child’s Age: ______Date of Birth: ______Sex: ______
Grade, Teacher, & RM #: ______
With whom does the child reside? _____Mother ______Father ____Other
Mother’s Name: ______Employer: ______
Business Phone: ______Business Address: ______
Hours of Employment: ______Email: ______
Mother’s Home Telephone #: ______Cell/Pager: ______
Mother’s Home Address: ______
Father’s Name: ______Employer: ______
Business Phone: ______Business Address: ______
Hours of Employment: ______Email: ______
Father’s Home Telephone #: ______Cell/Pager: ______
Father’s Address: ______
EMERGENCY CONTACTS MUST BE WITHIN 20 MINUTES OF THE SCHOOL
Alternative Emergency Contact: ______Phone #: ______
Relation & Address: ______
Alternative Emergency Contact: ______Phone #: ______
Relation & Address: ______
Name of Person(s) authorized to pick-up child other than parents:
(Child will not be released if person’s name is not listed.)
Does your child have any allergies? Y/N (circle one) Please describe:
______
Does your child have any special needs? Y/N (circle one) Please describe:
______
IN THE CASE OF AN EMERGENCY, IT IS EXTREMELY IMPORTANT FOR US TO HAVE THE FOLLOWING INFORMATION:
Name of Family doctor: ______Phone: ______
Name of family Dentist: ______Phone: ______
Insurance Provider: ______
Policy Number/Group Number: ______
Hospital Preference: ______
CHILD INFORMATION CARD
State of Delaware Department of Services for Children, Youth and Their Families
______Name of Child (Last, First, Middle Initial) Birthdate Date of Admission Date of Discharge
______Name of Parent(s) Home Address Home Phone Number
______1. Employer Hours of Employment
______Business Address Business Phone Number
______2. Employer Hours of Employment
______Business Address Business Phone Number
Person Other Than Parent to be Notified in Emergency Situation When Parent is not Available
______Name Address Phone Number
Names of Persons Other Than Parent to Whom Child May be Released 1.______2.______3.______4.______
Emergency Medical Care: I, ______, the parent (or legal guardian) of ______who is my minor child, hereby authorize emergency medical treatment for my child in the event I cannot be contacted to give permission to treat. I understand I will be financially responsible for the cost of such treatment.
Transportation: I, ______the parent (or legal guardian) of ______who is my minor child, hereby give permission for my child to be transported with his/her caregiver.
______
Signature of Parent or Guardian Date
______Name of Child’s Physician Address Phone Number Office Hours
______Special Medical Information (Allergies, etc.) Health Insurance Identification Information
The above information is essential for your child’s protection - Be sure to keep the information current
EMERGENCY AUTHORIZATION FORM
I hereby give my consent to The Boys and Girls Clubs of Delaware to call Dr.______at the following phone number ______, or to take my child to a hospital emergency room for medical or surgical care should any emergency arise where such service is indicated. I understand that the cost of this care will be paid by me.
It is understood that a conscientious effort will be made to notify me before such action is taken, if time permits.
I understand that The Boys and Girls Clubs of Delaware will contact me or the names I have designated on the enrollment application form to be called for emergencies if we can be reached, and time permits.
In order to meet all legal requirements, I hereby authorize an acting representative of The Boys and Girls Clubs of Delaware to give consent for any and for all necessary emergency medical care for my child named ______
while said child is in the care of The Boys and Girls Clubs of Delaware.
Parent/Guardian Signature ______Date ______
PERMISSION SLIP
I, the undersigned, give permission for my child or ward, ______, to go on various field trips scheduled throughout the school year and summer months by the Boys & Girls Clubs of Delaware School Site Child Care Program. Parents will be informed of the cost and destination two weeks prior to the trip. Parents/Guardians signature releases the Boys & Girls Clubs of Delaware from any liability should an accident/injury occur.
______
(Signature) (Date)
AUTHORIZATION FOR DISPENSING SUNSCREEN
During the Boys and Girls Clubs of Delaware Summer Fun Program, we will supply and apply one brand of sunscreen (Banana Boat SPF 50) for all enrolled children. We are not able to apply individual brands of sunscreen for each child. A staff person will administer sunscreen only if written authorization is given.
I give permission for a medication-certified staff member of the Boys and Girls Clubs of Delaware to apply the above listed sunscreen to my child on swimming days just before leaving for the pool.
Child’s Name ______
Parent Signature ______Date ______
*Please remember to apply your child’s sunscreen at home every morning before he/she attends our program. Thank you.
Child’s Name ______CENTER REQUIRED SIGNATURESPARENTS RIGHT TO KNOW NOTICE
UNDER THE DELAWARE CODE YOU ARE ENTITLED TO INSPECT THE ACTIVE RECORD AND COMPLAINT FILES OF ANY LICENSED CHILD CARE FACILITY. TO REVIEW A CHILD CARE FACILITY RECORD CONTACT: Ms. Ellen Linen, Office of Child Care Licensing, 4417 Lancaster Pike, Building #18, Wilmington, Delaware 19805, (302)892-5800.
You may also view substantiated complaints and compliance review histories for the past three years by visiting http://www.apex01.kids.delaware.gov:7777/occl/
I acknowledge I received this notice as part of the application packet. / Parent/Guardian Signature / Date
PARENT PERMISSION FOR DVD/TV VIEWING
Children, over the age of 2 years old, may have an educational movie or program incorporated into their curriculum. Movies shown will be age appropriate and not exceed one hour in length.
I hereby authorize my child to watch educational movies. / Parent/Guardian Signature / Date
PARENT PERMISSION FOR COMPUTER USAGE
Children, over the age of 2 years old, will have the opportunity to occasionally play educational games on the computer. Children will be closely supervised to ensure that age-appropriate and educational websites are being viewed while using the internet. Computer time will not exceed one hour in length.
I hereby authorize my child to use the computer. / Parent/Guardian Signature / Date
RECEIPT OF PARENT HANDBOOK
I certify that I have received information regarding the Center’s policies on following topics: a typical daily schedule, positive behavior management techniques, routine and emergency health care, health exclusions, and prevention of communicable diseases, food and nutrition, procedures for releasing children, reporting of accidents, injuries or critical incidents, mandatory reporting of child abuse and neglect, administration of medication procedures, non-discrimination, developmental and educational goals, complaints, and transportation, if provided.
Parent/Guardian Signature / Date
TRANSPORTATION PERMISSION I hereby give permission for my child to be transported by
______.
Please list any special needs or problems which might require special attention during transportation and directions on how to handle the special need or problem. This information will be carried with the operator of the vehicle named above. Each field trip requires separate written parent permission for transportation and attendance.
Parent/Guardian Signature / Date
Boys & Girls Clubs of DE School Site Program
“Getting to Know Your Child” Record
For YOUR CHILD to fill out
My name is: ______