Meadowthorpe PostTime
After SchoolCareProgram
2017 - 2018 SCHOOL YEAR APPLICATION FORM
•Applications are accepted on a"firstcome, first serve" basis until the program isfull.
•Applications considered only if accompanied by the registrationfee,firstweek’spayment,andimmunizationrecords.
Please check below which service you wish to enroll your child in:
Full Time 4 or 5 days: Dismissal 6:00 PM
$50.00/week
Part Time 3 or days:Dismissal 6:00 PM
$35.00/week
Please note that your child cannot switch between part-time and full-time without a written notice and approval from
the Site Director. ANY changes in enrollment must have approval from the Site Director or can be called into the school office at 381-3521.
PostTimeacceptschecksand/ormoneyordersONLY. NO CASH WILL BE ACCEPTED!!!
OfficeUseOnly
DateReceived: Amount Received:
Date of Enrollment ______
Make check payable to Meadowthorpe Elementary, and mailcompleted application to:
Meadowthorpe Elementary
1710 N. Forbes Rd.
Lexington, KY 40511
All Applications must come through the main office to be processed. A
$30.00 registration fee is charged for the school year.The maximum registration fee perfamily is
$40.00, plus first week’s payment.
Please mail check with application and immunization records.
CHILD INA
Please print all information and list the best number(s) to reach you in the event of an emergency.
PostTimeAfterSchoolCareProgram
PARENT CONTRACT
Child'sName
Iunderstandandacceptthe followingMeadowthorpePostTimePoliciesandProcedures(PLEASECHECKEACHBOX):
Iunderstandthatthisyear'sregistrationfeeandfirstweek’stuitionistobepaidby checkormoneyorderonly.Check,or moneyorderwillbeaccepteduponschoolstarting.Iunderstandthatapersonalcheckthatisreturnedforinsufficientfunds willincludeacheckcharge.
IagreetopaytheweeklyfeeeachMondayforthefollowingweek.Iunderstandthatpaymentnotreceivedby6:00p.m. Mondaywillbeassesseda$5.00/daylate fee.Accountsoverduetwoweekswillbeturnedoverforcollections,andyour
child’ss potinour programwillbeforfeited.
Iunderstandthatopeningtimeisat schooldismissal(2:35p.m.onschooldaysonly)andthatclosingtimeispromptlyat6:00 p.m.Closingtimeis6:00p.m.Shouldachildbepickedupaftertheclosingtime,theparentorguardianis assessedapenaltyof
$5.00at6:05p.m.A$2.00chargeforeveryadditionalminutetheparentislateperchild.Thisfeeisto bepaidwhenthechildis pickedup.If notpaidattimeofpick-up,it willbetackedontothenextweeklytuitionfee.Intheeventthatmychildisnotpickedup by7:00p.m.andIhavenotcontactedthestaff,Iunderstandthat,accordingtopolicy,he/shewill beconsideredabandoned andtheappropriatemeasuresandagencieswillbecontactedto ensuremychild'ssafety.
Iunderstandthatpaymentsmuststillbemadefordailyillness, absence,inclement weatherdays,orpartial attendance.Inthe event ofa seriousor lengthy illness orinjuryextendingfor a period of one (1) week or more,I may contactthe Meadowthorpe’s PostTimeDirector(381-3521)tomakearrangements onanindividualbasis.Intheeventofinclement weatherdays,thepaymentamountandscheduledoesnotchange.Chargeswillstillbeappliedandsimplybetransferredto theadditionalmake-updayslaterintheschoolyear.(AllinclementweatherdaysMUSTbemadeup.)
Iagreethatmychildwillbe signedin/outeachday byanadult(16yearsminimum)andIunderstandthatImustmaintainthe signin/outonadailybasis.IunderstandthatonlyindividualswhomIhavenamedontheauthorizationformmaysignoutmy childwithproperidentification.Ihavethesoleabilitytomakechangesonanypartofthisapplicationbutmustdosowith writtenconfirmation.Meadowthorpe’sPostTimeProgramwillhonorthisdocumentinallcustodydisputesuntilnotified otherwisebylegaldocumentation.
Iunderstandthatthestaffhastheauthorityto refusemychildadmissionintotheprogramif he/sheshowsanysignsofillness. IagreetokeepmychildabsentfromPostTimeifhe/shehashadafeveroracontagiousdiseasewithinthetwenty-four-hour periodpriortoattendingtheprogram.
Ifamedicalemergencyarises,I/WeauthorizethestafftocontactlocalParamedicstoprovideemergencymedicalattentionfor mychild.
Iunderstandthatthestaffwillmakeeveryefforttocontactmeassoonaspossibleintheeventofanemergency.I/Weaccept fullresponsibilityforallfinancialcoststhatarearesultofourchildreceivingmedicaltreatmentnotcoveredbyourpersonal insurance.
IunderstandIhaveaccuratelystatedallmedical/healthconcernsandlistedallmedicinemychild(ren)mayneed.Ialso understandthatImustprovideanymedicineaccordingtoproperdosageandsignamedicallogeachday.AnyMedical Concernsnotlistedaregroundsfordismissalfromtheprogram.I agreetoprovideimmunizationrecordsforeachchild.
MeadowthorpePostTimeProgramreservestherighttodismissyourchildfromour programintheeventthattheirbehavior threatensthesafetyofourstaffand/ortheotherchildrenintheprogram.Wedo nottoleratebullyingofanykind.
IhavereadtheMeadowthorpePostTimeProgramHandbookandwillcomplywithallthepoliciesandproceduresstated thereinandinthiscontract.Ialsoagreetoabideby theCivilityPolicydetailedintheHandbook.Iunderstandthatfailureto adheretothesepoliciesmayresultinmy child'sterminationfromtheMeadowthorpePostTimeProgram.
Parent/GuardianSignature: Date: _
MeadowthorpePost Time Program Waiver
Theundersigned (beingof lawful age and the parent/guardianof the undersigned student)having requested that theirminor child participate in theMeadowthorpePost TimeProgramand related eventsandactivities; and whereas FayetteCountyPublicSchoolsare willing to let their minor child participatein theMeadowthorpe Post Time Program.Theundersigned dohereby waive,release, anddischargeFayette County PublicSchoolsfromany andall claims, actions,demands, and unknownforeseenandunforeseen bodily/personalinjuriesand property damages,andconsequencesthereofresultingfromtheactivitiesof theMeadowthorpePost TimeProgram.
It isunderstoodthat for, and inconsiderationof,granting permissionfor theirminorchild to participateinthe MeadowthorpePostTimeProgramthattheundersigned herebyacknowledgesthattheyhavereceiveda copyof the PostTime ProgramHandbook,have thoroughlyfamiliarized themselveswithitscontents,andagree to obey andabide byall therulesand regulationscontainedherein.The undersignedfullydeclaresthattheyhave admonished theirminor child toconductthemselvesproperlyatall timesandhave advised theirchild thatif he/sheshould believeanyof thefacilitiesorequipment to be unsafe to immediatelyadvisehis/hercounselorof such conditionand refuseto participatefurther intheactivity.
Theundersigned consentsto allowthepicture or likenessof theparticipantto appear inanyofficial documentary, sponsor advertisement, ortelevisioncoverage of aneventinanymanner incidental toparticipate insaid event and/or programwithoutcompensationtome,myheirs, executorsand/or agentsand administrators.
THEUNDERSIGNED HASREAD THE FOREGOINGWAIVER AND FULLYUNDERSTANDSIT.
I furtherstate thatI have read the foregoing releaseand knowthe contentsthereof, andsign thesame asmyown free actandit ismyintentionto be legally bound hereby.
Signed,sealed and delivered this dayof 20 in Lexington. Kentucky.
Caution: Read before signing below. All parents/legal guardiansMUSTsign. WitnessesMUSTbe atleasteighteen
(18) yearsof age.
Student'sName:
WitnessSignature
Parent/Legal GuardianSignature
Meadowthorpe PostTimeProgramMedicalAuthorizationForm
DateofBirth
School
Child'sName Sex Age GradeEntering
Address Zip HomePhone
Mother/Guardian
CellPhone
PlaceofEmployment WorkPhone
Father/Guardian _CellPhone
PlaceofEmployment _WorkPhone
Childliveswith: BothParents Mother Father Guardian Other:(PleaseList)
EMERGENCYCONTACTS,*MUSTBECOMPLETEDFORATTENDANCE*
Name: Relationshiptochild: DaytimePhone:
Physician'sName Phone
Hospitalpreferenceineventofanemergency
HEALTHANDMEDICALCONCERNS
Listanyphysicallimitations/precautions, allergies,recentsurgery,accidents,etc.
Pleasecheckanyofthefollowingyourchildpresentlyhasorhasahistoryof:
Diabetes Heartcondition/heartsurgery ADHD Asthma Epilepsy/seizure
Needspecialaccommodationduetofoodallergies/disability,etc.,
Pleasedescribe:
Other(PleaseSpecify)
IfmedicationistakenonadailybasispleasealertSiteDirectoronfirstdayofcamp,ofthemedicationtobeadministeredby staff.Appropriateformswillbefilledoutatthattime.Pleaselistchild'scurrentmedications:
AdditionalImportantInformation:
Yourchild'snameandnameofmedicationmustbeclearlymarkedontheoriginalpharmacycontainer.
SiteDirectorwillmaintainamedicationlogastodate,timegiven,etc.
It istheparents'/guardians'responsibilitytoinformstaffofanychangesinwritinginyourchild'smedicationand to signdailymedicationauthorization.
SignatureofParent/Guardian Date:
POSTTIME CHILD RELEASE AUTHORIZATION
Pleaselistallpersonsincludingparent(s)withwhomtheylivewhoareauthorizedtopickupthechild.Onlyparent/guardian whohas enrolledthechildis allowedtomakechangestothisformandcanonlydoso by writtenconfirmation.
(Note:Allpersonsmustbe atleast16yearsold.)
Child'sName:
1. Name RelationtoChild Phone
2. Name RelationtoChild Phone
3. Name RelationtoChild Phone
4. Name RelationtoChild Phone
5. Name RelationtoChild Phone
ANYCHANGESIN THISFORM MUST BE RECEIVEDIN WRITING.
Ifamedicalemergencyarises,I/WeauthorizethestafftocontactlocalParamedicstoprovideemergencymedical attentionformychild.I understandthatthestaffwillmakeeveryefforttocontactme assoonaspossibleintheevent of anemergency.I/Weacceptfullresponsibilityforallfinancialcoststhatarea resultofourchildreceivingmedical treatmentnotcoveredbyourpersonalinsurance.
ParentSignature Date
Meadowthorpe PostTimeProgram
ParentHandbook:
Post Timeis afullylicensed, excitingprogramdesignedtoprovideactivitiesfor yourchildat a reasonablecost. Itoffersstudent enrichment opportunitiestoincludeeducational support,positivesocialization skills andavarietyof leisureactivities. Meadowthorpe’s Post Timeprogramis licensed bythestate of Kentucky. This handbook has been designedtoprovideyouwith important information andthepoliciesof thePost Timeprogram.
Administration and Staff:
ThePost Timeprogramis staffedwithasitedirectorwhois fullyemployedbyMeadowthorpeElementary.This person is responsibleforclosecommunication withthe schoolprincipal, staff andparticipatingstudents. Thesitedirector willalsoensure quality in programcurriculumandwillprovidecontinuity between Post Timeactivitiesandall regular schoolpolicies withregard tostudent conduct.
Program staff will includeschoolstaff, collegestudents andother individuals skilledin various leisureactivities. These individuals willprogram thedailyactivitiesandprovide therecreational support.Allsitepersonnelwill receive adequate in-servicetraining, backgroundchecks andaTB Skin Test prior toemployment.
Activities:
Both indoor/outdoorlearningopportunitiesareprovidedwithtime foractiveplayas wellashomework help,time torelax, read, andparticipatein quietactivities. Activitiesincludearts andcrafts, recreational games, music, drama,scienceexperiments, and natureactivities. Weather permitting;thestudents willspendtimeoutdoors. Pleasedress yourchild(ren)appropriatelyforthe outdoors.
Costs:
A $30 registration fee,plus first week’s tuition is duewiththeapplication forthe schoolyear. Themaximumregistration fee per family is $40. Belowis alist of theweeklyfees.
Fulltime= $50.00 4-5 days/week Part time=$35.00 3 days orless/week
AllweeklyfeesaredueeachMondayforthefollowing week.Pleasegiveyourchecks(payabletoMeadowthorpeElementary School)tothesitedirector orprogramsecretary. A $5.00latefeeperday willbeassessedtoall paymentsreceivedafter6:00p.m. onMonday. Pleasekeepyourweeklyfeescurrent:yourchildwilllosehis/herspot in theprogramduetoadelinquentaccount. Yourtuitionpaysfordirectoperatingcostsoftheprogram. Whenyouenroll,youare reservingthestaff,spaceandprovisionsfor yourchild(ren). Therefore,youareresponsibleforpaymentwhetherornotyourchild attends. Writtennoticemustbesubmitted toPostTimetwoweekspriortoachild'slastdayofattendance. Thisenablesthestafftoofferspacetoprospectivefamiliesthat maybe inneed ofthe program. Reentry intotheprogramatalatertimewill beavailableonlyifspacepermits. Ifyou dropthe programwithoutadequatenotice,youraccountwillbechargedaccordinglyandyouwillnotbeabletore-enrolluntilthisispaid. Intheeventofinclementweatherdays,thepaymentamountandscheduledoesnotchange.Chargeswillstillbeappliedand simplybetransferred totheadditionalmake-updays later in theschoolyear.(Allinclement weatherdays MUSTbemadeup.)
Program Closings:
Post Timeservices arenot availableon holidays, Records/Conference,Professional Development, or snowdays. Theprogramis offeredonlyon days FayetteCountyPublicSchools are insession.
ArrivalandPick-up:
Anadult (minimumof 16years old) must sign eachchildout of thePost Timeprogramdaily. Failure tosignout can result in the termination of Post Time services. Parents must entertheirchild's departuretimeon thesign out form. Parents/Guardians or an authorizedperson must accompanythechildfromthePost Timesite.Closingtimeis 6:00 p.m. Shouldachild bepickedupafter theclosingtime,theparent orguardian is assessedapenaltyof $5.00 at 6:05 p.m. A $2.00 chargefor everyadditionalminutethe parent is lateperchild. This feeis to bepaidwhenthechild is pickedup. If not paidat timeof pick-up, it willbetackedontothe next weeklytuition fee. After 6:00 p.m., if aparent hasmadenocontact, a responsiblepartyfromyouremergencycontact list will becontactedtocometo thesiteandpick upyour child. If nooneis availablefromyour emergencylist, thelocalpolicewillbe contactedat 7:00 p.m. andthechildwillbetaken intoprotectivecustodyuntilaparent can belocated. Failuretopickupyour child by6:00 p.m. on a regular basis is grounds fordismissal fromthePOSTTIME program.
Theonlypersons allowed topick upachildare thoseindicatedon thechild's authorization form. Thestaff has the right toask for proper identification andtorefusetoreleasethechildif aperson is noton thechild's authorizationform. If someoneother than
theparent orguardianis topick upthechild, asignednotemust besent tothesiteandit must be indicatedon the sign in/out form foryourchildforthat day.
Illnesses:
POSTTIME cannot provideforsick children. Pleasedo notsendyour child totheprogram if they areill. Weareconcernedfor the healthandwelfareof eachchild;therefore,werequire that your child bepickedupas soon aspossible intheevent that they become illat theprogram.
BehaviorManagement:
Standards of behavior in thePOSTTIME sitesparallelthose in the schoolclassroom. Childrenareexpectedtorespectthestaff and tofollowtherules. Allrules aredirected towardavoiding injurytopersons or propertywhileinsuringfairness. Toinsureasafe, courteous andpositive environment, it is necessarytofirmlydealwithunacceptablebehavior. Discipline inPOSTTIME is assertive ratherthan aggressive. Adisruptivechildmayberemovedfromagroup situation toregain self-controlorbedeniedaprivilege. Thegoalof theprogramis for childrentoacceptresponsibilityfortheir ownbehavior,boththerewards andconsequences. Any formof discipline that would impairastudent's self-respect is avoided. In theevent thatachild's behavior endangersanother's welfare, is destructive toproperty,or disrespectfultoauthority,they willbegiven adiscipline referral withacopygiven tothe parent. In theeventthat thesitedirector deemsit necessary,parents maybecalled topick uptheirchildimmediately. Three disciplinereferrals during theschoolyear willresult in thechild beingdismissedfrom theprogram, followed bya6-month ineligibility tore-enroll. Pleasehelpusprovideasafe,courteous environment for allstudents andstaff byemphasizing
appropriatebehaviors athomeandby supporting thePOSTTIME staff in theevent that adisciplineproblemmayarise.Ourgoalis
toassist children in learning totake responsibilityfor theiractions andreceive thenatural rewards andconsequences that their actions maybring. Behavior management is aday-to-daylesson in learningtomakecorrect choices as wellas learninghow to interact positivelywithbothchildrenandadults.
Emergency Situations:
In theevent of an emergencyornatural disaster, thefollowingprocedureswillbeineffect. Allchildrenwillfollow the schoolsite disasterplan that is posted. Allchildrenwillbe kept at the schooluntilthey arepicked upbytheparent orotherauthorized person. Aperson authorizedbytheparent topick upachildwillbeaskedtopresent identification tothestaff. Shoulditbe necessarytoevacuatechildren fromthe school, theevacuation sitewillbepostedon the schooldoor andeveryeffortwillbemade tocontact parent orguardians. Staff members willremainat thesitewith thechildrenuntiltheyarereleased totheparentor authorizedperson. Pleasekeeptheemergency information sheet in your child's filecurrent toassist thePOSTTIMEstaff in the event of anyemergency.
POST TIMECivility Policy:
It is the intent of ThePOSTTIME Programtoprovideapositiveenvironment for socialization as wellas learning. To that extent, everyadult that comesthroughthedoors becomesarolemodelforpositivesocialization skills andeffectiveproblem management. ThePOSTTIME Programreserves theright todeny service toanychildwhosefamilymembersor associatesdonot
exhibit theappropriatebehavior foranenvironment of growthandlearning. Allparents andassociatesare remindedthat displays of anger, inappropriatebehavior, andphysicalabusecan result in thetermination of services tothat entirefamily. Thefirst infraction willbegreeted withawarningtoinformthe familythat asecondinfraction will result in termination ofservices. The POSTTIME management staffreservestheright todeterminewhat constitutesan infraction. Swearing, threateninggestures,
raisedvoices, and intoxication areseveral goodexamples.Serious infractions may bereferredto theproperauthorities.
Tax Information:
TheMeadowthorpePOSTTIME tax IDnumberis 61-6001059. Theaddress forMeadowthorpeElementary is:1710 NorthForbes Road, Lexington, Kentucky40511. Wewillnot automaticallysendoutyearly statements. Pleasesaveyourcashedchecks foryourr records.Receipts areavailableweeklyfromthe sitedirectororsecretary for yourchildcarecosts.
If youhaveanyquestions orconcerns, pleasecalltheMeadowthorpe Elementaryofficeat (859)381-3521
.