After School Program Registration Packet
Table of Contents

After School Program Contract
2

Drop-In Policy
3

Homework Policy
4

Emergency Form
5

After School Clubs, Fall Session Registration Form
6

Parent-Teacher Conferences & Professional Development Days
7
1
JCDS After School Program Contract 2013– 2014
Child’s Name
Grade
Child’s Name
Grade
Child’s Name
Grade
Child’s Name
Grade
Please check one option
Circle the day(s) you wish to send your child/ren to the After School Program from 3:30-6:00:
_____ 1 day a week
M T
W TH
$1350
_____ 2 days a week
M T
W TH
$2670
_____ 3 days a week
M T
W TH
$3480
_____ 4 days a week
M T
W TH
$4050
1 Hour Rates:
Please check one option
Circle the day(s) you wish to send your child/ren to the After School Program from 3:30-4:30 ONLY:
_____ 1 day a week
M T W TH
$550
_____ 2 days a week
M T
W TH
$1100
_____ 3 days a week
M T
W TH
$1650
_____ 4 days a week
M T
W TH
$2200
Total: $_____________
2
Drop – In Policy
Every family must complete this form whether or not you plan to use the Drop-In program.
If you do not sign your child up for a contract and occasionally would like to send your child to After
School, the drop in rate is $40 per day or $18 per hour. When you pick up your child please be sure to
have a check to pay for your child’s stay.
Please note the following rules for Drop–In:
 You must call the office or speak to or email Gary Alpert to inquire regarding availability for any
given day. Sending in a note with your child concerning attendance in After School that
day, does not confirm space and cannot guarantee participation.
 The call to arrange for same-day care must be made by 2:00 pm on Mondays through
Thursdays.
 Payment should be made the same day as care. Checks should be made payable to JCDS After
School Program.
 JCDS After School Program reserves the right to assess late fees of 2% of the overdue balance
for payments over 30 days late. If balances remained unpaid for 60 days, I understand that my
child/ren will be suspended until such obligations can be fulfilled.
 JCDS After School Program retains the rights to change any portion of the contract. Parents
will be notified of the changes prior to implementation.
 If you use the After School Program Drop-In more than two times on the same day of the week
in one month, your child will automatically be enrolled for that day for the year.
This contract must be signed by a parent or guardian responsible for the student’s care.
Child’s Name
Grade
Child’s Name
Grade
Child’s Name
Grade
Child’s Name
Grade
Signature
Relationship to Child
3
Date
Homework @ After School
Choose one option per child from the following choices:
Option 1
We don’t have any time once my child comes home from After School.
Please have my child complete all of his/her homework before participating in After School activities.
Option 2
Balance is important. I want my child to complete some homework, but also have some time to play.
Work on homework for 20-30 minutes before joining the After School in planned programs.
Option 3
We’ll do homework at home. My child needs to play.
Please do not have my child work on any of their homework.
Child’s Name
Grade
Homework Option
Child’s Name
Grade
Homework Option
Child’s Name
Grade
Homework Option
Child’s Name
Grade
Homework Option
4
JCDS After School Emergency Form
Parent 1
Parent 2
Name
Work Number
Cell Number
E-mail address
Emergency Contact names and phone numbers (please list 2 people other than parents)
1.
2.
Child’s Name
Age
Allergies?
Grade
Yes
No
If so, please specify
Medications
Child’s Name
Age
Allergies?
Grade
Yes
No
If so, please specify
Medications
Child’s Name
Age
Allergies?
Grade
Yes
No
If so, please specify
Medications
Child’s Name
Age
Allergies?
Grade
Yes
No
If so, please specify
Medications
5
After School Clubs, Fall Session Registration Form
Parent Name:
Student Name & Grade
1.
E-Mail Address:
Day
Club Name
Cost
mon
tue
wed
thurs
2.
mon
tue
wed
thurs
3.
mon
tue
wed
thurs
4.
mon
tue
wed
thurs
Please make checks payable to the JCDS After School Program.
TOTAL
$
When signing up for music lessons please write the times that you are available, i.e.: 3:30-4:00pm, 4:004:30. We will make every effort to accommodate your request.
6
Special After School Programs:
Parent-Teacher Conference and Professional Development Days
Throughout the school year the building is opening but there are no classes on Parent-Teacher
Conference and Professional Development days. JCDS After School offers a special program, that
provides your children with a fun, safe place to spend the day with friends doing arts & crafts, playing
games, music and more.
The following is a list of dates and times we will be open and associated cost.
Date
Reason
Times:
Cost/child
November 6, 2013
Parent/Teacher Conference
Noon-5pm
$70
November 7, 2013
Parent/Teacher Conference
9am – 5pm
$90
December 9 2013
Professional Development
9am – 5pm
$90
January 27, 2014
Professional Development
9am – 5pm
$90
March 19, 2014
Parent/Teacher Conference
9am -5pm
$90
March 20, 2014
Parent/Teacher Conference
9am-5pm
$90
# Children
TOTAL $
Child’s Name
Grade
Child’s Name
Grade
Child’s Name
Grade
Child’s Name
Grade
7
Total