After School Care Program Registration Form PDF Details

After School Care Programs offer supervision and enrichment activities for school-aged children. This type of program can provide a much-needed break for working parents, as well as help kids with homework, study time, and physical activity. There are many different After School Care Program options available to choose from, so parents should research the different types of care available in their area. Most programs require registration forms to be filled out and returned prior to the start of the program. Parents should carefully read over all of the information included on the form before submitting it. Some common items that will be requested on an After School Care Program registration form include: contact information, emergency contacts, authorized pickup persons, allergies/medical conditions, fees/payment information, and schedule preferences.

QuestionAnswer
Form NameAfter School Care Program Registration Form
Form Length8 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min
Other names small school girl beeg form

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15-16 School Year WAMS

BERNARDS TOWNSHIP SCHOOL DISTRICT

AFTER SCHOOL CARE PROGRAM

William Annin Middle School

101 Peachtree Road

Basking Ridge, NJ 07920

908-204-2600 EXT. 102

June, 2015

 

TO:

Current & Prospective Families of the Middle School

 

After School Care Program

FROM:

Cherie Ackerman, Parent Relations Coordinator

RE:

Registration for 2015-16

This is the registration packet for the 2015-16 school year. The packet includes a registration form, release permission form and one monthly tuition form. The packet needs to be submitted yearly. Please include your $25 registration fee with your packet and return it by August 1, 2015. Your September tuition is due August 15, 2015. Please mail it to the above address or pay online at www.bernardsboe.com under the Payments on the bottom left of the screen.

You can mail your packet as well as your monthly payments to Bernards Township Board of Education, 101 Peachtree Road, Basking Ridge, NJ 07920 Attention: Cherie Ackerman. You also may submit your monthly tuition online. Please note your child’s name on your check.

If you should have any questions, please do not hesitate to contact Cherie Ackerman at ext. 102 or email at cackerman@bernardsboe.com

15-16 School Year WAMS

Bernards Township School District

After School Care Program

101 Peachtree Road

Basking Ridge, NJ 07920

908-204-2600 ext. 102 or 105 Aftercare@bernardsboe.com

William Annin Middle School

General Information

Mission

The Mission of the After School Care Program is to provide all children quality care in a safe, recreational environment that fosters mutual respect and offers children a variety of choices of developmentally appropriate and interest-driven activities.

Schedule

The Program is offered to William Annin students as follows on days when school is in session:

2:20 pm – 6:00 pm

On abbreviated schedule days the Program will begin immediately at dismissal. Please send a lunch with your child on those days as the cafeteria is closed. If your child is absent from school, you do not need to notify the Program. However, if your child attends school during the day but will not be attending the Program on a regularly scheduled day, please send a note to your child’s teacher. Your child must be present at dismissal in order to attend the Program. The Program does not run on the days that schools are closed.

15-16 School Year WAMS

Program

The Program will provide the opportunity for children to participate in a variety of active and quiet recreational and educational activities. Children will be grouped as closely as possible by grade, and will have the opportunity to spend some time completing homework assignments.

Pickup Procedures for the Release of Children

Only parents/guardians listed on the application are permitted to pick up your child.

If another person will be picking up your child, please submit a Release Permission Form to the Director. The person will be asked to provide a photo ID.

If a child remains past 6:00 pm, the staff members will attempt to contact the parent/guardian phone number listed on the application. The emergency contact will then be notified. There will be an additional charge of $10 for each 10 minute period beyond 6:00 pm.

Your child must be signed out, they are not permitted to leave school grounds alone.

If you are going to be late, you may call 908-204-2610 ext. 139

Tuition

A registration fee is due with your registration packet in the amount of $25 per child not to exceed $50 per family. Monthly tuition is due the 15th of the prior month. This will enable the Director to schedule appropriate staff. Your September tuition will be due on August 15th. You can mail your tuition to Bernards Township Board of Education, 101 Peachtree Road, Basking Ridge, NJ 07920 Attn: Cherie Ackerman.

Tuition is payable in monthly installments. There is no prorating. There will be a late fee of $10.00 for payments not received by the last day of the prior month. If tuition is not received by the first day of the month for which you are paying, your child will not be allowed to attend the program. In the event a check is returned by the bank due to insufficient funds, a $35 service charge will be imposed. Tuition is non-refundable.

In constructing our school calendar, we have already taken into consideration the holidays that school is not in session and have computed three (3) weather emergency days into that calendar as well. Your monthly tuition payment is based upon the average number of school days per month, and does not change based on actual school days per month. This is similar to an annual tuition bill you would receive from a private school or care provider. You make the same payment whether or not there is a school holiday or weather-related closing in a particular week. We will only cancel school due to an extreme weather condition. We are very sensitive to the fact that you have an obligation to get to work. We are committed to meet your needs and will continue to make that our priority.

15-16 School Year WAMS

Early Dismissals due to Weather or Other Emergency

There will be no After School Care. You will be responsible to pick up your child/children at dismissal, and will be notified by the Instant Alert System after the Superintendent has made a decision to close school early. The decision will be made by 10:30 am. The schools will be dismissed at 11:00 am. If you are concerned with weather conditions, you may pick your child up earlier than 11:00 am.

Student Absence

Because our costs remain constant throughout the school year, we cannot reduce your tuition payment if your family takes a vacation or if you choose to keep your child home for any reason.

Administration of Medication

A nurse is not on staff during the After School Care Program. Program staff may not administer medications. If your child requires medication during those hours, please arrange for the administration at home in the morning, or by the school nurse near the end of the school day. In emergency medical situations, such as seizure disorders, the Program staff may call qualified emergency personnel to attend to your child.

Code of Conduct

We encourage appropriate behavior by our students whether they are in school or in our After Care Program. In the event that unacceptable behavior is exhibited, parents will be contacted by Program staff. If the behavior is continual, the student may be removed from the Program.

Thank you for entrusting your child to our care. We are committed to providing a safe and enjoyable program. Please let us know if you have any questions or concerns.

15-16 School Year WAMS

Bernards Township School District

After School Care Program

William Annin Middle School

REGISTRATION FORM

Child’s name:____________________________________ Date of birth:________

Grade:___________________ Home Phone#_______________________________

Address:____________________________________________________________

*Phone number at 3:15 pm during dismissal: _____________________________

*This is so we may contact you immediately about any dismissal issues Mother’s Name:_____________________________________________________

Home email:_____________________________________________________

Work email:_____________________________________________________

Cell phone #_________________________Work #_________________________

Father’s Name:______________________________________________________

Home email:_____________________________________________________

Work email:______________________________________________________

Cell phone #_________________________Work #_________________________

Emergency Contact (Only called if the above can not be reached)

Name: _____________________________________________________________

Address:____________________________________________________________

Home#_____________________________ Work #__________________________

Cell#_________________________

Days of week your child will be attending: (please circle)

 

Monday

Tuesday

Wednesday

Thursday

Friday

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Medical History:

Allergies (include allergies to particular medicines, foods and insects):

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Does your child require an Epi Pen?

Yes*

No

*If your child requires an Epi Pen, please provide one to the After School Care Program, prior to the first day of school.

Physical disorders:____________________________________________________

If student is currently taking any type of medication, please list:

____________________________________________________________________

____________________________________________________________________

List any limits to student’s physical activity:______________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

I certify that I have registered for emergency notification by email and phone through the Honeywell Instant Alert system on the school district’s website.

I have read and accept the terms in the registration packet.

Parent Signature:_____________________________________________________

Date:________________________________________________________________

15-16 School Year WAMS

Bernards Township School District

After School Care Program

RELEASE PERMISSION FORM

I, _____________________________, give the Bernards Township

School District After School Care Program permission to release my child,

_____________________, to___________________________________,

who resides at ____________________________________________. The

person’s phone number is:__________________________. This release

may take place when I am unable to pick my child up form the Bernards Township School District After School Care Program at the time of its closing. Such release may require that my child be transported to the above residence.

Signed: __________________________________

Date: ____________________________________

Alternate Pick-up person #2:_______________________________

Address: _______________________________________________

Phone Number: _________________________________________

15-16 School Year WAMS

Bernards Township School District

After School Care Program

William Annin Middle School

TUITION FORM

2015-16 School Year

Student’s Name__________________________ Month _______________

Homeroom Teacher ___________________ Grade____

# of days per week_______ M T W TH F

(Please circle the days of the week)

Enclosed is a check for the full month’s tuition:

$__________________

Check #_________________

Please make checks payable to:

Bernards Township Board of Education

A YEARLY REGISTRATION FEE IN THE AMOUNT OF $25 IS DUE WITH

YOUR PACKET

2015-16 Tuition Rates

Schedule –PM only Option

Monthly Tuition

1 day of PM only per week

$70.00

2 days of PM only per week

$140.00

3 days of PM only per week

$210.00

4 days of PM only per week

$280.00

5 days of PM only per week

$350.00

TUITION IS NON REFUNDABLE 10% sibling discount on second child (this includes

your elementary student as well)

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