2012-2013 Corpening Memorial YMCA Afterschool Policy Form

This document summarizes the policies for the 2012-2013 Corpening Memorial YMCA Afterschool Program. It outlines policies regarding attendance, payments, deposits, financial assistance, emergency care, field trips, sunscreen use, behavior management, and photography/video consent. Parents must sign agreeing to abide by these policies, including being responsible for any outstanding fees, notifying staff of absences, and allowing their child to receive emergency medical care if needed.

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2012-2013 Corpening Memorial YMCA Afterschool Policy Form

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ymcawnc

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2012-2013 Corpening Memorial YMCA Afterschool Policy Form

Parents/Guardians, please read each area below carefully. Your signature on this document indicates your acknowledgement,

understanding, and agreement with all policies of the YMCA of Western North Carolina.
Policies/Procedures, Childcare Laws I have received a copy of the policies/procedures in the Afterschool Parent Handbook and agree to all policies. I have also received a copy of the North Carolina Child Care Law and Rules in my Registration Packet from the YMCA. Attendance, Payment Deadlines, Refunds, and Late Payments I understand that I am to notify my childs Site Director when he/she will be absent on scheduled days so that the YMCA staff know my child is safe. I understand payments are due in full by the deadlines outlined in the Parent Handbook regardless of absenteeism and weather related closings. Any deposits and other fees paid are non-transferable and will not be refunded due to cancellation. If drafts or checks are not honored you are still responsible for the payment plus a $30 service charge applied by Federal Automated Recovery System. If there is an outstanding balance on your childs account, your child(ren) will be unable to attend any YMCA program. Weekly Deposit and Registration Fees A one-time nonrefundable and non-transferable registration fee of $35 per child, $50 per family is due at the time of Summer Camp AND Afterschool Registration. Payment of a separate registration fee is required for both programs. YMCA Financial Assistance I understand that I am responsible for the full program fee, until a YMCA representative has contacted me regarding the amount of financial assistance I am eligible for. Subsidy Voucher Participation I agree to notify the YMCA of any changes in my subsidy voucher status and to abide by the rules set forth by the issuing agency. All subsidy voucher participants are responsible for paying the rate discrepancy between what the YMCA charges and what the voucher will reimburse. The parent/guardian is responsible for any payment for child care not covered by the voucher. Emergency Treatment/Emergency Transportation I agree that the operator, YMCA of Western North Carolina, may authorize the physician of their choice to provide emergency care in the event that I cannot be contacted immediately. I authorize for my child to be transported in the case of an emergency when medical attention by a physician is necessary. I understand that the YMCA will not transport children in their personal vehicles at any time and a hospital or fire/emergency department will always be contacted. I, as the operator YMCA of Western North Carolina, do agree to secure transportation to an appropriate medical resource in the event of emergency. In an emergency situation, other children in the facility will be supervised by a responsible adult. I will not administer any drug or any medication without specific instructions from the physician or the childs parent, guardian, or full-time custodian. Provisions will be made for adequate and appropriate rest and outdoor play. Field Trips/Transportation I permit my child to leave the YMCA on authorized trips under the supervision of the YMCA staff. A written schedule of all activities to be conducted off the YMCA Camp premises will be posted for parents to review. By signing this form, you give your child permission to be transported in YMCA vehicles. Activities Outside the Fenced Playground Area I hereby give permission to the YMCA of WNC for my child to participate in developmentallyappropriate supervised activities outside the fenced playground at the Corpening Memorial YMCA location. I understand this statement is required to be signed for licensing and that this space is still on the YMCA property. Sunscreen: (initial the appropriate statement) ______ I allow YMCA staff to provide sunscreen for my child (sunscreen product information available by request). ______ I will provide sunscreen for my child in an individual bottle labeled with their name and grade (given to a YMCA staff) School Success I understand that the YMCA works with the McDowell County schools to develop and deliver activities that engage and impact children. I give permission for YMCA staff to talk with school staff in regards to my childs grades, behavior and other information. Behavior Management Policy: I have read and signed the Behavior Management and Discipline Policy in the Registration Packet and agree with all policies as outlined. Registration Paperwork Signature on this document indicates responsibility for payments and is the only one who can alter the forms. I understand that if I do not fill out the Registration Packet completely, or fail to attach any of the required documents, my child will not be able to attend the program until complete. YMCA Statement I hereby, for myself, my family, heirs, executors, and administrators, waive and release any and all claims and damages I may have against the YMCA of Western North Carolina and their respective agents, representatives, successors, and assigns, for any and all injuries which may be suffered by me or my family in connection with participation in YMCA activities and programs. I agree to adhere to all policies as outlined on this policy/signature page. I also grant full permission to the YMCA to use any photographs or video recording taken of me or my family. I agree to comply with YMCA policies and procedures and understand that my participation can be terminated without refund for exhibiting inappropriate behavior or abuse toward the YMCA staff and/or facilities. Parent/Guardian Name:__________________________________________________________ Parent/Guardian Signature:____________________________________________________

(please print)
Childs Name:________________________________________________________________________ Date:________________________ Signature YMCA Representative: