Student Enrollment Card

Community Partnership Childcare Facilitated by Community After School Program (CASP)
1023 N. Flood

Norman, Oklahoma 73069

Norman Public Schools, United Way, Community After School Program, The Cleveland County Family YMCA, CCFI, and various other community partners have pooled their resources to provide childcare during the district-wide school closure. Enrollment space is limited and is open to NPS Elementary Students on a very LIMITED, first-come, first-served basis. We STRONGLY encourage all parents to utilize friends and family to care for each other’s children cooperatively as we anticipate the need being greater than the care we will have available. The number of children we will be able to serve is largely dependent on the availability of volunteers.

As we look at the possibility of the closure extending into the week of April 9, we are now accepting reservations for childcare for April 9-13 should the need arise. In order to continue to offer care, we will require a payment of $25/day per child to offset costs. Payments will be accepted day by day in order to avoid refunds if school resumes before the week ends

WHEN: April 9-13, 2018, 7:30 am – 5:30 pm daily (assumes school will be out all week)
WHO: Open to all NPS Elementary Students Grades K-5 (first-come, first-served basis by grade level)
WHERE: Students will be assigned to a site by CASP staff.
WHAT: Fun-filled days of large and small group activities including board games, arts & crafts, science, indoor & outdoor play, and group projects! Breakfast, lunch & snack will be provided.
COST: $25/day per child

Participant Information

Participant First Name *

Participant Last Name *

Birth Date * +

School Participant Attends *

Gender *

Grade *

Street Address *

City *

State *

Zip Code *

Adult Primary Contact

Adult 1 First Name *

Adult 1 Last Name *

Work Phone *

Mobile Phone *

Email Address *

Adult Secondary Contact

Adult 2 First Name

Adult 2 Last Name

Work Phone

Mobile Phone

Emergency/Pick Up Contacts

NOTE: First contact listed MUST be able to pick up within 15 minutes of an emergency or serious behavior issue. This information is required prior to attendance.

Emerg Contact 1 First Name *

Emerg Contact 1 Last Name *

Mobile Phone *

Emerg Contact 2 First Name

Emerg Contact 2 Last Name

Mobile Phone

Emerg Contact 3 First Name

Emerg Contact 3 Last Name

Mobile Phone

Child's Physician or Clinic *

Phone Number *

Street Address *

City *

State *

Zip Code *

Does your child have any special needs involving routine care, behavior and guidance, communication or positioning? *

Yes

No

If yes, please describe to help us better understand your child's daily needs. *

Does your child have any medical conditions such as Diabetes (Type 1 or 2), Attention Deficit Disorder, Asthma or health related issues that requires a special diet or medication(s)? *

Yes

No

If yes, please describe to help us better understand your child's daily needs. *

List all daily medication(s) and dosage schedule. (Please update this information if changes occur.) NOTE: Must complete appropriate CASP Medical Form(s) & provide labeled medication if dispensed during CASP program.

Describe any allergies, special dietary needs or activity restrictions. NOTE: Dr's. note required for substitute snack due to food allergies.

Parent/Guardian Acknowledgment: place a check mark next to each item indicating that you have read and agree to each statement. *

I understand that I am responsible for familiarizing myself and my child with all NPS & CASP policies and procedures as outlined in the NPS & CASP Parent Handbooks. I understand the CASP Parent Handbook is available for download online at www.caspinc.org or I can request a printed copy from the CASP Administrative Office.

I understand that I or another authorized adult (see pg. 1) must sign-in and sign-out my child to and from the program each day with a photo ID available for inspection by program personnel upon request.

I understand that the Community After School Program may take photos and/or videos of my child for CASP promotional purposes unless I revoke permission in writing to the CASP Administrative Office.

I understand that the Community After School Program is not a medical treatment facility, does not provide medical care, and its employees are not medically trained.

I understand that the Community After School Program does not provide one-to-one childcare. I give permission for my child to be transported in the event of an emergency.

I give permission to, and understand that, the Community After School Program works in partnership with Norman Public Schools and that this partnership may include the sharing of information to better meet the needs of my child.

I understand that the Community After School Program cannot enforce parent visitation schedules and cannot prevent a parent/guardian from picking up his/her child unless court documentation prevents visitation or unsupervised visitation.

Program Enrollment & Field Trip Permission *

I wish to enroll my child in the Community Childcare Partnership Camp and give my permission for my child to accompany this program on field trips either walking or by bus. I understand that I will be informed of these trips in advance and that it is my responsibility to see that my child reaches the program by the stated time of departure. If my child is not at the program by the stated time of departure, I understand that it is my responsibility to transport him/her to the field trip location, check him/her in with a CASP staff member, and sign the attendance sheet at the field trip location. I understand that if I choose to pick up my child before the end of a field trip, it is my responsibility to check him/her out with a CASP staff member and to sign the attendance sheet at the field trip location. I understand that misbehavior during a field trip is unsafe and may put my child and others at risk. I understand that if my child does not respond to discipline on a field trip, I may be contacted to pick up from the field trip location and/or my child may miss any future field trips. If unsafe behavior continues, my child may be dropped from the program.

I confirm that I have read the enrollment and permission statement provided above and will comply with the CASP regulations outlined therein *

clear

Please mark days & times of care needed. Please plan to pick up your child at the same time time you would on a normal school day as we will have limited staff and volunteers working with the students each day. *