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«Academic TWO trips Enrichment a week Swim Lessons Purchase of Included Care Accepted June 20, 2016 – August 19, 2016 7:30 am – 5:00 pm Ages 5-12 ...»

-- [ Page 1 ] --

Only $120 a

Neighborhood House Inc. Summer

week!

TRIP FEES

Enrichment Program 2016

INCLUDED!

Academic

TWO trips

Enrichment

a week

Swim Lessons

Purchase of

Included

Care

Accepted

June 20, 2016 – August 19, 2016

7:30 am – 5:00 pm

Ages 5-12

Daily Activities Include:

For More Information Please Contact:

Arts and Crafts

Cynthia Williams (302)658-5404 Outdoor Sports and Games • Amanda Cole (302)290-4574 Computer • Reading, Vocabulary and •

PLEASE RETURN COMPLETED APPLICATION TO:

Comprehension Instruction Neighborhood House, Inc.

Math Test Prep • 1218 B Street, Wilmington, DE 19801 Daily Exercise • Nutritious Meals /Snack • Neighborhood House, Inc.

1218 B Street, Wilmington, DE 19801

SUMMER ENRICHMENT PROGRAM

April 2016

Dear Parent/Guardian:

Thank you for choosing the Neighborhood House, Inc., Summer Enrichment Program for your child’s summer experience. We are looking forward to an exciting and memorable summer and we are delighted that you have chosen us. The program will begin on Monday, June 20, 2016 and end on Friday, August 19th 2016.

The cost for the Summer Enrichment Program is $120.00 per week. Breakfast will be served between the hours of 7:30 - 8:30. Camp will begin at 8:30 am; camp officially ends at 5:00. Purchase of Care will be accepted for those who qualify. Fees must be pre-paid or your child(ren) will not be permitted to attend the following week. All fees should be paid on Friday for the following week.

You may make special arrangements with me.

The Summer Enrichment Program will provide nutritious breakfast and lunch to all campers and an additional snack to children in the aftercare program. This will be provided to all students in attendance at no cost. A monthly breakfast and lunch calendar will be posted in all dining areas.

Your child may bring his or her own breakfast or lunch if they prefer.

We are looking forward to a fantastic summer. We have lots of fun and exciting activities and trips planned. Please remember that we are a summer enrichment program so we will complete grade level assignments in ELA and math on non-trip days. Computer lab, outdoor recreation, arts and crafts, swimming and field trips will also be provided as part of the enrichment experience.

Carefully review all forms. Fill in all applicable information and sign where indicated. Forms will be checked for completeness before your child is allowed to attend the Summer Enrichment Program.

Your child’s Summer Enrichment experience will be educational, inspirational and fun! We look forward to having you and your child in our program. If you have any questions, please contact me at (302) 658 5404 or 302-290-4574 Amanda Cole, Camp Director Cynthia Williams Neighborhood House, Inc., Summer Enrichment Enrollment Form Child’s Full Name: ____________________________________ Sex: ____M _____ F Child’s Current Age: ________ Birth date: ______________ Grade child is entering Fall 2016 ________ Street Address: _____________________________________ Home Phone:_______________________________

Primary Guardian(s)_________________________________ Primary Guardian Birthdate:____________________

Work Phone:_______________________________________ Cell Phone:_________________________________

Email:________________________________________________________________________________________

Guardian:________________________________________ Guardian Birthday:_____________________________

Work Phone:______________________________________ Cell Phone:___________________________________

Email:_________________________________________________________________________________________

Does the child primarily reside with one parent? ______ If so, which parent? _______________________________

Do you give permission for your child to leave at the end of the day without an adult? ______Yes ______No Emergency Contact Information (other than parent/guardians)

–  –  –

Family Physician:___________________________________ Phone Number:______________________________

Family Dentist:____________________________________ Phone Number:______________________________

Family Medical/ Hospital Insurance/HMO Carrier:_____________________________________________________

Insurance Policy #:_____________________________ Group #: ___________________________________

Child Release Information (Please include emergency contacts!) The following people are authorized to pick up my child from the Neighborhood House Summer Enrichment Program Name Relationship Primary Phone Number _____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________





Neighborhood House, Inc. Summer Enrichment Program Enrollment Form – Health History _____________________________________________________________________________________________

–  –  –

Additional information about your child (includes serious illness, accidents, operations, medications, etc..,. dates) Special information we should know about your child _____________________________________________________________________________________________

Medication your child takes _____________________________________________________________________________________________

Special restrictions or considerations while at the Neighborhood House.

_____________________________________________________________________________________________

Is the child progressing normally for their age group? _____Yes _____No If no, please explain Female campers, has the girl menstruated? _____Yes _____No

–  –  –

Please list ALL medications (including over-the counter or nonprescription drugs) taken routinely. If the camper will need to receive medication you will need to see Mrs. Wallace to fill out additional forms.

_______This person takes no medications on a routine basis ______This person takes medication as follows Med #1__________________________ Dosage__________________________ Times_____________________

Reason for taking_____________________________________________________________________________

Med #2 ________________________ Dosage__________________________ Times ______________________

Reason for taking_____________________________________________________________________________

Parent’s Authorization: This health history is correct as far as I know, and the person herein described as permission to participate in all prescribed camp activities, except as noted above.

Signature of Parent/Guardian:_______________________________________________ Date:_______________

Neighborhood House, Inc. Summer Enrichment Enrollment Form – Parent/Guardian Signed Releases Parent/Guardian Signed Releases Permission to Provide Necessary Treatment of Emergency Care: I hereby give permission to the medical personnel selected by the program administrator to order X-rays, routine tests, treatment, to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, for the person named above. The completed form may be photographed for trips out of camp.

Signature of parent/guardian:_______________________________________________ Date:_________________

Field Trip & Transportation Release: The Neighborhood House, Inc. Summer Enrichment Program has my permission to take my child on all pre-arranged trips as indicated on the camp calendar. I also give permission to take my child on walking trips throughout the Neighborhood House community and downtown Wilmington.

Signature of Parent/Guardian:________________________________________________ Date:________________

Photo Release: I hereby give permission for my child’s picture to be taken during any activity while a camper at the Neighborhood House, Inc... I agree that the picture(s) of my child may be used by Neighborhood House, Inc. for the purpose of public relations without compensation.

Signature of Parent/Guardian:________________________________________________ Date:________________

Child Release: I give the Neighborhood House, Inc. Summer Enrichment staff to release my child as indicated on the registration form. I understand that any changes to this information must be submitted in advance and in writing to the program administrator. In the event that there is a question about who my child is to go home with, the primary guardians will be notified.

Signature of Parent/Guardian:_______________________________________________ Date:_________________

First Aid Release: I give the Neighborhood House, Inc. summer enrichment staff to administer first aid as they deem necessary. First Aid treatment may include rinsing, the use of soap and water and Band-Aids.

Signature of Parent/Guardian:______________________________________________ Date:_________________

Parental Release for PG Rated Movies: Throughout the summer, we may show a PG (Parent Guidance suggested) movie. Parental Guidance is defined as some material may not be suitable for children”. This signifies that the film may contain some material parents might not like to expose to their young children. Explicit sex scenes and scenes of drug use are absent in PG movies. Nudity, if present is seen only briefly. Horror and violence do not exceed moderate levels. Examples of PG movies are “Like Mike”, “Shrek”, “Shrek 2”, “Daddy Day Care”, “Holes”, “pink Panther”, “Charlie and the Chocolate Factory”, “Madagascar”, “Robots”, “Because of Winn Dixie”, “Racing Stripes” and “Good Boy”. If you would not like your child to watch PG movies, they will be provided with an alternative activity outside of the movie viewing area.

Or ___My child is allowed to watch PG movies ___ My child is Not allowed to watch PG movies Neighborhood House, Inc. Summer Enrichment Program – Behavior Code All campers and parents must sign that they have read and understand the behavior code and discipline consequences of the Neighborhood House, Inc. Summer Enrichment Program.

We expect all campers to respect the teachers, staff, counselors, fellow campers and themselves. Disrespect of any supervising adult or counselor will not be tolerated. The first offense will result in a verbal warning, the second offense will result in a written warning, and the third time will result in the camper losing the privilege to participate in the next field trip or special event.

All students are expected to participate in all academic activities. We expect that all campers will try to start and complete academic tasks that they are given. We will try our best to place students in grade appropriate groups.

All students are expected to participate in whole and small group activities. Small and whole group activities may include basketball, kickball, relay races, musical chairs etc…,. Campers will go outside at least once a day and sneakers are required for them to participate.

Demerits will be given to students who do not participate in academic and whole group activities. Any camper that receives 5 demerits in one week will not be permitted to attend the next field trip or special event. Demerits will be given for non-participation in academic and whole group activities or unacceptable hallway behavior.

The Neighborhood House, Inc. hosts many programs and has visitors throughout the day. Keeping this in mind we ask that all campers are escorted to and from all locations with appropriate hallway behavior. Acceptable hallway behavior is campers that walk quietly in the hallway, laughing, giggling, running and screaming are unacceptable and those students will be given a demerit for each offense.

Behaviors which cause injury to others or significant property damage are grounds for immediate dismissal from the

Summer Enrichment Program. Major behavior problems are:

–  –  –

Major behavior problems will be managed in the following ways:

1ST Incident: Parents will be called in for a conference with child and Program Administrator. Child will not be allowed to attend until the conference takes place.

2nd Incident: Parent will be notified and another conference may be scheduled. Child may be dismissed from the Summer Enrichment Program.

If a child misbehaves on a field trip, he or she will not be permitted to attend the following trip. In the event of a behavior which risks or causes injury to other individuals or themselves, the child may be dismissed from the Program or prohibited from taking any future field trips.

I have read and understand the Behavior Code. I agree to abide by the social policies for Neighborhood House Inc. I agree to inform my child about my expectations of his/her behavior.

Parents/Guardian Signature_______________________________________ Date ___________________

Neighborhood House, Inc. Summer Enrichment Program – Policies Dress Code: All campers are required to wear sneakers to camp every day. In addition, campers will participate in activities that require them to sit on the floor/ground, because of this we ask all campers to wear comfortable clothing.

Water Play: A bathing Suit and a towel need to be brought on swim days. Bikini type bathing suits will not be permitted for swim and trip days. Any camper that brings a bikini bathing suit will not be permitted to swim that particular day.

Parent/Guardian Signature:__________________________________________________ Date:_______________



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