Student Name:______
2015 - 2016
AFTER SCHOOL DAYCARE REGISTRATION
Program Information & Expectations
Our after school program is housed at Woodlawn Elementary for current 2015-2016 students enrolled in grades K-5. It is our policy that we only accept children who are currently enrolled in the Highlands County School system. Students enrolled at the Kindergarten Learning Center may enroll at either school. Transportation is provided from KLC to WES if you prefer your child to enroll here. During school holidays, students from other schools may also attend at WES.
Hours: 2:00 p.m. - 5:45 p.m. (School Days)
12:00 p.m. - 5:45 p.m. (Early Release Days)
7:15 a.m. - 5:45 p.m.(Non-school Days)
____(Initial)
Registration: $10.00
Please submit payment with this form. This school-year program requires a separate fee from our summer program and is non-refundable. The registration is a one-time required fee of $10. If you have an outstanding balance from a previous school year, the summer program, or previous school, you will not be allowed to register until you have a zero balance.
Tuition Schedule:
It is School Board policy that daycare payments are made in advance.Please submit your tuition at the beginning of each week your child attends. Participants pay the weekly fee. Weeks that include holidays are prorated. If you are present 1-5 days during the week, the cost is the same. If you make an overpayment, the balance will roll forward to the next week. We provide care on all “early release days” for the same after school rate, and most “non-school days” at the daily rate.
1st Child $ 35.00
2nd Child$ 30.00
Three (3) children or more$ 20.00 for each additional child
Late Pick Up Fee (after 5:45)$ 15.00 per each occasion
Full day child Care$ 14.00
Early release days are provided at no additional cost.
** Please pay your daycare bill when you pick up your child on Friday afternoons for the following week.____(Initial)
Safety, Rules & Security:
At Woodlawn Elementary, we strive to provide a safe, educational, and enjoyable daycare program. To ensure your child's safety, you are required to sign your child out when picking him/her up.Be prepared to present a state-issued picture ID.
Other than who the child lives with, we can add two people who may regularly pick them up to our student information system.Daycare must be notified if someone other than a designated person is to pick up your child. If someone other than yourself or the normal pick up person is to pick up your child, you must submit your request in writing and deliver it to WES office/daycare staff. This ensures that all children are safe and released only to people that you have pre-approved. ____(initial)
It is very important that you keep us posted of any address, phone number, and job changes. If your child is sick or injured, we will contact you immediately at your place of employment to pick up your child. Custody papers must be on file with the Daycare Manager for students with court restrictions. Parents must give the Daycare Manager new court orders anytime a change is made.
Students must be signed out in the front office. The office will be open until 5:45.After being signed out, your child will come to the office to meet you.____(initial)
Rules that apply during the school day also apply during after school care. If your child misbehaves, appropriate action will be taken. Minor offenses will result in time-out and parents will be informed. Major offenses will result in a warning letter or possible suspension from the program. Depending on the nature of the offense, you may be contacted to pick up your child. If major offenses continue, your child will be removed from the program. ____(initial)
Services and Activities:
During the school year, students will be grouped by grade-level, and will participate in age-appropriate activities such as:
Independent homework time & assistance (not a tutoring program)
Computer lab access Game room
Outside games Movies
Crafts Character education
Contact Us:
You can contact us by phone at (863) 471-5444 during school hours until 5:45 pm.
Our daycare website is
You can also email Ms. Cornelius at .
2015-2016 REGISTRATION & STUDENT INFORMATION FORM
CHILD'S NAME______Current Grade K 1 2 3 4 5
DOB______AGE______
CHILD LIVES WITH: □ BOTH PARENTS □ MOM □ DAD □ OTHER ______
Please specify
PARENT E-MAIL ADDRESS: ______
MOTHER: ______HM PHONE______
ADDRESS ______ZIP______CELL ______
EMPLOYER ______WK PHONE______
FATHER: ______HM PHONE______
ADDRESS ______ZIP______CELL______
EMPLOYER ______WK PHONE______
EMERGENCY CONTACTS – The following people are authorized to pick up this child from WES after school daycare center.
1) ______
Name Relationship Phone Number
2) ______
Name Relationship Phone Number
3) ______
Name Relationship Phone Number
4) ______
Name Relationship Phone Number
MEDICAL CONCERNS WE SHOULD BE AWARE OF: ______
For staff use only:
$10.00 Registration Fee Paid: Date:______□ Cash □ Check # ______Taken by: ______
THE SCHOOL BOARD OF HIGHLANDS COUNTY
RELEASE OF LIABILITY
I, the undersigned, hereby grant my son/daughter/ward,
______
Please print child's name
permission to participate in the Highlands County Child Care Program at Woodlawn Elementary School. By my signature, I hereby release and hold harmless the above named school, their off campus facilities and the individual sponsors, including teachers, aides, staff members, administrators and principals from all liability, from mishap or injury to my child while engaged in the activities of this program. It is understood that extensive precautionary measures will be taken during the program operation.
I also understand that all School and School Board of Highlands County responsibilities end at 5:45 p.m.
______
Parent/Guardian Signature Date
______
Print name
EMERGENCY TREATMENT AUTHORIZATION AND HEALTH EMERGENCY INFORMATION
I,______, hereby approve emergency treatment by the hospital
Parent/Guardian (please print)
and/or physician for my child. I agree to pay bills for medical treatment either personally or through my insurance company.
______
Primary Insurance Company Insurance Company Address Policy Number
I hereby authorize any member of the school staff or chaperone of The School Board of Highlands County to further consent to emergency treatment for my said child and to sign such consents, authorization for treatment and agreements to pay as are reasonably necessary to obtain such treatment. In case of accident or illness, I request the school contact me. If the school is unable to reach me when my child is sick and he/she is not able to remain in school, I request that one of the persons listed as an emergency contact on this registration form be allowed to care for my child until I can be reached.
______
Parent/Guardian Signature Date
______
Print name