Royal Valley Community Learning Center (RVCLC)

Royal Valley Community Learning Center (RVCLC)

Participation Agreement

In consideration of the benefits to be received from the RVCLC program, which will be caring for my child while providing educational and recreational programs, I agree to my or my child's participation in the activities as follows:

Voluntary Program: The purpose of the Royal Valley Community Learning Center is to keep children safe, to provide academic enrichment, and other recreational and enrichment opportunities, such as band, drama, art, and other cultural events for children; and to provide life-long learning opportunities for community members. I understand that this program is voluntary and that my child is not obligated to participate in it. However, if my child elects to participate, then he or she must be present at the time the after school activities begin and not leave until dismissed for the bus or until a parent/guardian or other authorized adult signs the child out.

Release: I understand a written release may be required before my child may be allowed to participate in certain of the program's activities.

Medical Conditions and Emergency Situations: I understand if my child has a health problem, that I must inform the instructor or site coordinator of the nature of the problem before my child may participate in any activity. The RVCLC program reserves the right to require a medical release before allowing a child with a health problem to participate in activities of the program.

In the event of illness or injury to my child and if I cannot be immediately contacted by telephone, then I do hereby authorize any and all necessary medical and surgical treatment that may be necessary and appropriate for my child, including hospitalization and transportation by ambulance to the hospital if that is deemed necessary or appropriate.

I understand that the school district has purchased an accident insurance policy, which covers all students. Benefits provided under this policy are coordinated with the student's family insurance. The policy only covers treatment, which is provided by a licensed physician within thirty (30) days from the date of the accident. There are limits on the types of services and amounts of coverage provided. A copy of the complete policy is available at the district office.

I understand that if my child is injured during RVCLC hours, he or she should notify the Site Coordinator immediately. If my child receives medical treatment from a licensed physician, I understand that I must request from the RVCLC office a claim form. This claim form must be completed by me and submitted to the insurance company within thirty (30) days. I understand that I am responsible for filing the claim form by the due date.

Photographing and Field Trip Participation: I grant my permission for my child to be photographed or videotaped for educational purposes and/or promotion of the program. My child has my permission to attend all local field trips with the RVCLC program. I understand that advance notice will be given for all field trips and will include the date, time of departure, and return time at the program site. If my child arrives late for a field trip and the group has already departed, I assume full responsibility for my child. Should this occur, I understand he/she may be unsupervised at the program site, and may need to walk home. I release USD #337 from any liability should this occur.

Internet and Technology: RVCLC and USD#337 provide access for students and community members to computer technology and Internet usage. It is a privilege to have access to these resources, and therefore, all users must agree that they will comply with the Unified School District No. 337 Technology and Internet User agreement. Users will agree to use the Internet for only lawful purposes and contact host sites, which are considered to be appropriate at school. I understand that I must sign the Technology and User agreement in order to be allowed to use the internet and technology, and that if I choose not to follow the guidelines, I may lose my internet or computer privileges.

Behavior and Expectations: My child and I understand that all policies and procedures of the Board of Education for Unified School District No. 337 must be adhered to during all RVCLC program activities both on school property and in alternate locations (field trips). I acknowledge that if my child does not abide by the rules established by the RVCLC program, my child or I might no longer be eligible to participate in the program.

Dismissal: I understand that the RVCLC hours of operation and dismissal procedures differ at each site. I agree that I will comply with the dismissal procedures of the site in which my child is attending.

Data Collection: The RVCLC is a federally funded program and data must be collected. I grant my permission for data to be collected on my child by the RVCLC program and The Austin Peter's Group, Inc. This data will be kept confidential and may include, but will not be limited to grades, ethnicity, gender, and age. I understand the data will not be used for any other purpose than for reporting to the federal government concerning the program's effectiveness and progress and will not be connected to my child's name. As a participant in the Royal Valley Community Learning Center, you and your child may be asked to help with the evaluation of the program. Throughout the program, we will conduct an evaluation to tell us how well the program is working. You and your son/daughter may be asked to respond to a questionnaire(s) (written or telephone). All information collected will be anonymous, and you and/or your child's responses will not be identified in any way. If you or your child decides not to participate, it will not affect your participation in this program.

I have read the above statements and fully understand and agree to the contents.

Child's Name (please print) ______

Parent's Name (please print) ______

Parent's Signature ______

Date ______