St. Carries Center SMART Academy Afterschool Enrichment Program
St. Carries Center SMART Academy is pleased to welcome you to apply for our 2017-2018 afterschool program. The afterschool program operates until 5:45pm, Monday through Thursday, with special field trips and activities scheduled on one Friday a month (to be announced). SCC SMART Academy is funded through corporate and government grants to provide services to elementary, middle, and high school serving grades K though 12. Each SCC SMART Academy site program has a funding allotment which dictates capacity of the program. There will be a one-time $50 registration fee due at enrollment. Any parent or teacher may refer a child to the program. This is an academic enrichment program and not a recreational program nor a babysitting service. We work on homework as well as academic enrichment.
There are three major components in the program:
- Tutoring/homework help
- Academic support in Language Arts, Math, & Science.
- Enrichment time in Technology, Art, followed by Recreation.
Students also receive a nutritious snack each day
Academic success occurs with daily practice, and our program funding relies on regular daily attendance. Three unexcused absences and your student will be dropped. Please notify us ahead of time in case of family emergency, or any other reason your child will not be able to attend.
Please complete the entire application packet for each child in your family you wish to enroll. Return the application packet to the afterschool site. Read and sign all forms. There will be a $50 registration fee for the first student, and an additional $25 registration fee for each other sibling. You will be notified in writing about your child’s enrollment status in the afterschool program as soon as the application is processed. The program will begin the day after Labor Day, September 5th, 2017. Parent Orientation will be held August 28th, 2017.
Any questions or concerns should be communicated to SCC SMART Academy office at (951)444-1820
Parents – Keep this page for your records
Hours of Operation
SCC SMART AcademyAfterschool Enrichment Program will serve students and families from 2:15pm to 5:45pm every Monday through Thursday that there is school (excluding minimum days). We will also hold field trips or special activities 1 Friday per month (to be announced).
Attendance
Students must attend the afterschool program every day that they attend regular school. Students must check into the afterschool program immediately after school. The program is not responsible for students who have not checked in with the program right after school. Parents must communicate the nature of any absences from the afterschool program to the Site Facilitator. Three unexcused absences will result in being dropped from the program.
Program Description
All SCC SMART AcademyAfterschool Enrichment Programs will provide:
- Homework assistance
- Extended opportunities for literacy, math, and science learning
- Enrichment activities
- Physical education
- Opportunities for learning about community service
- Recreational activities
- Youth development activities
- A nutritious snack
It is the students’ responsibility to bring their homework to the program for completion. A regular 1 hour period is scheduled every Monday thru Thursday; we will work with students and parents to provide additional time in lieu of enrichment activities to help students complete assignments. Homework assistance does not ensure all homework is completed or fully accurate, but we will do the best we can. Through community partnerships SCC SMART Academyprovides opportunities for students to participate in field trips and guest speakers/teachers to supplement program themes.
Student Pick-Up
Parents must indicate who may sign out and pick up their children on this application form. The information must be updated whenever changes occur. It is the parents responsibility to notify the Site Facilitator if there is any changes prior to expecting changes to occur. Students will not be allowed to walk home alone. Parents may elect to have siblings 13 years of age or older walk their children home. This must be clearly stated on this application form. St Carries Center will not be held liable for children after they are picked up from the program.
Late Pick-Up
Please call the SCC SMART Academy office if you are running late. The afterschool program starts at 2:15pm and ends at 5:45pm. We understand that occasionally parents may be a few minutes late. However, if a parent is late picking up a student, then we must pay our staff overtime to stay late. Therefore, parents that are late will be charged a $1 per minute late fee, per student. Parents who are late will be given a Late Notice Acknowledgement Charge Form, and all charges are to be paid by the end of the following day.
Each participant must have a current account. Participants with past due accounts will not be permitted to attend the program until their account is brought current. Refunds will not be issued for any reason.Unpaid charges after 5 school days will result in the student or students being dropped from the program. If a parent is 30 minutes late, the local law enforcement department will be called and your child will be turned over to their care.
It is the policy of St. Carries Center to assess a $30 charge service charge on all returned checks. The returned check and service charge must be paid in cash, money order, or cashier’s check. Two returned checks will require that future payments be made in cash, money order or cashier’s check.
Parents – Keep this page for your records
Discipline
Participation in the SCC SMART Academy Afterschool Enrichment Program is a privilege. Behavior of students who attend the afterschool program is expected to mirror those of the regular instructional day, including cell phone usage. We will not tolerate bad behavior. Students who receive three strikes for inappropriate behavior will be dropped from the program. Parents and students will be required to sign a copy of our behavior expectations at the Parent Orientation meeting at the beginning of each school year.
Physical violence or verbal abuse will NOT be tolerated. Any program participant displaying such behavior will be immediately removed from the program and subject to permanent suspension. This is an academic enrichment program, and not a recreational program. Children are expected to complete their homework with assistance and cooperate with staff by participating in enrichment activities. Children who consistently refuse to cooperate with staff will be reported to parents and may be removed from the program. Positive reinforcement principles will be used in dealing with children. Short time outs will be used when children need a “cooling off period”.
Parental Involvement
All parents are expected to attend the Parent Orientation at the beginning of the school year to review policies and guidelines. Parental involvement is needed to support our committed and qualified staff. You are an important partner in our programs success. We need and invite you to help with field trips, be a guest speaker, attend our family events, and donate supplies as feasible for special projects.
SCC SMART Academy seeks volunteers to enrich our program activities. All volunteers must be fingerprinted and fulfill health screening requirements. Please contact the SCC SMART Academy office at (951)444-1820 for volunteering information and opportunities.
Employees
All SCC SMART Academy staff who supervise students meet the established qualifications for a tutor. Aditionally, it is exected that all staff participate in professional development activites on a regular basis. The SCC SMART Academy Director has a current certification from the California Department of Education Teacher Credentialing.
Activity Program and Information regarding risk
Any and all recreational activities involve the risk of injury. We provide 30 minutes per day of recreational activity which may be combined with Math or Science. The Participant must be aware of the particular risks involved in the activities selected. There are physical activities and movement involved in the program. Participants must understand that all activities have the potential for injury. Participants must understand and agree that they take part in the activity at their own risk.
Personal Items
Please be aware that all personal items are the responsibility of your child, not SCC SMART Academy staff. Please mark all personal items with your child’s name. If an item has been lost please check with staff. All items unclaimed after two weeks will be donated to a local charity.
Illness Procedures
Children displaying physical signs of a communicable disease such as pink eye, head lice, etc. will not be permitted to participate in the program until they have been cleared by a physician. A physician’s note must accompany the child on the first day back to the program. SCC SMART Academy is not be responsible for out of date health information. Please keep all information current. Medication will NOT be administered by any staff member.
Parents – Keep this page for your records
St. Carries Center SMART Academy Afterschool Enrichment Program
Child’s First Name:Last Name:______
Date of Birth: ____/____/____ School:Grade:______
Parents or Guardian’s Name(s): ______
Address: ______Home Phone #: ______Email address: ______
Mother’s Work Phone #Father’s Work Phone#: ______
Mother’s Cell#Father’s Cell Phone#:______
Person(s) authorized to pick up your child / Emergency Contacts: (Person must show picture I.D.)
Name:______Relationship: ______Phone#:______
Name:______Relationship: ______Phone#:______
Name:______Relationship: ______Phone#:______
Name:______Relationship: ______Phone#:______
Student lives with: ___ Father ____ Mother ___ Step Parents ___ Foster ___ Legal Guardian ___ Other
Primary Language: □English □Spanish □Other:______
Is your child under medical care or taking any medication(s)? □ Yes □ No
If yes, please check all of the following conditions that your child has
□ Bee Sting Allergy□ Epi-pen□ Other Allergies: ______
□ Asthma Inhaler□ Insulin□ Special Needs / Disability:______
□ Diabetes□ List all medications:______
□ Vision / Hearing □ Glasses□ Other conditions:______
*Please note: Medication will not be administered by any staff member*
Are there any activity restrictions while at the Afterschool Program?______
______
Has your child had any behavior/health related problems in the past? (Please explain and give dates treated)
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Family Health Care: Physician’s Name:______Phone #:______
Address:______Health Insurance # ______
Parent Signature:______Date:______
My signature indicates that I have read this information packet and agree to the program rules and policies stated within. Consent is hereby given for my child to participate in the SCC SMART Academy Afterschool Enrichment Program. I give permission for any emergency anesthesia, operation, hospitalization or other treatment that may become necessary. Failure to disclose such medical information could result in serious harm. I certify that the information on this form is correct to the best of my knowledge and that there is no other medical or psychological information I am withholding that will in any way affect my child’s participation in the Afterschool Program.
Parents – Fill out, sign, and return this page to SCC SMART Academy
St. Carries Center SMART Academy Afterschool Enrichment Program
Agreement Waiver and Release
In consideration for being permitted by SCC SMART Academy to participate in the above program, I hereby waive release and discharge any and all claims for damages for personal injury, death, or property damage which I may have, or which may hereafter accrue to me, as a result of participation in said activity. This release is intended to discharge in advance the above (it’s officers, employees and agents)from any and all liability arising out of, or connected in any way with, my participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that this activity involves an element of risk and danger of accidents and knowing those risks, I hereby assume those risks. It is further agreed that this waiver, release, and assumption of risk is to be binding on my heirs and assigns. I agree to indemnify and to hold the above persons or entities free and harmless from any loss, liability, damage cost or expense which they may incur as the result of my death or any injury or property damage that I may sustain while participating in said activity.
I hereby consent that my son/daughter ______participate in the above activity, and I hereby execute to above Agreement, Waiver and Release on his/her behalf. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any loss, liability, damage, cost or expense which they may incur as a result of the death or any injury or property damage that said minor may sustain while participating in said activity.
Video Photo Release & Academic Files
I understand that during SCC SMART Academy program activities my photograph and/or the photograph of my child may be taken by SCC SMART Academy, producers, sponsors, and/or organizers. I agree that my photography and/or the photograph of my child, including video photography, film photography, or other reproduction of my likeness or the likeness of my child, may be used without charge by SCC SMART Academy, producers, sponsors, organizers, and /or it’s assigns for such purposes as they deem appropriate. We will not release the last names of the parent nor the student. I understand that SCC SMART Academyreceives corporate and government grants. I give permission for staff to review my child’s academic files for the purposes of analyzing program effectiveness and reporting to funding sources.
Authorization to Treat a Minor
I, the parent or legal guardian, of the child listed above, do hereby authorize and consent to any X-ray examination, anesthetic, medical or surgical treatment rendered under the provisions of the Medical Practice Act or a Dentist licensed under the provisions of the Dental Practice Act and on the staff of any acute general hospital or emergency care facility holding a current license to operate a hospital or emergency care facility from the State of California Department of Public Health. I understand that the authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power to render care which the aforementioned physician in the exercise of his/her best judgment, may deem advisable for my child. Further I understand my child will be participating in recreational activities and may be injured and agree to pay for my child’s medical expense. I understand that all effort shall be made to contact me prior to rendering treatment to my child, but any of the above treatment will not be withheld if I cannot be reached. This authorization is given pursuant to the provisions of the California Civil Code.
I HAVE CAREFULLY THIS AGREEMENT, WAIVER AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND SCC SMART ACADEMY, AND I SIGN IT OF MY FREE WILL.
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Signature Date
______
Name Printed
Parents – Fill out, sign, and return this page to SCC SMART Academy
St. Carries Center SMART Academy Afterschool Enrichment Program
SCC SMART Academy Participant Rules
The S.M.A.R.T Academy is a safe place for all participants and staff. All participants must adhere to the following rules:
- I may not carry any firearms, knives, or any other type of dangerous weapons.
- I may not engage in fist fighting, aggressive horseplay, or assault.
- I may not take any property from another person without consent.
- I may not abuse, deface or destroy any property, equipment or structure.
- I may not enter into unauthorized areas of unless accompanied by staff.
- I may not use tobacco products illegal narcotics, or drink alcoholic beverages.
- I may not use vulgar or offensive language.
- I may not use the Center’s phone for personal use.
- I may not wear any offensive or inappropriate clothing.
- I may not engage in any type of sexual behavior at the Academy.
- I must be courteous and respectful at all times.
- I must obey all reasonable and lawful directives of staff and volunteers.
- I shall wear modest and acceptable clothing at the academy.
- I shall use all buildings and materials appropriatelyand for the designed purpose.
- I will demonstrate fair play and good citizenship at all times.
- I will set a good example for those around me.
- I will always be safe and make things fun for those around me.
- I will respect and thank all staff for caring and respecting me.
- I will respect myself and other Scholars.
- I will abide by all the rules so that I may have a productive experience.
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Scholar or Participant Print Name Signature Date
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Parent/Legal Guardian Print NameSignatureDate
Parents – Fill out, sign, and return this page to SCC SMART Academy
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