CHILD CARE ymcagwc.org - YMCA of Greater Williamson County

LEARN, GROW& THRIVECHILD CAREAfterschoolYMCA OF GREATERWILLIAMSON COUNTY2011-2012RegistrationPacketymcagwc.org

Y AFTERSCHOOL REGISTRATION FACTS2011-2012 SCHOOL-YEAR REGISTRATION DATESMonday, April 11, 2011 - Friday, April 29, 2011ONSITE REGISTRATION FOR CURRENT PARTICIPANTS ONLYis conducted at all district locations.Monday, May 2, 2011OPEN ENROLLMENT FOR THE PUBLIC begins - subject to availability.2011-2012 SCHOOL-YEAR MONTHLY TUITION RATES (per child)School District Y Family Member Rate School District Full-Time Employee Rate Non-Member RateHutto $187 $187 $205Leander $187 $187 $205Liberty Hill $169 $169 $185Round Rock $187 $187 $205Taylor & Thrall $169 $169 $185•A nonrefundable and nontransferable registration fee of $40 is required per child when registering forprocessing and curriculum materials (of note - families receiving financial assistance pay a $5 per child registration fee).•The Y provides financial assistance to families in need who cannot afford to participate in Y programs due to financialconstraints. Log on to our website (www.ymcagwc.org) or contact the Licensed Child Care Services Desk (512-615-5563)for more information on the application process.•The first tuition payment is due on August 1, 2011, for all districts.2011-2012 SCHOOL-YEAR TUITION PAYMENT SCHEDULEPayments are due on or before the 1st of each month from August through May.A $25 late fee will go into effect on the 2nd of each month (unless noted below):Tuition Due Date Tuition Due Day Tuition Late Fee DateAugust 1, 2011 Monday August 2, 2011September 1, 2011 Thursday September 2, 2011October 1, 2011 Saturday October 4, 2011November 1, 2011 Tuesday November 2, 2011December 1, 2011 Thursday December 2, 2011January 1, 2012 Sunday January 3, 2012February 1, 2012 Wednesday February 2, 2012March 1, 2012 Thursday March 2, 2012April 1, 2012 Sunday April 3, 2012May 1, 2012 Tuesday May 2, 2012•Payments can be made in person at the Y Licensed Child Care Office in Round Rock, the Hutto Family YMCA,the Twin Lakes Family YMCA in Cedar Park or the Taylor Family YMCA. Payments can also be mailed to:YMCA of Greater Williamson County, P.O. Box 819, Round Rock, TX 78680. All mailed payments must be postmarked bythe 1st or a $25 late fee will be charged. We do not accept payments over the phone.•A drop box is located in the window of the door to the Licensed Child Care Services Desk in Round Rock for paymentsthat need to be made after business hours (M-F: 7:00 a.m. - 7:00 p.m. / Sat.: 9:00 a.m. - 2:00 p.m.).Please include the child’s first and last name, date of birth and school on the check.

Y AFTERSCHOOL REGISTRATION FORM - Part IChild’s First Name: ___________________________________________ Middle Initial: __________ Last Name: __________________________________________Gender (circle one): Boy Girl Date of Birth: _______ / _______ / _______ Afterschool Start Date: ________________________Child’s School: ___________________________________________ Grade (during 2011-2012): _____________Child’s Address: _________________________________________________________________ City / State / Zip: __________________________________________PARENT / LEGAL GUARDIAN #1First Name: _______________________________________________________ Last Name: _______________________________________________________Address: _______________________________________________________ City / State / Zip: _______________________________________________________E-mail: _______________________________________________________ Employer: _______________________________________________________Home Phone Work Phone Mobile / Pager Phone Alternate PhonePARENT / LEGAL GUARDIAN #2Eligible to pick-up child: Y N If no, please attach a copy of legal documentation.First Name: _______________________________________________________ Last Name: _______________________________________________________Address: _______________________________________________________ City / State / Zip: _______________________________________________________E-mail: _______________________________________________________ Employer: _______________________________________________________Home Phone Work Phone Mobile / Pager Phone Alternate PhoneLocal person other than those listed above to contact in case of emergency if the parent / legal guardian cannot be reached:(to be in compliance with Y association policies and the TDFPS, the individuals authorized to pick up your child must be at least 18 years of age)Name:Contact Number:Address:Relationship to Child:Contact Number:City / State / Zip:in addition to THOSE listed above, I hereby authorize the Y staff to allow my child to leave the facility only with the following person(s):(to be in compliance with Y association policies and the TDFPS, the individuals authorized to pick up your child must be at least 18 years of age)Name:Contact Number:Address:Relationship to Child:Contact Number:City / State / Zip:Name:Contact Number:Address:Relationship to Child:Contact Number:City / State / Zip:Name:Contact Number:Address:Relationship to Child:Contact Number:City / State / Zip:All information on this form is required by Texas Department of Family & Protective Services (TDFPS) or the Y to ensure the safety of your child.This information can only be changed through the Y Licensed Child Care Office by an authorized parent or legal guardian.

Y AFTERSCHOOL REGISTRATION FORM - Part IIChild’s First Name: ___________________________________________ Middle Initial: __________ Last Name: __________________________________________Child’s School: ___________________________________________ Grade (during 2011-2012): _____________ Password (from last page): ______________________EMERGENCY INFORMATIONIn the event of an emergency and a parent / legal guardian is not available, your designated physician, hospital or clinic will be contacted foremergency management / transportation (please refer to the medical waiver below). Additionally, please indicate whichElementary School: ________________________________________________ has your child’s current immunization record, including tuberculosis (TB) test.Licensed PhysicianName Phone Address City / State / ZipHospital or ClinicIn order to best meet your child’s needs, we require that you list any special needs that your child may have, such as physical limitations, emotionalor behavioral issues, allergies, existing illness, previous serious illness, injuries during the past 12 months, any medication prescribed forlong-term continuous use, and any other information the staff should be aware of:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Treatment to be given: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Parent / Guardian AcknowledgementsPlease INITIAL or ANSWER all lines to indicate received written policies / materials and agree to terms.______________ Policy Agreement (Required): I acknowledge that I have been made aware of where to access or have received a copy of the Y’sAfterschool Family Guide. I accept responsibility to read and adhere to all billing procedures and all policies as set forth in that guide.______________ ADA Policy (Required): Parents have the obligation to disclose significant, medical, physical or behavioral issues at the time of the child’senrollment and on an ongoing basis. Due to the large group format of our program, we are unable to provide one-on-one care for any childexcept on an intermittent basis, such as injuries, immediate disciplinary issues and certain personal care needs customarily provided toother children.______________ Waiver for Medical Treatment (Required): In the event that my child requires emergency medical treatment and I cannot be reached,I hereby authorize the Y staff to make arrangements to transport my child to the physician, hospital or clinic that I have designated or thenearest hospital / emergency medical facility. I give my consent for any and all necessary medical care treatment for my child during this time.______________ Waiver for Participation (Required): I understand that Y activities have inherent risks and hereby assume all risks and hazards as a resultof my child’s participation in all Y programs and facilities, including transportation to and from said activities. I further release, absolve,indemnify and agree to hold harmless, the Y, the organizers, supervisors, directors, staff, volunteers, participants, coaches, referees, as well aspersons or parents transporting participants to or from such activities from any claims or injury sustained during my use of Y facilities orparticipation in any Y activity, whether located on Y property or not.______________ Waiver for Photo / Video / Audio Release (Optional): I give my consent for any photos, video and/or audio taken of my child involved inY programs to be used for Y promotions, trainings and/or displays.______________ Is either parent or legal guardian employed by the Hutto, Leander, Liberty Hill, Round Rock, Taylor or Thrall ISDs?Of note, in order to receive the program’s teacher rate, please provide a current pay stub.______________ Is your family a member of the YMCA of Greater Williamson County? If so, please provide your member number: _________________________________ I understand that a nonrefundable, nontransferable $40 registration fee is due at the time of registration. This fee is charged perchild for registration processing and curriculum materials.______________ I understand that withdrawal from the program requires two weeks written / faxed notice. I also understand that the Y alsoreserves the right to dis-enroll a participant for non-payment and/or behavioral issues.______________ I understand that my tuition is due on or before the 1st of each month. Failure to pay before the 2nd of the month will result in a$25 late fee and could possibly result in removal from the program.Parent / Guardian Signature: __________________________________________________________________________ Date: ______________________________________

DISCIPLINE & GUIDANCE POLICY FORMChild’s First Name: ___________________________________________ Middle Initial: __________ Last Name: __________________________________________Child’s School: ___________________________________________ Grade (during 2011-2012): _____________8 Discipline must be:1. Individualized and consistent for each child2. Appropriate to the child’s level of understanding3. Directed toward teaching the child acceptable behavior and self-control8 A caregiver may only use positive methods of discipline and guidance that encourageself-esteem, self-control and self-direction, which include at least the following:1. Using praise and encouragement of good behavior instead of focusing only upon unacceptable behavior2. Reminding a child of behavior expectations daily by using clear, positive statements3. Redirecting behavior using positive statements4. Using a brief cooling off period when appropriate; which is limited to the child’s decision to rejoin the group8 There must be no harsh, cruel or unusual treatment of any child.The following types of discipline and guidance are prohibited:1. Corporal punishment or threats of corporal punishment2. Punishment associated with food, quiet time or bathroom use3. Pinching, shaking or biting a child4. Hitting a child with a hand or instrument5. Putting anything in or on a child’s mouth6. Humiliating, ridiculing, rejecting or yelling at a child7. Subjecting a child to harsh, abusive or profane language8. Placing a child in a locked or dark room, bathroom or closet with the door closed9. Requiring a child to remain silent or inactive for inappropriate periods of timeTexas Administrative Code, Title 40, Chapters 746 and 747, Subchapters L, Discipline and Guidance.Parent / Guardian AcknowledgementMy signature verifies that I have read and received a copy of this discipline and guidance policy.__________________________________________________________________________________________Child Name__________________Date__________________________________________________________________________________________Parent / Guardian Signature__________________Date

BANK DRAFT FORMYMCA of Greater Williamson County Afterschool Agreement ACH/CC Automatic Payment OptionSTEP #1Child’s Full NameChild’s AddressCity, State, ZipSTEP #2Begin DraftDate:STEP #3______ / ______ / _______Phone Number (Day / Evening)Child’s SchoolDraft DatesMonthly onthe 1stSemi-Monthly onthe 1st & 15thAmount$$STEP #4m OPTION Ause currentinformationon filem OPTION Bfill outinformationto the rightAccount Type: m Checking m Savings m Credit Card(circle one) (voided check required) (voided check required) ( MasterCard Visa )Credit Card Number:Credit Card Expiration Date:Cardholder’s Name:a Only 1 Form of Draft Payment can be entered per person. a Children enrolled in Summer Camp may have a larger draft amount on May 15 & Aug. 1.AUTOMATED CLEARING HOUSE (ACH) DRAFTS ARE REQUIRED TO HAVE A VOIDED CHECK.DEBIT CARDS ARE NOT ACCEPTED. MUST BE ACH OR CREDIT CARDS ONLY.1. I understand that this transfer will occur twice monthly on the 1st; semi-monthly on the 1st and 15th of each month for checking / savings and credit card drafts.First draft begins Aug. 1.2. I understand that should I choose to terminate or change Bank Accounts, Banks, Account Types or Child Care Plan in anyway, I must provide the Ywith at least a 2 week written notice prior to my transfer date.3. I understand that the information above will be used to transfer payment from my account.4. I understand that if my payment is returned for non-sufficient funds (NSF) for any reason, the item(s) will be re-presented electronically and I understand I will becharged a $30 non-sufficient funds (NSF) processing fee. I am also responsible for all other recovery costs.5. I understand that if my account has a late pick up fee or late payment fee, the amount will be drafted from my account on the next draft date.6. The Y only accepts Visa and MasterCard.7. I understand that after three returned items, I will be ineligible to use the automatic payment option. My account will then become cash or money order only.___________________________________________________________________________Account Holder Signature__________ / __________ / __________DatePleaseStapleHereSTAPLE VOIDED CHECK HEREPleaseStapleHere

Y AFTERSCHOOL PARENT & GUARDIAN INFORMATIONY PhilosophyWe uphold the heritage, traditions and values of the Y throughout our program activities. Our events reflect non-denominational,universal beliefs that transcend all cultures. We consistently demonstrate respect and support for all families - appreciating their rightto determine and practice their own beliefs.FAMILY GUIDE (required signature on prior page): I acknowledge that I have been made aware of where to access or have received acopy of the Y’s Afterschool & Day Camp Family Guide. I accept responsibility to read and adhere to all billing procedures and all policies asset forth in that guide. Of note, you may access the family guide online at www.ymcagwc.org.ADA POLICY (required signature on prior page): Parents have the obligation to disclose significant, medical, physical or behavioralissues at the time of the child’s enrollment and on an ongoing basis. Due to the large group format or our program, we are unable toprovide one-to-one care for any child except on an intermittent basis, such as injuries, immediate disciplinary issues andcertain personal care needs customarily provided to other children.ABSENCE POLICY: Parents are encouraged to call by 2:00 p.m. to report if their child is going to be absent from the program.WAIVER FOR MEDICAL TREATMENT (required signature on prior page): In the event that my child requiresemergency medical treatment and I cannot be reached, I hereby authorize the Y Afterschool staff to make arrangement to transportmy child to the physician, hospital or clinic that I have designated or the nearest hospital / emergency medical facility. I give my consentfor any and all necessary medical care treatment for my child during this time.WAIVER FOR PARTICIPATION (required signature on prior page): I understand that Y activities have inherent risks and hereby assumeall risks and hazards as a result of my child’s participation in all Y programs and facilities, including transportation to and from saidactivities. I further release, absolve, indemnify and agree to hold harmless, the Y, the organizers, supervisors, directors, staff, volunteers,participants, coaches, referees, as well as persons or parents transporting participants to and from such activities from any claims orinjury sustained during my use of Y facilities or participation in any Y activity, whether located on Y property or not.WAIVER FOR PHOTO / VIDEO / AUDIO RELEASE (optional signature on prior page): I give my consent for any photos, video and/or audio taken of my child involved in Y programs to be used for Y promotions, trainings and/or display.REGISTRATION FEE: A $40 nonrefundable, nontransferable deposit is required for each child at registration.TUITION FEE: Tuition is due on or before the 1st of each month. Failure to pay by the 2nd of the month will result in a $25 late fee.The Y reserves the right to dis-enroll participants who do not render payments for services according to the payment schedule.WITHDRAWALS: Withdrawal from the program requires two weeks written notice. Please call the Y Licensed Child Care Services Deskat (512) 615-5563 for more information. The Y reserves the right to dis-enroll participants for non-payment and behavioral issues.PASSWORD: The Y is committed to the safety and security of your child. Therefore, if you wish to arrange for another person to pickup your child and the person is not on your authorized list, you must call the Y and give them this confidential password.Password: _________________________________________Y MISSION: To put Christian principles into practice through programs that build healthy spirit, mind and body for all.Y FOCUS: The Y is for youth development, healthy living and social responsibility.Y VALUES: The values of the Y are caring, honesty, respect, responsibility and faith.

YMCA OF GREATER WILLIAMSON COUNTYLicensed Child Care1812 N. Mays StreetRound Rock, TX 78664P 512 615 5563F 512 310 9372ymcagwc.org