Cheltenham School District Before-and-After-School Program Childcare Services Registration Instructions 2017-2018

(Please read carefully and keep this page for your records)

Below you will find all the relevant information for completing the registration process for C.L.A.S.P. Registration forms can be submitted to Cheltenham School District’s administration building in person, by US mail, fax or email. ¨ If you fax or email the registration forms, it is very important that you call the office to confirm receipt/legibility of all items.

Phone: 215-886-6805 Fax: 215-881-6452 Email: cercolono@cheltenham.org (Claire Ercolono)

Reg istra tio n Checklist (registration is NOT complete until ALL items are received): (Every field on form must be complete) 1. Childcare Enrollment Contract 2. Emergency Contact & Parental Consent Form 3. Civil Rights Compliance & Getting to Know You Form 4. Child Health Report -to be completed by your child’s physician or a copy of your child’s recent physical. 5. IEP (if applicable) - submit for review before your child starts 6. Registration fee* and 1st month’s tuition (*registration fee-only pay once; see Enrollment Contract)

Pro g ra m Hours: Each elementary school houses its own program. Afternoon services only for grade 5&6. • Morning program from 7:00am to 8:45am • Afternoon program from the end of the school day until 6:30pm (prompt pick-up is required)

Students gr. 5&6 are transported by school bus to their neighborhood elementary school for childcare services.

Reg istra tio n Deadline: Returning Students — Please read carefully. WE HAVE A NEW SOFTWARE PROGRAM– SANDBOX – YOU WILL RECEIVE AN EMAIL

WITH INSTRUCTION & AN INVITATION FOR YOU TO UPDATE YOUR CURRENT INFORMATION IN YOUR PARENT PORTAL FOR THE 2017-2018 SCHOOL YEAR.

It is important, for any family returning to CLASP in September 2017, to complete all items on above checklist and UPDATE on or before June 8, 2017.

New Families: Any family that requires childcare services for an incoming kindergarten child should register for C.L.A.S.P. at the time of kindergarten registration. New Families grade 1-6, please visit www.cheltenham.org to download the registration form. After June 20th, the process for new registrations will change to a paperless process using our new software, SANDBOX.

ALL families: The deadline to ensure a start date of the 1st day of school, September 5th is Friday, August 4th. AFTER August 4th: you will be notified of your child’s start date when you submit all items for registration.

Ø There may be a delay in the start date until the paperwork is processed. Reg istra tio n during the school y ea r: he/she can start C.L.A.S.P. 5 business days after receipt of all items for registration. Tuitio n P a y ment a nd Pro g ra m Po licies:

• If your child has an IEP (Individualized Education Plan), please submit for review before your child starts. • Tuition is due by the 20th of each month prior to the month of service (e.g. October tuition is due by September

20th) If the 20th of the month falls on a weekend or holiday, payment is due on the next business day. • Your account must have a $0 balance on the 1st of each month for continued participation. • Any family w ith CCIS s ub sidy - payment is due on a weekly basis so that your balance is $0 on the 1st of the

month. • LATE Pa y ment Po licy - If your payment is not received by the 1st of the month or your account has a balance

greater than $10, your account will be charged a $10 late fee. * If your account incurs four (4) late fees or returned payments over the course of the school year, your

child will be withdrawn from the program for the remainder of the school year. • You must UPDATE/CHANGE your child’s contracted days (increasing or decreasing) through the

Parent Portal. • You will be contacted when these changes are approved. • Monthly tuition is determined by dividing the annual cost of your child’s enrollment into 10 equal payments.

• Monthly tuition remains the same regardless of attendance, the number of school days in a particular month, or school closures due to inclement weather.

• There is a 10% family discount on the second, third, etc., children concurrently enrolled in a family. • There is a 20% employee discount for all children of employees of the Cheltenham School District.

It is extremely important to notify the office/staff of all active contact information to reach you during the day.

Cheltenham School District Before-and-After-School Program

Childcare Services Enrollment Contract 20

Office use only:

Start date:_______________

Exit date:

Child’s Name: First

Date of Birth: ________/________/________ Middle

Grade for 2017-2018: Age:_______ Month Day Year

Grade 5&6 - Neighborhood Elementary School:

African American Asian Hispanic Native American Other

Cost (per month) Initials

x Full Time $391 _______________ x PM only $246 _______________ x AM only $164 _______________ x Early Dismissal Wednesdays $33 _______________

(if your aftercare schedule already includes Wednesdays you do not have to pay extra)

x Partial Week (3 day minimum—No exceptions)AM Mon____ Tues____ Wed____ Thurs____ Fri____ (3 days=$98/mo; 4 days=$131/mo) PM Mon____ Tues____ Wed____ Thurs____ Fri____ (3 days=$155/mo; 4 days=$202/mo) AM & PM Mon____ Tues____ Wed____ Thurs____ Fri____ (3 days=$235/mo; 4 days=$313/mo)

Do you receive CCIS subsidy? Yes No If yes, which CCIS agency? List weekly parent copay $

Are you a SDCT employee? Yes No If yes, enter employee ID#: Additional fee/tuition information: x There is a one-time registration (non-refundable) fee for new C.L.A.S.P. enrollees. The fee is $45 for the first child and $40 for subsequent children.x On some school Inservice days, C.L.A.S.P. is open all day for child care. These days cost additional $45 and will be advertised within one month of the

Inservice day. Details at time of event.

Please read and initial each of the following statements:

My child has an IEP and I agree to give a copy for review to C.L.A.S.P. before start date. My child does NOT have an IEP

I receive CCIS and I agree to remit my parent copay WEEKLY.

I agree to update the emergency contact/parental consent form information whenever changes occur or every 6 months at a minimum. (§ 3270.124, 3280.124, 3290.124)

I received complete written program information at the time of enrollment (§ 3270.121, 3280.121, 3290.121)

I agree to pay the monthly tuition listed above for the enrollment category that I have selected. I understand that tuition must be paid in full by the 20th day of the month prior to service rendered (e.g. tuition for November must be received by October 20th). If payment is not received by the 24th of the month, I agree to pay a $10 late fee.

I understand that C.L.A.S.P. monthly tuition is determined by dividing the annual price of my child’s enrollment into ten equal payments and that my monthly tuition will remain the same regardless of my child’s attendance, the number of school days in a particular month, or school closures due to inclement weather.

In the event of a late pick-up of my child from the program, I agree to pay the $5 per minute late pick-up fee.

I understand that the Parent Handbook is available on the C.L.A.S.P. page at www.cheltenham.org and that it is my responsibility to read the hand-book and comply with all policies therein. (If you need a copy of the Parent Handbook, please request one from C.L.A.S.P. administration office).

I understand and agree to adhere to C.L.A.S.P. policies regarding late payments. (i.e. If your account incurs four (4) late fees or returned payments over the course of one school year, your child(ren) will be removed from the program at the end of the current month and will not be eligible to re-enroll in the program until the start of the next school year.

I acknowledge and agree to the statements above. By initialing above, I verify my understanding of these guidelines and all responsibilities pertaining to each of these statements.

Parent/Guardian Signature Relationship to Child Date

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Every child. Every family. Every caregiver. Every day…

Emergency Contacts/Authorized Pick-up (other than parents/guardians listed above). At least one person must be listed: Circle One

1. Name:________________________________________ Phone number while child is in care:______________________________ Cell Work Home

Address:_______________________________________________________________________________________________________________

2. Name:________________________________________ Phone number while child is in care:______________________________ Cell Work Home

Address:_______________________________________________________________________________________________________________

3. Name:________________________________________ Phone number while child is in care:______________________________ Cell Work Home

Address:_______________________________________________________________________________________________________________

Health Information (all fields are required)

Family Physician: Address: Phone:

Health Insurance Company/Medical Assistance Benefits:________________________________________ Policy #:____________________________

Allergies (including medication reaction):________________________________________________________________________________________

Medical or dietary information necessary in an emergency situation:___________________________________________________________________

Special disabilities:__________________________________________________________________________________________________________

Medications:

If your child will require the use of medication while at CLASP, please list the medication and condition here and see your Site Director for a medication log.

A physician’s script MUST be with all medication. C.L.A.S.P. staff DO NOT have access to medication in the nurse’s office.

Cheltenham School District C.L.A.S.P.

Emergency Contact & Parental Consent Form 2017-2018

Parent/Guardian Information: (please write legibly; if a parent/guardian is listed, we will assume he/she is legally permitted access to the child)

Child’s Name: First

Date of Birth: ________/________/________

Middle Last

School:____________________________________________ 2017-2018 Grade: ______________ Month Day Year

Primary Contact Person (Parent/Guardian)

Name:_______________________________________________________

Relationship to Child:___________________________________________

Home Address:________________________________________________

City, State, Zip:_______________________________________________

Phone: Home_____________________________

Cell_______________________________

Work______________________________

Email:_

_ Employer Name & address:

Secondary Contact Person (Parent/Guardian) -- optional

Name:_______________________________________________________

Relationship to Child:___________________________________________

Home Address:________________________________________________

City, State, Zip:_______________________________________________

Phone: Home_______________________________________________

Cell_________________________________________________

Work________________________________________________

Email:_______________________________________________________

Employer Name & address:

Please SIGN your full signature beside the following statements to indicate your consent. x I permit C.L.A.S.P. to obtain emergency medical care for my child:____________________________________________________________________

x I permit C.L.A.S.P. to administer minor first-aid procedures:_________________________________________________________________________

x I permit my child to be transported from the facility in case of an emergency:____________________________________________________________

x I consent to the use of my child’s photograph in promotional materials published by C.L.A.S.P.(optional):_____________________________________

x I agree to update this information when changes occur or every six months:______________________________________________________________

Parent/Guardian Signature:_____________________________________________________ Date:_________________________________

Signature after 6 mo. update:____________________________________________________ Date:_________________________________

Page 2 of 3

Start:

Every child. Every family. Every caregiver. Every day…

Check box to indicate the # that will reach you in case of an emergency

Cheltenham School District C.L.A.S.P.

Civil Rights Compliance 2017-2018 School Year

In accordance with applicable federal and state civil rights laws and regulatory requirements, you and you children, as a client of this program who is qualified to receive services, have the right:

x To be provided services and to be referred for services at other facilities without regard toyour race, color, religious creed, ancestry, national origin, age or sex.

x To file a complaint of discrimination if you feel you have been discriminated against on thebasis of your race, color, religious creed, ancestry, national origin, age or sex.

Complaints of discrimination may be filed with any of the following: Cheltenham School District PA Human Relations Commission Office of C.L.A.S.P. Philadelphia Regional Office 2000 Ashbourne Road 110 North 8th Street, Suite 501 Elkins Park, PA 19027 Philadelphia, PA 19107

Department of Public Welfare Commonwealth of Pennsylvania Bureau of Equal Opportunity DPW Southeastern Regional Office Room 223, Health & Welfare Building 801 Market Street, Suite 5034 PO Box 2675 Philadelphia, PA 19107 Harrisburg, PA 17105 US Dept of Health & Human Services Office for Civil Rights Suite 372, Public Ledger Bldg South 150 South Independence Mall West Philadelphia, PA 19106-9111

Parent/Guardian Signature Date C.L.A.S.P. Staff Signature Date

Getting to Know You As we get to know you and your child, we invite you to take a few minutes to talk to your child’s C.L.A.S.P. staff about your child and his/her experience in our program. Often this conversation is especially good to have after your child has been in our program for 3-4 weeks. We welcome your input and your questions at all times.

Here are a few possible questions and suggestions for discussion: x What are your expectations of our program?x Is there any information about your child’s culture, ethnicity, language or religion that is important for

us to know?x Would you like to be a resource for cultural awareness activities?x What are your child’s favorite toys games and activities at CLASP? At home?x Is your child feeling positive about C.L.A.S.P.? Does he/she have friends in the program?x Does the staff seem to know your child’s likes, dislikes, strengths and needs?x How can we make your child’s experience at C.L.A.S.P. better?x Is there anything else you would like us to know about your child or your family?

I understand that I can request a meeting at any time with the CLASP staff at my child’s school and that the Site Director and Program Administrator are available to discuss any comments or concerns I have about the program.

Parent/Guardian Signature Date C.L.A.S.P. Staff Signature Date

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Parent(s) Gaurdian(s)/Site Director Conference Parents/Guardians are welcome to schedule a conference with the Site Director to discuss your child’s progress,

behavior issues, social and physical needs.

Parent/Guardian Signature Date C.L.A.S.P. Staff Signature Date

Every child. Every family. Every caregiver. Every day…

Child’s Name: