HORNET CLUB
SUMMER PROGRAM INFORMATION SHEET
Please print out these forms. Fill them out by hand, sign with your original signature as
well as a copy of your driver’s license and return them at your earliest convenience. Do not
e-mail your forms back to us. At the top of the application form, please list your child's age
as of May 28, 2020.
1. Payments for the summer trip fees may be paid in installments if
registering during the school year. A payment schedule must be
established that will have this paid off by the last day of school. (For
example; 10 payments (one payment every week for next 10 weeks, with
first payment due 3/20/20 would mean 10 payments of $20.72 each
week). We also have options to pay half in March and the other half in
April or May. You can also pay the entire $207.20 any time before
summer. Your spot is reserved upon receipt of a completed registration
packet AND your first trip fee payment of $20.72, as well as a registration
fee of $30 (if you are new to our program). (If you are already in our
program you will pay reg. fee with new fall applications).
2. If I do not have an approved criminal record check, you will need to
get one IF you plan to chaperone one of our trips. Please turn in these
criminal records checks as soon as possible. It takes time to get them and
if left until the last moment, you risk being unable to attend a trip. Parent
chaperone tickets must be paid for at the door.
3. Given that insurance policy#, information, birth certificates, physical
exam forms and immunization forms are State requirements and are
requested here in this packet, please be advised that no child will be
allowed to begin attendance to the program IF these items are not in our
file.
4. I will need immunization records, physical exam forms, and birth
certificates for students attending from other Franklin County Public
Schools.
5. All fees paid for registration are non-refundable. If your child later
decides not to participate in the summer program or decides not to go
on a trip, the fees are non-refundable. Parents trip tickets purchased are
also non-refundable. You may, however, let someone else use your ticket,
if you can't attend.
6. All payments must be check or money order, NO CASH.
7. All ASP accounts must be paid in full before your child can attend the
summer program.
8. PLEASE NOTE: Weekly tuition fee for the summer program is $100/week.
No account may be more than one week behind. If you fall behind in your
payments, your child may be removed from the program. Please
remember that tuition payments are due regardless of whether your child
is present or absent and regardless of number of days in the week. (You
will not be charged on days that the program is closed (i.e. holidays))
9. Given that our staff’s primary duty at the pool must be monitoring the
safety of your children, please be advised that payments and account
inquiries need to be made at the school.
10. If you wish to withdraw your child from the program, you must give a
two weeks’ notice in writing and pay for the two weeks.
11. Your child must be brought into the building each morning and signed
in with the time and your name. The Hornet Club is not responsible for your
child until he or she is signed in and delivered to their instructor. Our doors
now stay locked at all times. If you need to pick up your child early and
arrive at one of the odd times that the door may be unattended, please
call us at 859-421-5788 and someone will be at the door to let you in.
12. Our colored shirts are worn on all major trips. Make sure that your
child's shirt is clean and ready to wear. If you are a divorced parent and
your child spends time with both parents, please consider ordering two
shirts (one of which you will have to pay). Please make sure that your
child's name is on the label in permanent marker.
13. Hornet Club will be closed July 4, 2020, for a federal holiday. You will
not be billed for that day’s tuition since the program will be closed.
14. All medications administered to children must be in the original
container with the child's name. A prescription medication form must be
filled out for every day medication is to be administered.
15. Tennis shoes (not sandals) are required for all trips and for playing on
the playground. FLIP FLOPS ARE NEVER ALLOWED as they are a danger
during active play. Sandals with ankle straps are allowed, but not
encouraged for other times.
16. Disrespect to the director or staff will not be tolerated. Please remind
your child that they must keep their hands to themselves. There is no
hitting, biting, kicking, spitting, pinching, cursing or bullying allowed. These
kinds of behavior are unacceptable and can result in your child's
dismissal from the program.
17. If your child wants to buy extra food from the concession stand at the
pool during a designated time, then he/she must bring their own money.
18. Sunscreen (must be Papa Free) should be provided for each child.
Mark your child's name on the outside of the container. Children who are
prone to burn should have an extra white t-shirt in their swimming bag to
put on over their swim-suit, especially 5-6 year olds. On swim days make
sure that your child brings his/her swimsuit, towel, sunscreen, and deck
shoes, if needed. Children will not bring floats, big canvas bags, or pool
toys to the pool. There is not enough room on the bus.
19. The latest pick-up daily is 5:30.
20. Children's shirt sizes are: small (6-8), medium (10-12), and large (14-
16). Adult sizes are Sm, Med, LG, XL, and XXL. If in doubt about size, order
the next larger size. The Hornet Club will purchase the first shirt for you.
22. Children of parents driving on trips may ride with their parents. No other
child can ride with you unless the other child's parent is with you. Parents
driving their children are not covered under the School’s Liability
coverage. Due to the School’s Liability Insurance, parents/siblings are not
allowed to ride on the buses.
23. Parents of children with continuous behavior issues will be expected to
accompany their child on trips.
24. Children should not bring personal items from home. Under no
circumstances may a child bring a CD player, iPod, i-Phone, net pads,
cell phones or Kindles to the summer program. Please see the director if
your split family needs to check in items with the ASP office.
25. All school rules and bus rules will be followed during the summer
program.
26. Trip chaperones must accompany their assigned children to the
bathroom on trips. No child is to go to a restroom without adult
supervision.
27. Our school is a smoke free campus. No parent or staff member may
smoke in front of the children or on school property.
28. Departure time for all trips is critical. We cannot wait for anyone.
29. Children who bring money for trips are responsible for their own money
except 6 year olds. Parents of 6 year olds, please give their money to their
instructor. Please put the money in a zip lock bag in small denominations
with your child's name on it.
30. Please do everything possible to register and have your paperwork
completed no later than May 15, 2020. Our office MUST have time to
establish our summer records in order to be prepared to receive your
child on the first day.
31. Please instruct your child that no child is to leave the
building/playground or their group without instructor being made aware
of their sign out/leaving.
32. Base fee policy- on days when program is open, your base fee is
payable whether you attend or not since we receive no federal or board
money to run the program. Our Staff still has to be paid and food and
snacks purchased.
33. My door is always open if you have a concern, please feel free to call
me at (502) 695-6760, Cell 859-421-5788 (Please use only if it is an
emergency and you cannot reach me by office #), or come into my
office.
To: Parents/Guardians
From: Marilyn Nichols, Director
Re: On-going invitation to share time with children/request
Date: March 15, 2020
As always, you have a personal invitation to help make our program the
best that it can be. We are always open for your suggestions and input
into the program. Together, we can make The Hornet Club even better.
We extend an invitation to use your talents with our children. Come teach
our ASP children pottery making, acting/drama, dance, yoga, sports and
maybe teach a different language or teach the children how to make a
successful musical instrument. Maybe you would like to read to our
younger children. Maybe arts and crafts are your specialty or you are
good with nails or hairstyles. We could use your talent.
In the form of a request, the program is in need of any type of jars, nuts
and bolts, tools (any size), empty shoe boxes, old but good clean paint
brushes, and old (not rusty) gardening tools, buckets, small or large plastic
containers and toilet tissue rolls for crafts. Any of these would be greatly
appreciated.
We want you to know again, that we (The Hornet Club Staff) take pride in
working with your children. Their safety and happiness, is our number one
concern.
**The above mentioned invitation to come and share time with our
children MUST accompany a background check and possibly
fingerprinting done at your expense. **
WE DO NOT/CANNOT PAY this fee for anyone.
** Eat breakfast at home and wear Hornet Club shirts on all trips (except swimming
pool). Bring extra money if you want to buy souvenirs. Bring sun-screen if needed.
Program reserves the right to reschedule any event (with notice) to other dates, or
substitute equivalent event if trip is missed due to unavoidable circumstances. **
SUMMER SCHEDULE OF EVENTS –2020
MAY
First Day of Summer Program May 27, 2020
JUNE
Kona Ice - June 3, 17, 24, July 1, 8, 15, 29
Juniper Hills Pool – June 4, 11, 18, 25, July 2, 9, 16, 23, and 28
Legends Ball Park Splash Day June10
Farmers Market –June 18 exploring
Kentucky Science Center – June 23
Farmers Market – June 25 learning about amazing seeds
JULY
Picnic/Parade - July 1 @11:00-1:00 (EVERYONE INVITED)
Farmers Market – July 2 Eating our plants ☺
Louisville Slugger Museum - July 7
Farmers Market – July 9 Quickles
Franklin Square Cinema – July 14
Farmers Market – July 16 Corn
Kentucky Kingdom – July 21 and 22 (this is back-to-back because the
22nd is FREE!! Except for food ☺ (lunch included in price for the 21st visit)
Bring/send extra money from home (at least $10 for evening meal/snack).
If swimming, money is needed for clothes locker. Bring extra money if you
want a souvenir. Please put extra money in a baggie with child’s name on
it and amount.
Farmers Market – July 23 Stone Soup
Last day of Summer Program August 2, 2020
*The Farmers Market is for the children to learn agriculture-Educational
and FUN at the same time!* Heading to the pool immediately after.
Hornet Club SUMMER HANDBOOK
Note: Every effort has been made to align program policies with FCPS
District Policies/Handbook. If any discrepancy arises, then District
Handbook/Policies apply.
Hornet Club Philosophy:
To provide a quality, affordable, and safe environment for school-age
children. To offer activities that encourages social interaction, creativity,
decision-making, and the expression of each child's unique individuality,
without regard to race, creed, or ethnic origin.
Ages:
Hornet Club is open to exiting kindergarten age children through 5th
grade.
Hours of Operation:
Hornet Club summer program is open from 7:30 A.M. to 5:30 P.M. Monday
through Friday, except on the 4th of July. On long trips, hours may be
expanded to 6 or 9 P.M. You will be notified well in advance if this would
be the case.
Registration and Fees: All Registration fees and trip fees are non-
refundable
Summer registration is open first to Hearn students, and then to other
Franklin County Public School students. Children must be pre-registered in
order to participate in the program. Summer registration information and
forms will be available on line. Registration forms along will all required
fees and documents must be turned in at registration time which will be
announced. No child is enrolled until necessary forms with original
signatures and fees are received. All balances for prior participation in
any ASP or summer program must be paid in full before your child can be
officially registered for the summer program.
Students registering from another Franklin County public school must have
a copy of current immunization, a copy of their physical, and a copy of
their state birth certificate in order to be registered.
Weekly Fee:
The weekly fee is $100. The child's legal guardian must register the child
and the person registering the child is responsible for payment of tuition. A
10% discount (on each additional child) on tuition will be given to families
with more than one child in attendance in the program (no discount on
registration or trips fees). The weekly fee is due every week, but when not
convenient, no longer than every two weeks. Failure to keep your
account balance total at an amount equal or less than your families “1
week total” (i.e. $100.00 for 1 child/$190.00 for a family with 2 children,
etc...) will result in dismissal of your child from the program. All accounts
must be paid by check or money order only. No cash please. If paying by
check, we will need a birthdate and driver's license number of person
writing check.
Late Pick-up Fees:
Late fees will be assessed to each family if tardiness occurs in picking up
students from the program. This is going to be strictly enforced and the fee
will be due at pick-up. After (5) minutes, a fee of five dollars ($5.00) will be
assessed for the first minute and $1.00 for each additional minute late for
pick-up.
Withdrawal from the Program:
A two week notice in writing must be given when withdrawing your child
from the program. You will be responsible for payment for those two
weeks.
Drop-Off/Pick-Up:
During the summer program parents/guardians are required to sign their
child or children in at drop-off and out at pick-up. Only authorized persons
listed on the parent/guardian pick-up list will be allowed to pick up your
child. Any changes in your pick-up list must be in writing. Any new
authorized person on your pick-up list must be prepared to produce a
picture I.D.
The program ends at 5:30 P.M... Beginning at 5:35, a late fee will be
charged as listed in the late fees section. Should a child remain at the
program 30 minutes past closing time, our only remaining recourse will be
to contact legal authorities. It is extremely important that all contact
numbers are up-to-date and working. Parents/guardians consistently
picking up their child or children late will be asked to find other care.
Health Rules/Emergency:
If your child has been exposed or contracted any contagious disease
such as measles, mumps, rubella, scarlet fever, strep infections, hepatitis,
chicken pox, head lice, scabies, impetigo, or flu, etc. please contact the
program immediately. We reserve the right to restrict attendance. If your
child becomes ill or is injured, we will contact you immediately. Please
make sure all contact numbers are currently up-to-date.
In the event of an emergency, parents/guardians will be contacted
immediately. If we feel that it is necessary, the Emergency Medical
Service will be asked to assist us in first aid procedures or to transport the
child to the hospital. Emergency medical information for your child must
be kept up-to-date. A staff member will accompany the child to the
hospital and stay until a parent/guardian arrives.
Any child with a temperature of 100 or above must be picked up
immediately. Your child will be separated from the other children and
monitored until pick-up. The child cannot stay in the program until you
decide to pick them up - immediately means immediately. The child
cannot return to the program until he/she has been fever free for 24 hours
without the use of medication.
Discipline:
The Hornet Club expects that all children in the program will have respect
for their instructors, other children and their property. However, if a child's
behavior endangers the safety of another child, he/she will be placed in
age-appropriate "time-out". The child will remain in the room but will be
separated from the activities for a short-time (5-10 minutes). If the
disruptive behavior continues, a conference with one of or both of the
parents will be requested. If parental intervention does not eliminate the
disruptive behavior, the child will be released from the program.
Please instruct your children that there is no hitting, biting, name-calling,
kicking, throwing of rock or gravel, or bullying, etc.
Medication:
All medications must be in original containers along with a completed
prescribed medication form stating the time and dosage to be given. The
medication needs to be given to a staff member when your child arrives
each day. A medical permission form for prescribed medication must be
completed for each day that medication is administered.
Meals/Snacks:
During the summer, breakfast, lunch, and a mid-afternoon snack will be
served. All meals meet the Kentucky Division of School Food Service
guidelines. Students cannot bring their own snack to the program unless
they have specific allergies or they are diabetic. Children allergic to milk
must produce a doctor's statement.
Personal Belongings:
All clothes, swimming items, etc. should be marked with the child's name.
No personal toys, etc. may be brought from home. No boom boxes, head
phones, Walk-mans, CD players, or DS are permitted unless announced
on special occasions.
****UNDER NO CIRCUMSTANCES will CELL PHONES, IPODS, IPHONES,
LAPTOPS, KINDLES, or ANY OTHER DEVICE WHERE ONE CAN TEXT, MAKE
CALLS, GOOGLE AND SO ON be brought to the program. (Please contact
Director if devices need to be checked into the program office for
purposes of transferring between split family homes) ALL CHILDREN WILL
NEED A BASKET FOR THEIR BELONGINGS ON FIRST DAY OF ATTENDING. You
can purchase these baskets for $1.00 at the Dollar Tree.
Swimming Pool:
Each child will need to bring a swimsuit and towel for the pool. Deck shoes
are permitted. Sunscreen will be applied to a child upon request in the
form of a note from the parent. Only PABA free sunscreen is permitted.
Children who sunburn easily should wear a white tee shirt over their
swimming suit. *** All 6 year olds will bring a white tee shirt with them to the
pool.
No rafts, rings, or other swimming accessories will be brought to the pool.
There is no room on the bus.
Dress:
Children should wear play clothes that they can get dirty and are
comfortable. Athletic shoes are required - no flip flops. They do not
provide ankle support when running and the child can run out of them,
easily resulting in falls. Sandals must have full ankle straps.
Please be aware that arts and crafts are an important learning part of our
program and they may sometimes be messy. Washable and non-
washable paints are utilized as age appropriate and project appropriate.
If you care to send a paint smock or shirt, please feel free to do so.
Hornet Club shirts must be worn on all trips except the swimming pool.
Trips/Special Activities:
Any child participating in special activities or taking a trip with the
program is required to stay with their assigned chaperone. If for any
reason a child leaves his/her chaperone and group, he/she will not be
permitted to go on the next trip. Any child that embarrasses the program
by displaying rude behavior or talk, breaking the rules of the business
being visited, etc. will not be permitted to travel with our program. The
children registered in the program represent Hearn Elementary and should
not embarrass their parents, the school or my staff.
INSURANCE/REQUIRED INFORMATION:
State regulations require our program to have insurance policy
number/information, birth certificates, physical exam forms and
immunization forms in our files. (We can sometimes assist with this via the
front office of the school, if your child attends Hearn Elementary). We,
therefore, must restrict attendance to the program until these documents
are provided.
FRANKLIN COUNTY PUBLIC SCHOOLS
AFTER SCHOOL PROGRAMS
DISTRICT HANDBOOK
(This handbook is currently under review, policies subject to change)
REGISTRATION
1. A $30 non-refundable registration fee will be assessed for each school
year program. This fee applies to any student enrolling into an After School
Program including those who are transferring from another FCPS After-
School Program.
2. All registration documents must be completed/ submitted prior to
admittance, including:
a. After School Program Registration Packet
b. Student Information Sheet
c. Medical History Form
d. Emergency Contact Information
e. Child Pick-up List
f. Medication Information
g. Current Immunization Certificate
h. If child has been previously enrolled in another Franklin County Public
Schools After-School Program, all prior balances must be paid in full prior
to acceptance into the program.
REGULAR FEE SCHEDULES
1. Fees are to be set at fifty dollars ($50) per week and forty five dollars
($45) each for siblings in the program
2. Fees are due weekly on the day set forth by individual schools
3. NO cash is to be accepted at any time as payment
4. All enrolled students in the After School Program will be responsible for
the daily base rate of ten dollars ($10.00) when the program is open
regardless of whether or not the student is in attendance (sibling rate)
would be nine dollars ($9) per day.
LATE PICK-UP FEES
1. This is going to be strictly enforced and the fee will be due at pick-up.
After (5) minutes, a fee of five dollars ($5.00) will be assessed, and $1.00 for
each additional minute late for pick-up. Should a child remain at the
program 30 minutes past closing time, our only remaining recourse will be
to contact legal authorities. It is extremely important that all contact
numbers are up-to-date and working.
RETURNED CHECK FEES
1. Returned checks will be turned over to a collection agency contracted
by the Franklin County Board of Education. Also, once a check is
returned, we will no longer accept a personal check from you, however,
we will accept money orders.
HOURS OF OPERATION
1. Hours of operation will be left to the discretion of each individual After
School Program and may vary.
2. A schedule for hours of operation will be given to each guardian upon
admittance into the Program.
INCLEMENT WEATHER /NON SCHOOL DAYS DURING REGULAR SCHOOL
YEAR
1. An additional ten dollars ($10.00) charge for a total of twenty dollars
($20) per day will be assessed if the child is present on inclement weather
days or days during the regular school year when school is not in session.
2. Hours of operation will remain that of regular day unless otherwise
announced by the Superintendent.
EARLY RELEASE DAY FEES
1. Fees will be the regular weekly fee, plus an additional five dollars ($5) for
each early release day if the child stays beyond school dismissal time.
CALENDARS
1. Calendars of days of operation will be left to the discretion of each
individual After School Program and may vary.
2. All centers will be closed on Franklin County Board of Education
recognized holidays as reflected on the district calendar.
3. A calendar reflecting days of operation will be given to each guardian
upon admittance into the program.
4. Calendars will reflect Early Release Days built into the school schedule.
SUMMER PROGRAMS
1. Fees and/or activities will be left to the discretion of each individual
After School Program and may vary. (Extra fees may be incurred for field
trips, etc.)
2. Calendars of events scheduled for each summer program will be given
to each guardian upon admittance into the summer program.
WITHDRAWAL NOTICE
1. Withdrawal from an After School Program requires notification (in
writing) to the director a minimum of two (2) weeks in advance of the
child’s last day of attendance.
2. Failure of notification may result in charges for services being incurred.
ARRIVAL PROCEDURES
1. During regular school days, children participating in the After School
Program will be escorted to the designated area upon school dismissal.
2. On full-day care, the parent/guardian will be required to escort the
child to the designated program area and sign in.
DISMISSAL PROCEDURES
1. Children will be released from the program according to the
information provided on the Childs Pick up List.
2. If someone different than those listed on the Child Pickup List will be
picking up the child, staff must be given a written note of change that is
signed and dated by the parent/guardian and must state specifically
who will be picking up the child.
3. Anyone picking up a child from the After School Program must provide
staff with photo identification in order to take the child.
HEALTH CONCERNS
1. Parents are legally responsible for notifying the After School Program of
exposure or contact of any contagious disease such as measles, mumps,
rubella, scarlet fever, strep infections, hepatitis, chicken pox, head lice,
scabies, impetigo, flu, shingles, etc., immediately. After School Programs
reserve the right to restrict attendance based on any contagious illness.
2. For any ill or injured child, the After School Program will contact the
child’s guardian immediately.
MEDICATION
1. All medications must be in the original container and not outdated. A
permission form for the prescribed medication must be completed for
each day that the medication is administered.
USE OF TOBACCO PRODUCTS
1. The use of any tobacco product is prohibited in any building owned or
operated by Franklin County Public Schools.
2. The use of any tobacco product is prohibited for all chaperones,
whether ASP employees or not, while in any supervisory role with children
on field trips, etc.
DISCIPLINE PROCEDURES
1. All discipline policies and procedures will be left to the discretion of
each individual After School Program and may vary.
ITEMS BROUGHT FROM HOME
1. All policies and procedures relating to items being brought to the After
School Program, including but not limited to toys and electronics, will be
left to the discretion of each individual After School Program and may
vary.
* Child's shirt size_____ *REQUIRED INFORMATION
HORNET CLUB SUMMER APPLICATION Student's full name: _____________________________________ Age Now_____
Address ___________________________ City _______________ Zip ____________
Mother's name _______________________________
Mother driver’s license DOB * ________________________________________
Address (if different) __________________________________________________
Day phone ___________________ Evening phone_________________________
Cell ___________________________*** Work Phone ________________________
E-mail _____________________
Father's name __________________________________
Father driver’s license DOB * _________________________________________
Address (if different)___________________________________________________
Day Phone ____________________Evening phone ________________________
Cell _________________________* Work Phone___________________________
E-mail _______________________
Child's birthday __________________________*
Child's siblings: Name __________________________
School attended ____________________________________________________
Name ___________________________ School attended__________________
Preferred Physician ___________________________
Phone number_______________________
Frankfort Regional Medical Hospital will be used unless another specified:
______________________________________________________________________
**Medical insurance carrier ______________* Policy number
____________________
Person to call in case of emergency ***Phone # _______________________
Medical Physical limitations __________________________
Food allergies _____________________________________
Other allergies ____________________________________
Does your child take medication? Yes_____ No ______
Name of medication ____________________________________
Will the child be taking medication during the program? Yes No _______
Child's hobby/hobbies _______________________________________________
If your child should become injured or ill while at The Hornet Club, please
list the phone numbers where you can most often be reached.
Mother's name __________________ Day phone ___________Cell ___________
Father's name __________________ Day phone ___________ Cell ___________
HORNET CLUB DISMISSAL FORM
*This form must be completed for each child enrol1ed in The Hornet Club.*
Child's Name ___________________________
Child's Social Security Number ________________
We will only release your child to the people below if:
1. We have their given name
2. They can show accurate identification
PERSONS WHO MAY PICK UP YOUR CHILD/and TELEPHONE NUMBER
______________________________ ______________________________
______________________________ ______________________________
______________________________ ______________________________
______________________________ ______________________________
______________________________ ______________________________
______________________________ ______________________________
______________________________ ______________________________
______________________________ ______________________________
PERSONS WHO MAY NOT PICK UP YOUR CHILD
______________________________ ______________________________
______________________________ ______________________________
______________________________ ______________________________
Mother's name and Signature: __________________________________
Name Signature _______________________________________________
Father's name and Signature: __________________________________
Name Signature _______________________________________________
** ANY CHANGES MUST BE IN WRITING. NO TELEPHONE NOTIFICATIION.
If you cannot be reached, please give the name and number of a person
authorized to act in your place.
Name (Relationship to child) ________________________________________
Day phone ___________________
If this person cannot be reached, what steps would you like for us to take?
I, the undersigned, do hereby authorize the staff of The Hornet Club to
seek medical treatment for my child in the event of an emergency. I will
not hold the staff of The Hornet Club, school, personnel, or the school
district responsible for the emergency care and/or transportation of my
child. I understand that if any child is injured and requires doctor's care, I
will be contacted.
Parents/guardian ________________________________________
Date ______________
I have read and understand the policies of The Hornet Club handbook.
I give consent for my child __________________________ to participate in all
activities of the program.
I understand that the registration fee and all trip fees are non-refundable.
All fees are due in advance on a weekly basis regardless of absences or
number of days in the week. The program understands that hardships may
occur, but you need to contact Mrs. Marilyn, Director, if such a case
arises. However, non-payment is reason for my child's dismissal from the
program. I further understand and agree that all account balances will be
maintained to a 2 week (or less) balance and that failure to keep
account balances within this 2 week amount are grounds for suspension
and/or dismissal from the program.
Parent/guardian ______________________________
Date _____________
* If you will be writing a check for your tuition payment, we will need the
birth date and driver's license number of the person writing the check.
THE HORNET CLUB ENROLLMENT AGREEMENT
Child's name: ____________________________ Date of registration: __________
I agree to comply with the rules and regulations of The Hornet Club After-
school and summer programs regarding tuition fees, attendance, health
and other items specified in the handbook. I understand that all
registration and trip fees are non-refundable.
I agree to notify the Director at least two weeks in advance of
withdrawing my child from The Hornets Club.
I understand that tuition fees are due weekly and will be paid weekly. I
also understand that if I do not keep my account within a 2 week
balance, my child will be removed from the program.
I understand that in event of an absence during program hours, I will be
responsible for fees for time reserved, not actual time spent at The Hornet
Club.
I will notify the Director immediately if I have an address or telephone
number change.
I authorize The Hornet Club to release my child to the individuals listed on
the enrollment application form in case of my absence.
If a medical emergency arises, The Hornet Club staff will first attempt to
contact me. If I cannot be reached, the staff will contact the persons
listed as emergency contacts. If the emergency is such that immediate
hospital attention is necessary, an ambulance or emergency vehicle may
take my child to the hospital.
I hereby agree to the above terms and give my child permission to
participate in the Hornet Club After-school and/or Summer Program.
Signature Parent/Guardian: _________________________________
Date signed: _____________
Child's name: ____________________________
The Hornet Club DISCIPLINE AGREEMENT
I have read and understand to the best of my ability and agree to the
discipline procedure outlined in the Hornet Club handbook. I understand
that the following procedure will be used to correct behavior that may
endanger the safety of another child or adult or is disruptive to the
program.
1. "Time-out" for a brief period (age appropriate)
2. Parent notification
3. Parent conference (parental intervention must eliminate the behavior)
4. Release and/or suspension of the child from the program.
Child’s name: ________________________________
Parent/Guardian signature _______________________
Date: ___________
To: Parents/Guardians
From: Marilyn Nichols, Director- Hornet Club
Date: May 15, 2019
Re: Chaperone ticket fees
Child’s Name: ______________________________
Chaperone Name: __________________________________________
The following trips will be taken by The Hornet Club this summer. The
program will need as many chaperones as we can get. (You will only be
watching your child). Tickets for all trips that you wish to chaperone must
be paid at the door. Each parent/Guardian wishing to chaperone must
have a criminal record check. If you had one done last summer and I
have a copy, or one done by the school this year, your record check is
good.
DRIVING LIST FOR TRIPS - 2020
I will be driving on the following trips and my child will ride with me
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
PERMISSION SLIP for KONA ICE
I give permission for my child _____________________________________ to
participate in the following field trip at (Hearn): June _____3, _____17,
____24, July _____1, _____8, _____15, _____29
Furthermore, I waive, release, and hold harmless any staff member,
owner, director, or other employee of The Hornet Club from any and all
claims and liability arising from my child's participation in the field trip and
transportation thereto and therefrom as described above.
In the event of a medical emergency or accident, I authorize the
supervising staff person of The Hornet Club to obtain emergency medical
care for my child.
NAME OF PHYSICIAN: _____________________________
Program will use Frankfort Regional Medical Hospital unless another is
specified. Other HOSPITAL: ___________________
SIGNATURE OF PARENT/GUARDIAN: ____________________________________
PARENT'S/GUARDIAN PHONE NUMBER: ________________________
DATE: ____________
SWIMMING PERMISSION SLIP FOR JUNIPER HILL- June - July 2020
I give permission for my child ___________________________ to participate in
the following trips to Juniper Hill pool.
Please check each date your child will participate. June ____4, ____11,
____18, ____25, July____ 2, ____ 9, ____16, ____ 23, ____28
Furthermore, I waive, release, and hold harmless any staff member,
owner, director, or other employee of The Hornet Club from any and all
claims and liability arising from any child’s participation in the field trip and
transportation to and from as described above.
In the event of a medical emergency or accident, I authorize the
supervising staff person of The Hornet Club to obtain emergency medical
care for my child.
Name of child’s physician ______________________
Program will use the Frankfort Regional Medical Hospital unless another is
specified. Other HOSPITAL: ___________________
Signature of parent/guardian ___________________________
Parent/Guardian phone number ___________________
Date _________________________
Hornet Club SUMMER PROGRAM
SWIM PROFICIENCY FORM
Parent/Guardian:
Since the children are taken to Juniper Hill Pool, it is important for our staff
to know something about their swimming ability. Please write your child's
name in the appropriate description.
My child______________________________________ is an accomplished
swimmer and may go anywhere in the pool including the diving board.
My child_______________________________________ is a good swimmer and
can go anywhere in the pool except the diving area.
My child_______________________________________ can swim somewhat, but
I do not want him/her to go past the 5 foot marker.
My child________________________________________ cannot swim, but is not
afraid of the water and may stay in the 3 foot or under.
My child________________________________________ is afraid of the water
and must be watched like a hawk.
Parent/Guardian Signature: ____________________________________
Date: _______________
The Hornet Club Sunscreen Use Agreement
I, ______________________________ give permission to The Hornet Club staff to allow the
application of sunscreen to my child, ____________________________________ for outdoor
activities. I will provide my child with sunscreen and assure that the sunscreen is PABA free.
Please initial dates and sign parent signature:
______ June 4, ______ June 11, ______June 18, ______ June 25, ______,July 2,
_______July 9, ______July 16, ______July 23, ______July 28,
Parent/Guardian signature: ________________________________________
Date: _____________________
PERMISSION SLIP for Legends Ball Park Splash Day
I give permission for my child ____________________________________ to
participate in the following field trip: Legends Ball Park on June 10, 2020,
and to participate in Splash Day. (Water fun @ Legends)
Furthermore, I waive, release, and hold harmless any staff member,
owner, director, or other employee of The Hornet Club from any and all
claims and liability arising from my child's participation in the field trip and
transportation thereto and therefrom as described above.
In the event of a medical emergency or accident, I authorize the
supervising staff person of The Hornet Club to obtain emergency medical
care for my child.
NAME OF PHYSICIAN: _____________________________
Program will use the Frankfort Regional Medical Hospital unless another is
specified. Other HOSPITAL: _______________________________________
SIGNATURE OF PARENT/GUARDIAN: __________________________________
PARENT'S/GUARDIAN PHONE NUMBER: ______________________________
DATE: __________
PERMISSION SLIP for Farmers Market Downtown Frankfort
I give permission for my child _______________________________to
participate in the following field trip: Farmers Market _____ June 18,
_____June 25, _____ July 2, _____ July 9, _____July 16 and _____July 23.
Furthermore, I waive, release, and hold harmless any staff member,
owner, director, or other employee of The Hornet Club from any and all
claims and liability arising from my child's participation in the field trip and
transportation thereto and therefrom as described above.
In the event of a medical emergency or accident, I authorize the
supervising staff person of The Hornet Club to obtain emergency medical
care for my child.
NAME OF PHYSICIAN: _____________________________
Program will use the Frankfort Regional Medical Hospital unless another is
specified. Other HOSPITAL: ___________________
SIGNATURE OF PARENT/GUARDIAN: ________________
PARENT'S/GUARDIAN PHONE NUMBER: ______________
DATE: _____________
PERMISSION SLIP for Kentucky Science Center
I give permission for my child _______________________________to
participate in the following field trip at: Kentucky Science Center June 23
Furthermore, I waive, release, and hold harmless any staff member,
owner, director, or other employee of The Hornet Club from any and all
claims and liability arising from my child's participation in the field trip and
transportation thereto and therefrom as described above.
In the event of a medical emergency or accident, I authorize the
supervising staff person of The Hornet Club to obtain emergency medical
care for my child.
NAME OF PHYSICIAN: _____________________________
Program will use the Frankfort Regional Medical Hospital unless another is
specified. Other HOSPITAL: ___________________
SIGNATURE OF PARENT/GUARDIAN: ________________
PARENT'S/GUARDIAN PHONE NUMBER: ______________
DATE: _____________
PERMISSION SLIP for Louisville Slugger Museum
I give permission for my child _______________________________to
participate in the following field trip: Louisville Slugger Museum July 7
Furthermore, I waive, release, and hold harmless any staff member,
owner, director, or other employee of The Hornet Club from any and all
claims and liability arising from my child's participation in the field trip and
transportation thereto and therefrom as described above.
In the event of a medical emergency or accident, I authorize the
supervising staff person of The Hornet Club to obtain emergency medical
care for my child.
NAME OF PHYSICIAN: _____________________________
Program will use the Frankfort Regional Medical Hospital unless another is
specified. Other HOSPITAL: ___________________
SIGNATURE OF PARENT/GUARDIAN: ________________
PARENT'S/GUARDIAN PHONE NUMBER: ______________
DATE: _____________
PERMISSION SLIP for Franklin Square Cinema
I give permission for my child _______________________________to
participate in the following field trip: Franklin Square Cinema July 14
Furthermore, I waive, release, and hold harmless any staff member,
owner, director, or other employee of The Hornet Club from any and all
claims and liability arising from my child's participation in the field trip and
transportation thereto and therefrom as described above.
In the event of a medical emergency or accident, I authorize the
supervising staff person of The Hornet Club to obtain emergency medical
care for my child.
NAME OF PHYSICIAN: _____________________________
Program will use the Frankfort Regional Medical Hospital unless another is
specified. Other HOSPITAL: ___________________
SIGNATURE OF PARENT/GUARDIAN: ________________
PARENT'S/GUARDIAN PHONE NUMBER: ______________
DATE: _____________
PERMISSION SLIP for Kentucky Kingdom/Water Park
I give permission for my child ______________________________________ to
swim, participate in water activities, and ride water rides at Kentucky
Kingdom on ______July 21 and _____July 22, 2020.
Furthermore, I waive, release, and hold harmless any staff member,
owner, director, or other employee of The Hornet Club from any and all
claims and liability arising from my child's participation in the field trip and
transportation thereto and therefrom as described above.
In the event of a medical emergency or accident, I authorize the
supervising staff person of The Hornet Club to obtain emergency medical
care for my child.
NAME OF PHYSICIAN: _____________________________
Program will use the nearest available Hospital in Louisville Kentucky unless
another is specified. Other HOSPITAL: __________________
SIGNATURE OF PARENT/GUARDIAN: ________________
PARENT'S/GUARDIAN PHONE NUMBER: ______________
DATE: _______________
Child Care Animal Consent Form
Center’s Name: The Hornet Club
Center’s Address: 300 Copperleaf BLVD, FRANKFORT, KY 40601
Child’s Name: ____________________________________
DOB: _______________
I _______________________________________ give my permission for my
child________________________ to be in the presence of the animals listed
below.
Animals
1. ______ Lizard ___________________________________
2. ______ Cat ______________________________________
3. ______Dog ______________________________________
4 _______ Fish _______________________________________
5. ______ Snails ______________________________________
6. ______ Ants _______________________________________
7. ______Worms ______________________________________
8. ______Turtle ______________________________________
Name of Parent/Guardian: ___________________Date:_________
Signature of Parent/Guardian: ______________________________
Child Care regulatory policy will allow the following enclosed or caged
classroom animals with parental consent: fish, hamsters, gerbils, guinea
pigs, hermit crabs, turtles, birds, non-poison amphibians, bearded
dragons, rabbits, chinchillas as well as caterpillars and butterflies.
PHOTOGRAPHY RELEASE FORM
This completed form is needed for student participation in activities that
involve photographs or videotaping.
___ Yes, I hereby give and grant permission to The Hornet Club After-
School and Summer Programs to use my child's photograph or voice in
any way that would reasonably and properly portray the program at
Hearn Elementary School. Such usage may include newspapers, district
wide publications and presentations at Family Resource functions.
____ No, I do not give or grant permission for use of my child’s photograph,
likeness and/or voice as described above.
Parent signature _____________________________
Child’s Name: ______________________________
Date: _______________
HORNET CLUB PARENTS/GUARDIANS
Child’s Name: _________________
(Complete only 1 section)
I, _________________________ give my permission for my child,
____________________________, to watch G rated movies only.
Signature ______________________
Date: ___________
I, _____________________________ give permission for my child,
_____________________, to watch PG movies that have been pre-viewed by
an adult/teacher
Parent/Guardian Signature: ______________________________
Date: _____________
Children's shirt sizes are small (6-8), medium (10-12), and large (14-16).
Adult sizes are Sm, Med, Lg, XL $6.00 each, and XXL $8.00, XXXL $8.50. If
in doubt about size, order the next larger size. Please make all checks
payable to The Hornet Club
My child ________________________________________ shirt size is
________ Small (6-8)
________ Medium (10-12)
________ Large (14-16)
If parents would like a shirt, please indicate name and size below:
I ________________________________ need shirt size
__________ Small
__________ Medium
__________ Large
__________ XLarge
___________ XXLarge
PERMISSION SLIP for Republic Movie Theater
I give permission for my child ____________________________________ to
participate in the following field trip: Republic Movie Theater July 14
Furthermore, I waive, release, and hold harmless any staff member,
owner, director, or other employee of The Hornet Club from any and all
claims and liability arising from my child's participation in the field trip and
transportation thereto and therefrom as described above.
In the event of a medical emergency or accident, I authorize the
supervising staff person of The Hornet Club to obtain emergency medical
care for my child.
NAME OF PHYSICIAN: _____________________________
Program will use the Frankfort Regional Medical Hospital unless another is
specified. Other HOSPITAL: ___________________
SIGNATURE OF PARENT/GUARDIAN: __________________________________
PARENT'S/GUARDIAN PHONE NUMBER: ____________________
DATE: _______
I have received a copy of the CHILDREN AND PARENTS RIGHTS pursuant to
KRS 199.898.
Parents/Guardians signature:
_______________________
Child’s name: ____________________________
Date: ________________
CHILDREN AND PARENT RIGHTS
PURSUANT TO KRS 199.898
(l)All children receiving child care services in a day-care center licensed
pursuant to KRS 199.896, a family child-care home certified pursuant to
KHS 199.8982, or from a provider or program receiving public funds shall
have the following rights:
(a) The right to be free from physical or mental abuse;
(b) The right not to.be subjected to abusive language or abusive
punishment; and
(c) The right to be in the care of adults who shall meet their health, safety;
and developmental needs.
(2) Parents, custodians, or guardians of these children specified in
subsection (1) of this section shall have the following rights:
(a) The right to have access to their children at all times the child is in care
and access to the provider caring for their children during normal hours of
provider operation and whenever the children are in the care of the
provider;
(b) The right to he provided with information about child-care regulatory
standards, if applicable; where to direct questions about regulatory
standards; and how to file a complaint;
(c) The right to file a complaint against a child-care provider without any
retribution against the parent, custodian, guardian, or child; and
(d) The right to review and discuss with the provider any state reports and
deficiencies revealed by such reports.
(3)The child-care provider who is licensed pursuant to KRS 199.896 or
certified pursuant to KRS 199.8982 shall post these rights in a prominent
place and shall provide a copy of these rights at the time of the child'
enrollment in the program.