LEARN GROW THRIVE CHILD CARE & YOUTH SERVICES
at the Door County YMCA OVERVIEW
FEATURING: • Nutrious Breakfast & Lunch Daily • Day Care • After School Programs • Kid’s Day Out • Onsite Kid Care • Summer Camp • Income-Based Financial Assistance
www.DoorCountyYMCA.org
TABLE OF CONTENTS
YMCA CHILD CARE OVERVIEW Welcome..........................................................................................2 ProgramOfferings....................................................................3
CHILD’S CHOICE. PARENT’S CHOICE.
Benefits of Child Care Programming..............................4 Child Day Care - Barker..........................................................5 Before & After School Care.................................................6 Kids Club • Sturgeon Bay at Sunset....................................................7 • Southern Door.......................................................................8 • Sevastopol at Barker Center...........................................9 Kids Day Out............................................................................10 Summer Foods.........................................................................10 Summer Camp..........................................................................11 Youth, Preschool & Family Programming................12 Kid Care........................................................................................12 Service & Fee Agreement..................................................13 Photo Release/Sunscreen Form...................................14 RegistrationForms.......................................................15-20 Everyone Belongs at the Y...............................................21 Inquiry/Enrollment Forms.................................................22
Contact Map: Sturgeon Bay Program Center & Kid Care 1900 Michigan Street | 920.743.4949
Northern Door Program Center & Kid Care 3866 Gibraltar Road | 920.868.3660
Barker Center
1743 Egg Harbor Road | 920.818.0691
Lansing Avenue Center
876 S Lansing Ave | 920.818.0796
Children are our future. The Door County YMCA Child Care is about the basics in life, caring, learning, healthy, relationships and safety. Families trust the YMCA Child Care to give their children the opportunity to develop in spirit, mind and body.
WELCOME OUR MISSION: We engage and connect all people in pursuit of well-being and a vibrant, healthy and welcoming community.
A NOTE FROM OUR TEAM: All YMCA Child Care programs are dedicated to offering a high quality, educational and caring experience. We are designed around encouraging children to build healthy, happy attitudes and to acquire competencies and skills through a variety of educational and play experiences. Our goal is to develop a positive self-image, to foster a joy of learning to expand understanding and to assist children in forming rewarding social relationships. The development of desirable attitudes, healthy habits and skills is the end result. We believe that through engaging early OUR PROMISE: education curriculum that includes literacy development, Strengthening the creativity, self-choice, and learning through play children build the Foundations of Community necessary skills to create a foundation to be successful not only in school, but in their adult lives as well. Our staff at all our child The demands of life often leave care programs work together to develop a schedule and lessons parents with the need to find care that are based on each child’s individual goals and achievements. for their children when they can’t be Each child enrolled in any one of our programs is valued and there. This decision can be marked recognized as a unique individual with an opportunity for growth with uncertainty, stress, and anxiety. and development.
We strive to serve the growing needs of both the child and the parent by putting Christian principles into practice through programs that build healthy spirit, mind and body for all.
2
Overview of Child Care & Youth Program Offerings Child Care at Barker Center At the Y, strengthening community is our cause. The child care program is the Y’s response to assist working families with their need for safe quality care for their child(ren) each day while parents are at work.
Before & After School Care • Sturgeon Bay School Kids Club (Pg. 7) • Southern Door School Kids Club (Pg. 8) • Sevastopol School Kids Club (Pg. 9) Child Care at the Y is about nurturing a child’s development by providing a safe place for them to learn foundational skills, develop healthy, trusting relationships and build self-reliance through the Y values of caring, honesty, respect and responsibility.
Kids Day Out Children will discover new interests, gain independence, and make lasting friendships - all while having a great time in a safe and structured environment! Our fun-filled summer program is packed with weekly field trips, specialty clubs, sports, and outdoor activities.
Summer Foods Keep children well fed and active during the out of school months with summer foods. Nutritious meals and active programming will keep them healthy during the summer months.
Summer Camp Children will discover new interests, gain independence, and make lasting friendships - all while having a great time in a safe and structured environment! Our fun-filled summer program is packed with weekly field trips, specialty clubs, sports, and outdoor activities.
Youth Preschool & Family Programs The Y offers adults and children with special needs the support and priceless experience of interacting with and being accepted by their peers while providing parents with the peace of mind their children can become healthy and happy members of the community.
Onsite Kid Care
3
Drop in child care at Northern Door & Sturgeon Bay program centers service is available to parents while participating in YMCA programming or while working out in the YMCA facility. Staff is on duty to ensure each child’s visit is a safe, fun and nurturing experience.
BENEFITS OF DOOR COUNTY YMCA CHILD CARE PROGRAMMING AT BARKER CENTER Our Barker Center is located at 1743 Egg Harbor Road, Sturgeon Bay and is a group licensed Child Care Center for children aged 6 weeks - 12 years old. CENTER PROVIDES
A FUN ATMOSPHERE AND DIVERSE CURRICULUM
CARE IS PROVIDED BY
PROFESSIONAL AND EXPERIENCED STAFF MEMBERS.
• A variety of age appropriate and education equipment is provided. • Lesson plans provide time and socialization, physical activity, and team building. • Children are prepared emotionally, physically, and educationally for Kindergarten.
• Staff nurture children to develop meaningful relationships with peers and adults. • Children learn in a positive, caring environment. • Children feel valued and appreciated while increasing their self confidence. • Certified early childhood teachers.
LICENSED PROGRAM
CHILDREN AGES 3+ HAVE THE OPPORTUNITY TO EXPERIENCE INSTRUCTOR BASED LESSONS IN AREAS LIKE
ENSURES QUALITY STANDARDS ARE ACHIEVED • Youngstar rating 4 • Wisconsin shares subsidy available upon qualification.
YOUTH MEMBERSHIP
ALL FULL TIME ENROLLED CHILDREN AT BARKER • Receive a youth membership at the Door County YMCA
SWIMMING AND GYMNASTICS.
• Children will take frequent trips to the YMCA facility for programming and fun. • Facilitates team building and social skills. • Provides physical activity for a healthy lifestyle. • Skill development encourages fun age appropriate activities.
PROGRAMS PROVIDE
NUTRITIOUS, BALANCED MEALS SERVED FAMILY STYLE. • Children develop motor skills by serving plates themselves and passing food dishes to others. • Social skills, manners, and language are developed through conversation at the table. • Encourages healthy eating habits by learning portion sizes. Water is the preferred beverage choice and will be offered with every meal. • Infant formula, cereal, and infant foods provided to children less than 12 months of age.
WE’RE MORE THAN YOU KNOW. WE’RE A CAUSE. The Y. So Much More™
4
CHILD CARE
AT BARKER CHILD DEVELOPMENT CENTER
Children feel valued & appreciated while increasing their self-confidence with trained & educated teachers. We encourage healthy eating habits by learning portion sizes & balanced meals, served family style. Social skills, manners, & language are developed through conversation at the table. We provide formula, cereal, & infant food to children under 12 months of age. Children ages 3+ will take trips to the YMCA for programming & fun. 15 minutes of physical activity each hour is integrated into the curriculum. Certified staff will work to develop your child’s motor, cognitive, language, & social skills.
4-5 Days Per Week
Age Full Time* 6wks - 2yrs $215.00
1-3 Days Per Week
4 Hours or Less
Daily $60.00
Hourly $13.00
2 - 3yrs
$187.00
$55.00
$12.00
3 - 4yrs
$174.00
$54.00
$11.00
4 - 5yrs
$171.00
$48.00
$10.00
5 - 6yrs
$165.00
$45.00
$10.00
Rates effective as of 2/5/18 Registration Fee Upon Enrollment: $50.00 for first child & $15.00 for each additional child
5
Barker Center Monday - Friday | 5:30am- 5:45pm
BENEFITS
All children enrolled full time* at the Door County YMCA Barker Center receive a Youth Membership to the Door County YMCA. Full time* enrolled families may upgrade to a family membership at the Door County YMCA and receive a $30.00 monthly discount.
RATES Weekly Tuition
CENTER HOURS
ADDITIONAL CHARGES *Applies to all programs*
$50 per child $15 per additional child $1 per min. after 5:45p Late pick up: $10 Habitual failure to sign in/out: $25 Returned check fee: Center supplied sheets & blankets: $5 per day $3 per diaper Center supplied diapers: Registration fee upon enrollment:
*Forms required on pages 15-20
BEFORE & AFTER SCHOOL CARE Kids Clubs in partnership with Sturgeon Bay, Southern Door & Sevastopol schools. OUR CAUSE
THE Y IS FOR EVERYONE
At the Y, strengthening community is our cause. We believe that lasting personal and social change can only come about when we all work together to invest in our kids, our health and our neighbors. With a focus on youth development, healthy living, and social responsibility, the Y nurtures the potential of youth and teens, improves the nation’s health and well-being and provides opportunities to give back and support our neighbors.
OUR FOCUS
PROGRAM HIGHLIGHTS At the Y, we care for kids! With so many demands on today’s families, parents need all the support they can get. YMCA After school Programs provide a safe, structured, and fun environment for children right on school campus. With several affordable care options, including financial assistance for qualifying families, YMCA After school meets all of your needs by providing safety, homework support, recreation, and enrichment for your child before and after school. Our caring staff and well-rounded curriculum provide opportunities for your child to learn, grow, and thrive through participation in the arts, sports, and community service projects.
The Y makes accessible the support and opportunities that empower people and communities to participate and make a difference locally. As a nonprofit, charitable organization we serve the entire community. Donations support our scholarship program and our commitment - to strive to keep programs open to all. Youth Development - Nurturing the potential of every child and teen • Swim, Sports & Play • After school Care • Camp • Education & Leadership Healthy Living - Improving the nation’s health and well-being • Health, Wellness, & Fitness • Sports & Recreation • Family Time
KIDS CLUB The YMCA Kids Club philosophy is to develop the whole child in Spirit, Mind, and Body... SPIRIT • Character Development, focusing on the Y core values of Caring, Honesty, Respect, and Responsibility, is woven into all activities. • Opportunities for service learning and building community awareness. MIND • A variety of learning centers focusing on: creative arts, hands-on science, composition, reading, listening skills, and dramatic play. • Homework time is scheduled daily, and one on-one mentoring is available. BODY • Opportunities to enjoy healthy foods while learning about and practicing healthy lifestyle choices. • Time for recreational play or organized cooperative gaming (15 minutes each hour).
Social Responsibility - Giving back and providing support to our neighbors INVEST IN QUALITY CARE. • Community Services • Volunteerism & Giving • Service Learning The Y. So Much More™
6
STURGEON BAY KIDS CLUB AT SUNSET SCHOOL
GETTING REGISTERED
The YMCA is pleased to offer school age enrichment programs to children aged 4 through 12 years, within local communities including the Sturgeon Bay School district on site at the Sunset School. Through this important partnership, the Y provides opportunities for children to enrich their physical and emotional well-being while enhancing their academic needs. With this approach, the Y creates a safe and fun atmosphere that fosters new friendships, expands social skills and provides numerous opportunities to learn and grow every day. Kids Club enrollment includes all regularly scheduled school days. Additional programming available on school days out as planned and promoted, based on need. Additional fees apply. Watch for additional information coming through Kids Club.
KIDS CLUB RATES 2017-2018 After School After School Monday-Friday | 2:30-5:45pm
$43.00
Daily (Up to 3 Days/Week) Half Day In-service Full Day In-service Before School Daily (Up to 3 Days/Week) Before School Weekly (4-5 Days/Week) Before and After School Weekly
$12.00 $15.00 $28.00 $8.00 $30.00 $51.00
4K Wrap-Around Care
4K Wrap-Around Care
Monday (7:20am-5:45pm) Monday + Tuesday-Friday Before & After School Monday + Tuesday-Friday After School Tuesday-Friday After School (2:30-5:45pm) Monday-Friday After School Sevastopol Only Full Day In-service Half Day In-service
$42.00 $108.00 $97.00 $63.00 $63.00 $28.00 $15.00
*4-5 days Per Week
(All before school is at the Barker Center)
7
(All before school is at the Barker Center)
Registration for families wishing to enroll their child(ren) is done with the Y Kids Club Site Supervisor. Paperwork should NOT be sent to Sturgeon Bay or Sunset School offices or teachers. There is an one-time registration fee for the YMCA Before and After School program. $50 for one; $15 for each additional child. Registration fees are non-refundable and nontransferable. • Fees are based on contracted schedule NOT attendance • Payments are made on a weekly basis for the current week of service. • Payments are accepted via Automatic Bank Draft, Credit Card Draft, or on site. • Fee includes daily afternoon nutritious snack.
PROGRAM HOURS
• Kids Club is offered each day school is in session. Additional school days out are planned and promoted; additional fees apply. (See Kids Day Out Pg. 10) • Before school care is offered at the YMCA Barker Center starting at 5:30am. • Part-time schedules and pricing are available. • After school care begins at the end of the school day and ends at 5:45 pm. Full day 4k care on Mondays begins at 7:20am, and ends at 5:45pm.
*Forms required on pages 16-20 **Kids Club does not meet during Winter Break. Information about other YMCA Kids Day Out programming for these days will be shared.
SOUTHERN DOOR KIDS CLUB AT SOUTHERN DOOR SCHOOL
The YMCA is pleased to offer school age enrichment programs to children aged 4 through 12 years, within local communities including the Southern Door School District on site at the school. Through this important partnership, the Y provides opportunities for children to enrich their physical and emotional well-being while enhancing their academic needs. With this approach, the Y creates a safe and fun atmosphere that fosters new friendships, expands social skills and provides numerous opportunities to learn and grow every day. Kids Club enrollment includes all regularly scheduled school days. Additional programming available on school days out as planned and promoted, based on need. Additional fees apply. Watch for additional information coming through Kids Club.
KIDS CLUB RATES 2017-2018 School Age Care (Grades K-5) After School Monday-Friday | 3-5:45pm Daily After school
$43.00/Week $12.00/Day
School Days Out (Additional Fee) 1/2 Day In-service Full Day In-service *Must bring lunch
$15.00/Day $28.00/Day
4K Wrap-Around Care Monday-Thursday | 11:30-3:30p Monday-Thursday | 11:30-3:30p +Friday 7:45a-3p
$90.00/Week $110.00/Week
Registration for families wishing to enroll their child(ren) is done with the Y Kids Club Site Supervisor. Paperwork should NOT be sent to Southern Door School offices or teachers. There is an one-time registration fee for the YMCA Before and After School program. $50 for one; $15 for each additional child. Registration fees are non-refundable and nontransferable. • Fees are based on contracted schedule NOT attendance • Payments are made on a weekly basis for the current week of service. • Payments are accepted via Automatic Bank Draft, Credit Card Draft, or on site. • Fee includes daily afternoon nutritious snack.
PROGRAM HOURS
• Kids Club is offered each day school is in session. Additional school days out are planned and promoted; additional fees apply. (See Kids Day Out Pg. 10) • After school care begins at the end of the school day and ends at 5:45 pm. • Wrap around care for 4K with an option to add after school care for an additional fee. • Part-time schedules and pricing are available.
MEALS
4k Wrap-Around Care & After School Monday-Thursday | 11:30-5:45p Monday-Thursday | 11:30-5:45p +Friday 7:45a-5:45p
$125.00/Week $150.00/Week
Non-Club Participation Rate Daily Drop-In (Full Day In-service)
$35.00/Week
*Forms required on pages 16-20
GETTING REGISTERED
Healthy snack is provided after school. 4K WrapAround students have the opportunity to participate in the school lunch program (call school for pricing and to arrange an account) or to bring their own lunch.
**Kids Club does not meet during Winter Break. Information about other YMCA Kids Day Out programming for these days will be shared.
8
SEVASTOPOL KIDS CLUB AT BARKER CENTER
The YMCA is pleased to offer school age enrichment programs to children aged 5 through 12 years, within local communities. Through this important partnership, the Y provides opportunities for children to enrich their physical and emotional well-being while enhancing their academic needs. With this approach, the Y creates a safe and fun atmosphere that fosters new friendships, expands social skills and provides numerous opportunities to learn and grow every day. Kids will be bused from Sevastopol School to Barker Center via regular Sevastopol School bus route.
KIDS CLUB RATES 2017-2018
Regular programming includes all regularly scheduled school days. After School Monday - Friday | 3:30-5:45pm
$43.00/Week
Daily Fee (Up to 3 Days/Week)
$12.00/Day
1/2 Day In-service Additional Fee
$15.00/Day
Full Day In-service Additional Fee $28/day
$28.00/Day
*4-5 Day/Week
*Before school care is available at Barker Center. Part time rates also available.
*Forms required on pages 16-20
GETTING REGISTERED
Registration for families wishing to enroll their child(ren) is done with the Barker Center. Paperwork should NOT be sent to Sevastopol School offices or teachers. Payments are made on a weekly basis for the current week of service. There is an annual registration fee for the YMCA Before and After School program. $50 for one; $15 for each additional child. Registration fees are non-refundable and nontransferable. • Fees are based on contracted schedule NOT attendance • Payments are due on or before Monday of the week of service. • Payments are accepted via Automatic Bank Draft, Credit Card Draft, or on site. • Fee includes daily afternoon nutritious snack.
PROGRAM HOURS
• Kids Club is offered each day school is in session. Additional school days out are planned and promoted; additional fees apply. (See Kids Day Out Pg. 10) • After school care begins at the end of the school day and ends at 5:45 pm.
KID’S DAY OUT
LET LOOSE & MAKE FRIENDS Kids out of school for the day, or have an early release day? No problem! The Y offers enlightening experiences for school-aged children and an option for working parents when school is not in session. Keep their minds and bodies active with games and activities and their spirits full with artistic creations, when they are enrolled in our Kids Day Out programs. Kid’s Day Out is provided to Gibraltar, Sevastopol, Sturgeon Bay & Southern Door School Districts.
LEARNING & GROWING TOGETHER. The Y. So Much More™
Grades K-5; Program dates, fees, locations, and curriculum are published through our program brochures. Additional information can be found on our website www.DoorCountyYMCA.org
SUMMER FOODS PROGRAM
FUELS DOOR COUNTY COMMUNITY CHILDREN The Door County Y’s Sturgeon Bay Program Center sponsors a Summer Foods Program, where any child 18 and under that would like a FREE lunch during the summer will be fed a well-balanced, nutritious meal. With a mission to promote a healthy spirit, mind and body for all, and a focus on youth development, fueling the brains and bodies of Door County Community kids is what The Y is all about. Participants in Sturgeon Bay Camp Compass programs will receive FREE breakfast and lunch through this program, while other community locations will be served a lunch or snack, according to a set schedule. Full distribution sites are available starting in May on our website at www.DoorCountyYMCA.org
HEALTHY EATING & PHYSICAL ACTIVITY
• Water is accessible and available to children at all times, including at the table during snacks and meals. • Fruits or vegetables are served for every meal and snack. • We provide foods that don’t list sugar as one of the first three ingredients. • Children will be provided opportunities for moderate and vigorous physical activity for at least 60 minutes per day during a full-day program.
10
MAKE IT THE BEST SUMMER EVER AT DOOR COUNTY YMCA SUMMER CAMP Friendship. Accomplishment. Belonging. SUPPORT OF FAMILIES
SAFETY • Highly trained staff • Background checks • Certifications include CPR, First Aid, and Child Abuse Prevention • Licensed programs available • Security structured environments
TRADITION & VALUES • Door County YMCA has more than 20 years of camping experience. • Focus is fostering friendships, belonging, and accomplishments through age-appropriate enrichment activities. • Swim lessons and/or water safety instruction are included in full-time camps. • Free nutritious meals are included as a part of the Summer Food Program.
• Enrollments for the day, week, full-summer to fit every family’s busy calendar. • Various camps available for children aged 4-12, plus leadership camps for grades 7 & up. • Full-time camp hours available from 5:30am-5:45pm M-F during the out of school time. • Programming includes full day and half day care, specialized activity camps, CIT’s.
IT’S A SUMMER TO DISCOVER... The Y. So Much More™
11
COMMUNITY REPUTATION At the Y, you’re not just a member of a facility; you’re part of a cause with a shared commitment to nurture the potential of youth, improve health and well-being, give back and support our neighbors. YMCA members enjoy special pricing on programs and receive priority registration. • Summer Camp Brochure is released early March; registration starting mid-March. • Discounts for early registration for *most camps (prior to May 1st). • Wisconsin Shares accepted for licensed camps; YMCA scholarships also available. • Information also available online starting in march on our website www.DoorCountYMCA.org
YOUTH, PRESCHOOL & FAMILY PROGRAMMING FOR YOUTH DEVELOPMENT The Y nurtures the potential of every child and teen by supporting their unique youth development journey through values based programming and character development. From cradle to career, the Y provides youth with all the love and resources they need to succeed in life. The Y. For a better us™
LEARNING & GROWING TOGETHER • Gymnastics • Swim Lessons • Swim Team • Youth in Government • Dance • Art Classes • Youth Sports • Rotary Interact
• Busy Babies • Girls Night Out • Home School Phy-Ed • Strength & Conditioning • Under Water Hockey • Karate • Family Gym • Prime Time Family Center
• Northern Door After School Program Monday - Friday *bus available from Gibraltar to the Y
Programs are released in 6 sessions throughout the year. Please see our website www.DoorCountyYMCA.org or call the Y to get a brochure mailed directly to you.
KID CARE Drop in child care at Northern Door & Sturgeon Bay program centers service is available to parents while participating in YMCA programming or while working out in the YMCA facility. Staff is on duty to ensure each child’s visit is a safe, fun and nurturing experience. Our Kid Care will accommodate children 6 weeks and up. We also will take your children in the gym or in the family center depending on the availability of these rooms.
RATES
YMCA Members
$2.00/Child/Visit
Community Participants
$4.00/Child/Visit
**Please pre-pay at the Welcome Center when you arrive at the YMCA, (Max length of visit | 1 1/2 Hours)
PROGRAM HOURS STURGEON BAY CENTER
PROGRAM HOURS NORTHERN DOOR CENTER
FALL HOURS Monday-Friday | 8-11:30a Monday-Thursday | 4-7:00p *Closed Friday Evenings Saturday | 8:30-10:30a
FALL & SUMMER HOURS Monday-Friday | 8-11:00a Saturday | 8:30-10:30a *Closed Sunday
SUMMER HOURS Monday-Friday | 8:30-10:30a Monday-Thursday | 4:30-6:30p *Closed Friday Evenings **Closed Saturday & Sunday
WEE DELIVER
FOR THE STAFF
Let the childcare staff know if there is anything to make your child more comfortable if he/she is having trouble with the transition. If your child is upset for more than 15 minutes we will come and let you know. (Sooner than 15 minutes if you would like.)
CHILD WELL-BEING
Please, for the well-being of all other children in our kid care centers, do not bring your child if he/she is not feeling well.
Does your child need to be delivered to a program while you are busy with your class? No problem! At no extra charge, a qualified YMCA staff person will deliver your child to/from a YMCA program. Arrangements for Wee Deliver must be made when your child is signed into Kid Care. A separate sign-in book is available for this service. Kid Care does not deliver to swim or any of the lockers due to extra time needed.
SERVICE & FEE AGREEMENT Child:___________________________________________________ Date of Birth:_____________________________ The YMCA agrees to provide the following enrollment for the named child. The undersigned parent/guardian is registering for the named child to participate in and to pay the following fees and tuition.
Weekly Schedule
Arrival Time
Departure Time
Monday Tuesday Wednesday Thursday Friday • Tuition for the above mentioned child is completed and I agree that this accurately summarizes my intentions for my child’s enrollment for the center.
Weekly Fee Schedule Tuition
• Upon initial enrollment there is a $50.00 registration fee. ($50.00 for the first child, $15.00 for each additional child.) • I understand that all of the necessary forms must be completed and returned before my child may attend the center’s program.
Weekly Tuition
• The schedule for my child is also summarized above and I agree to provide a 2 week written notice for a revised schedule. • I understand that I am responsible for payments not paid by any third source funding, including, but not limited to Public Assistance. • I understand the terms and provisions of the Fees Policies cannot be amended, changed, modified or deleted unless in written form on a new Tuition Payment Agreement which is signed by an authorized representative. • All tuition is contracted and will be charged and expected to be paid weekly whether the child is or is not utilizing our services, while under the signed contract.
Parent/Guardian Signature:______________________________________________________ Date:___________________ 13
YMCA Director Signature:________________________________________________________ Date:___________________
PHOTO RELEASE FORM I give consent to let my child be photographed for use by the center in newspapers or other media for the purpose of publicity or advertisement. No last names will be published. Please circle:
Yes
No
PARENT/GUARDIAN’S PERMISSION
FOR THE APPLICATION OF SUNSCREEN TO CHILD Child:___________________________________________________ Date of Birth:_____________________________ As a parent/guardian of the above child, I give permission for the staff at the YMCA to apply a sunscreen product that is broad spectrum with SPF 30 or higher to my child as specified below. I understand that sunscreen may be applied to exposed skin, including by not limited to the face (except eyelids), tops of ears, nose, bare shoulders, arms and legs. I have checked below all applicable information regarding the child care program’s choice in brand/type and use of sunscreen for my child: __________ Staff may use the sunscreen of the program’s choice following the directions and recommendations printed on the product container. __________ I have provided the following brand/type of sunscreen for use on my child: ____________________________________________________________________________________________________________ __________ For medical or other reasons, please do NOT apply sunscreen to the following areas of my child’s body. ____________________________________________________________________________________________________________ Parent/Guardian Signature:______________________________________________________ Date:___________________ 14
This form is required ONLY for Barker Center Care Program DEPARTMENT OF CHILDREN AND FAMILIES Division of Early Care and Education
dcf.wisconsin.gov/
CHILD HEALTH REPORT – CHILD CARE CENTERS Use of form: Use of this form is voluntary; however, completion of this form meets the requirements of DCF 202.08(4), DCF 250.07(6)(L)3., and DCF 251.07(6)(k)3. Failure to comply with these rules may result in issuance of a noncompliance statement. Personal information
you provide may be used for secondary purposes [Privacy Law, s.15.04(1)(m), Wisconsin Statutes].
Instructions: Each child under 2 years of age shall have an initial health examination not more than 6 months prior to nor later than 3 months after being admitted to the center and a follow-up health examination at least once every 6 months thereafter. Except for a schoolaged child, each child 2 years of age or older shall have an initial health examination not more than one year prior to nor later than 3 months after being admitted to a center and a follow-up health examination at least once every 2 years thereafter. The parent / guardian shall give this form to the physician, physician assistant or HealthCheck provider to be completed, signed and dated. The licensee shall obtain a copy for the child’s record. Note: Children are also required to have on file at the child care center documentation of immunizations; it may be helpful if the parent / guardian were to include a copy of the child’s immunization record when submitting this form to the child care center.
PARENT OR GUARDIAN – Complete this section. Name – Child (Last, First, MI)
Birthdate – Child (mm/dd/yyyy)
Address – Child (Street, City, State, Zip Code) Name – Parent or Guardian (Last, First, MI) Address – Parent or Guardian (Street, City, State, Zip Code)
HEALTH PROFESSIONAL – Complete this section.
Instructions for feeding and care of child with special problems, including allergies – Specify (attach information as necessary).
Yes
No Does the child have a milk allergy? If “Yes”, identify the recommended milk substitute.
Date of most recent blood lead test: (mm/dd/yyyy). Note: Children on Medicaid are required to be tested at around ages 12 months and 24 months or once between the ages of 3 and 5 years if no previous test is documented. Lead testing is optional for children who are not on Medicaid. Immunization(s) not to be administered to child due to medical reason(s) – Specify.
AUTHORIZATION I certify that I have examined the above child on this date and that he / she is able to participate in child care activities. Name – MD, PA or HealthCheck Provider (type or print) SIGNATURE – MD, PA or HealthCheck Provider
DCF-F-CFS0060-E (R. 07/2013)
15
Address (Street, City, State, Zip Code) Date of Examination
16
HEALTH HISTORY AND EMERGENCY CARE PLAN
Page 1 of 2
STATE OF WISCONSIN
Address – Medical Facility
PHYSICIAN / MEDICAL FACILITY INFORMATION Name – Physician
Telephone Number – Work
Telephone Number
Telephone Number – Cellular
No I authorize the center to allow my child to self-apply sunscreen.
1.
Epilepsy / seizure disorder
Cerebral palsy / motor disorder
Non-food allergies – Specify.
Food allergies – Specify food(s).
Ingredient Strength
Any disorder including Cognitively Disabled, LD, ADD, ADHD, or Autism
Gastrointestinal or feeding concerns including special diet and supplements
Milk allergy. If a child is allergic to milk, attach a statement from the medical professional indicating the acceptable alternative.
Other condition(s) requiring special care – Specify.
Diabetes
Asthma
Check any special medical condition that your child may have. No specific medical condition
Brand Name Yes No I authorize the center to apply repellent to my child. Yes No I authorize the center to allow my child to self-apply repellent. HEALTH HISTORY AND EMERGENCY CARE PLAN If available, attach any health care plan information from the child’s physician, therapist, etc.
Yes
SUNSCREEN / INSECT REPELLENT AUTHORIZATION If provided by the parent, the sunscreen or insect repellent shall be labeled with the child’s name. Per DCF 251.07(6)(f)2., authorizations shall be reviewed every 6 months and updated as necessary. Per DCF 250.07(6)(f)2.a., Authorizations shall be reviewed periodically and updated as necessary. Brand Name Ingredient Strength Yes No I authorize the center to apply sunscreen to my child.
Telephone Number – Home
Name
Telephone Number – Cellular
Date – First Day of Attendance (mm/dd/yyyy)
Provide information where the parent(s) / guardian(s) may be reached while the child is in care. Telephone Number – Home Telephone Number – Work
Birthdate (mm/dd/yyyy)
Telephone Number
PARENT / GUARDIAN INFORMATION Name
Address – Home (Street, City, State, Zip Code)
CHILD INFORMATION Name (Last, First, MI)
Instructions: The parent / guardian should complete this form for placement in the child’s file prior to the child’s first day of attendance. Information contained on the form shall be shared with any person caring for the child. The department recommends that parents / guardians and center staff periodically review and update the information provided on this form.
Use of form: This form is required for family and group child care centers and day camps to comply with DCF 250.04(6)(a)1. and 250.07(6)(L)5., DCF 251.04(6)(a)6. and 251.07(6)(k)5., and DCF 252.44(6)(g) of the Wisconsin Administrative Codes. Failure to comply may result in issuance of a noncompliance statement. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(1)(m), Wisconsin Statutes].
DEPARTMENT OF CHILDREN AND FAMILIES Division of Early Care and Education DCF-F (CFS-2345) (R. 03/2009)
This form is required ONLY for Barker Center Care & Kid’s Club Programs
Steps the child care provider should follow. If prescription or non-prescription medications are necessary, a copy of the form Authorization to Administer Medication should be attached to this form. Note: group child care centers and day camps may use their own form.
Identify any child care staff to whom you have given specialized training / instructions to help treat symptoms. a.
4.
5.
When to consider that the condition requires emergency medical care or reassessment.
Additional information that may be helpful to the child care provider.
7.
8.
Review dates:
SIGNATURE – Parent or Guardian
When to call parents regarding symptoms or failure to respond to treatment.
6.
c.
Date Signed (mm/dd/yyyy)
Signs or symptoms to watch for – Specify.
3.
b.
Triggers that may cause problems – Specify.
Page 2 of 2
STATE OF WISCONSIN
2.
DEPARTMENT OF CHILDREN AND FAMILIES Division of Early Care and Education DCF-F (CFS-2345) (R. 03/2009)
17
18
CHILD CARE ENROLLMENT
http://dcf.wisconsin.gov
Birthdate (mm/dd/yyyy)
First Day of Attendance
Place of Employment and Work Phone No.
Place of Employment and Work Phone No.
Email Address Where Reachable While Child is in Care
Does child reside at this location? Yes No
Home / Cell Phone No.
Does child reside at this location? Yes No
Home / Cell Phone No.
Email Address Where Reachable While Child is in Care Place of Employment and Work Phone No.
DCF-F-CFS0062 (R. 12/2014)
No No No No
Address (Street, City, State, Zip Code)
Telephone Number
I hereby give my consent for emergency medical care or treatment to be used only if I cannot be reached immediately. I have had an opportunity to review the policies of this child care center and a summary of the Wisconsin Rules for Licensing Child Care Centers. I give permission for my child to participate in Transported Walking field trips and other activities during operating hours. I have been informed of the number of pets in the center and their degree of contact with the enrolled children. Note: If pets are added after a child is enrolled, parents shall be notified in writing prior to the pet's addition to the center. Date Signed SIGNATURE – Parent or Guardian
Yes Yes Yes Yes
AUTHORIZATIONS
PHYSICIAN OR MEDICAL FACILITY Name
EMERGENCY CONTACT – The person to be notified in an emergency when parents / guardians cannot be reached. Yes No This person is authorized to pick up the child. Name and Relationship to Child Home / Cell Phone No. Email Address Where Reachable While Child is in Care Place of Employment and Work Phone No.
b. Name and Relationship to Child
AUTHORIZED PERSONS – Persons other than parents / guardians who are authorized to pick up the child or accept the child if dropped off. If no one, write "None." a. Name and Relationship to Child Home / Cell Phone No. Email Address Where Reachable While Child is in Care Place of Employment and Work Phone No.
Home Address (Street, City, State, Zip)
b. Name and Relationship to Child
Home Address (Street, City, State, Zip)
PARENT OR GUARDIAN – All parents / guardians are permitted to visit during center hours and are allowed to pick up the child unless access is prohibited or restricted by a court order. Attach court order, if any. If the child resides at multiple locations, the department recommends the provider obtain and attach a schedule. a. Name and Relationship to Child Home / Cell Phone No. Email Address Where Reachable While Child is in Care
CHILD INFORMATION Name (Last, First, MI)
Use of form: Use of this form is mandatory for Family Child Care Centers to comply with DCF 250.04(6)(a)1. Failure to comply may result in issuance of a noncompliance statement. This form may also be used by Group Child Care Centers and Day Camps to comply with DCF 251.04(6)(a)1. and DCF 252.41(4)(a)1. respectively. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(1)(m), Wisconsin Statutes]. Instructions: The parent / guardian shall fill out the form completely, sign it and submit it to the center prior to the child's first day of attendance. Information on this form shall be kept current. When enrolling a child under two years of age, a completed Intake for Child Under 2 Years form must also be on file prior to the child's first day of attendance.
DEPARTMENT OF CHILDREN AND FAMILIES Division of Early Care and Education
This form is required ONLY for Barker Center Care & Kid’s Club Programs
This form is required ONLY for Barker Center Care & Kid’s Club Programs DEPARTMENT OF HEALTH SERVICES Division of Public Health F-44192 (Rev. 09/08)
STATE OF WISCONSIN ss. 252.04,Wis. Stats.
DAY CARE IMMUNIZATION RECORD
COMPLETE AND RETURN TO DAY CARE CENTER. State law requires all children in day care centers to present evidence of immunization against certain diseases within 30 school days (6 calendar weeks) of admission to the day care center. These requirements can be waived only if a properly signed health, religious, or personal conviction waiver is filed with the day care center. See “Waivers” below. If you have any questions on immunizations or how to complete this form, please contact your child’s day care provider or your local health department. STEP 1
PERSONAL DATA
Child’s Name(Last, First, Middle Initial)
PLEASE PRINT
Date of Birth (Month/Day/Year)
Name of Parent/Guardian/Legal Custodian (Last, First, Middle Initial)
Area Code/Telephone Number
Address (Street, Apartment number, City, State, Zip)
IMMUNIZATION HISTORY
STEP 2 List the MONTH, DAY AND YEAR the child received each of the following immunizations. DO NOT USE A (ȼ) OR (X) except to indicate whether the child has had chickenpox. If you do not have an immunization record for this child, contact your doctor or local public health department to obtain the records. TYPE OF VACCINE First Dose Second Dose Third Dose Fourth Dose Fifth Dose Month/Day/Year Month/Day/Year Month/Day/Year Month/Day/Year Month/Day/Year Diphtheria-Tetanus-Pertussis (Specify DTP, DTaP, or DT) Polio Hib (Haemophilus Influenzae Type B) Pneumococcal Conjugate Vaccine (PCV) Hepatitis B Measles-Mumps-Rubella (MMR) Varicella (chickenpox) vaccine Vaccine is required only if the child has not had chickenpox disease. Has the child had Varicella (chickenpox) disease? Check the appropriate box and provide the year if known. Yes year _____________________ (Vaccine is not required) No or Unsure (Vaccine is required) STEP 3
REQUIREMENTS
The following are the minimum required immunizations for the child’s age/grade at entry. All children within the range must meet these requirements at day care entrance. Children who reach a new age/grade level while attending this day care must have their records updated with dates of additional required doses. AGE LEVELS NUMBER OF DOSES 5 months through 15 months 2 DTP/DTaP/DT 2 Polio 2 Hib 2 PCV 2 Hep B 1 2 3 16 months through 23 months 3 DTP/DTaP/DT 2 Polio 3 Hib 3 PCV 2 Hep B 1 MMR 1 2 3 2 years through 4 years 4 DTP/DTaP/DT 3 Polio 3 Hib 3 PCV 3 Hep B 1 MMR 1 Varicella 4 3 At Kindergarten entrance 4 DTP/DTaP/DT 4 Polio 3 Hep B 2 MMR 2 Varicella 1
If the child began the Hib series at 12-14 months of age, only 2 doses are required. If the child received one dose of Hib at 15 months of age or after, no additional doses are required. Minimum of one dose must be received after 12 months of age (Note: a dose 4 days or less before the first birthday is also acceptable).
2
If the child began the PCV series at 12-23 months of age, only 2 doses are required. If the child received the first dose of PCV at 24 months of age or after, no additional doses are required.
3
st
MMR vaccine must have been received on or after the first birthday (Note: a dose 4 days or less before the 1 birthday is also acceptable).
4
th
rd
th
th
Children entering kindergarten must have received one dose after the 4 birthday (either the 3 , 4 or 5 ) to be compliant (Note: a dose 4 days or th less before the 4 birthday is also acceptable).
STEP 4
COMPLIANCE DATA AND WAIVERS
IF THE CHILD MEETS ALL REQUIREMENTS (sign at STEP 5 and return this form to the day care center), OR IF THE CHILD DOES NOT MEET ALL REQUIREMENTS (check the appropriate box below, sign and return this form to day care center). Although the child has not received all required doses of vaccine for his or her age group, at least the first dose of each vaccine has been received. I understand that it is my responsibility to obtain the remaining required doses of vaccines for this child WITHIN ONE YEAR and to notify the day care center in writing as each dose is received. NOTE: Failure to stay on schedule or report immunizations to the day care center may result in court action against the parents and a fine of up to $25.00 per day of violation. For health reasons this child should not receive the following immunizations __________(List in STEP 2 any immunizations already received) ______________________________________________________________________ Physician’s Signature Required For religious reasons this child should not be immunized. (List in STEP 2 any immunizations already received) For personal conviction reasons this child should not be immunized. (List in STEP 2 any immunizations already received):
STEP 5
19
SIGNATURE To the best of my knowledge this form is complete and accurate. ____________________________________________________________________________
______________________________________
SIGNATURE - Parent, Guardian or Legal Custodian
Date Signed
This form is required ONLY for Barker Center Care & Kid’s Club Programs DEPARTMENT OF CHILDREN AND FAMILIES Division of Early Care and Education
http://dcf.wisconsin.gov
ALTERNATE ARRIVAL / RELEASE AGREEMENT – CHILD CARE CENTERS Use of form: This form is voluntary. However, this completed form, when on file in the child's record, meets the requirements of DCF 250.04(6)(a)3. and DCF 251.04(6)(a)5. and 251.095(4)(a)2. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(1)(m), Wisconsin Statutes]. Instructions: Complete this form for placement in the child's file when the child will arrive at the center from school, home or other activities, or depart from the center to go to school, home or other activities, and the child will not be accompanied by a parent or other previously authorized person or transported by the center. This form should be updated as information changes. Periodic review with the parent / guardian is recommended to ensure safety. If the center transports the child, the department’s form “Transportation Permission – Child Care Centers” may be used to obtain parental authorization.
ARRIVAL INSTRUCTIONS My child
(Child’s name)
will arrive at
(Name of center)
from
(School, home or other activity)
by way of at on
(Walking, bicycle, bus, car pool, etc. Be as specific as possible.) A.M. OR
(Time of arrival) Sunday
Monday
My child will arrive from this destination
P.M. Tuesday
with OR
Wednesday Thursday (Days of the week)
Friday
Saturday
without center supervision.
RELEASE INSTRUCTIONS My child
(Child’s name)
will leave
(Name of center)
by way of
(Walking, bicycle, bus, car pool, etc. Be as specific as possible.)
to go to at on
(School, home or other activity) (Time of departure) Sunday
A.M. OR
Monday
My child will travel to this destination
P.M.
Tuesday
with OR
Wednesday Thursday (Days of the week)
Friday
Saturday
without center supervision.
ADDITIONAL INSTRUCTIONS
I understand that I am responsible for notifying the center of any changes in this schedule such as vacation, school conference days, etc. SIGNATURE – Parent
DCF-F-CFS0104-E (R. 09/2009)
Date Signed (mm/dd/yyyy)
20
EVERYONE BELONGS AT THE Y
Our members and friends call us THEIR Y. We call them OUR greatest resource - the hundreds of people who work alongside us and support our work to help our community to learn, grow and thrive. With programs from A to Z such as athletics to advocacy, dance classes to disease prevention, basketball to volunteerism - we don’t just strengthen individuals, we strengthen our community. Each year hundreds of volunteers reach out to the community through Campaign to raise funds & awareness for the great work the Y is doing to strengthen the foundations of the community in Door County. Through programs that support youth development, promote healthy living, and foster social responsibility, the Y is bringing communities together and changing lives everyday.
FINANCIAL ASSISTANCE IS ALWAYS AVAILABLE THROUGH THE MEMBERSHIP FOR ALL PROGRAM The Door County YMCA is committed to making membership and access to programs affordable for everyone in our community. If at any time you feel you cannot include the cost of a YMCA membership in your monthly budget, please consider joining through our income-based pricing option! It’s easy and confidential. Your membership rate is based upon your household size and gross household income.
ANNUAL CAMPAIGN YMCA programs are open to everyone in the community, regardless of ability to pay. The YMCA leads an Annual Campaign to raise money for scholarships and program subsidies to support the involvement of all community members in our programs.
21
YOUTH DEVELOPMENT
All kids deserve the opportunity to discover who they are and what they can achieve, under the guidance of adults who care about them and believe in their unique potential. We see every interaction with young people as an opportunity for learning and development.
HEALTHY LIVING
Health and well-being are all about balance. That’s why we help the entire community build and maintain healthy habits for spirit, mind, and body in their everyday lives. By helping kids, adults, families, and seniors from all backgrounds improve their health and well-being, we build a stronger community.
SOCIAL RESPONSIBILITY
With our doors open to all, we work every day to connect people from all backgrounds and support those who need it most. We take on the most urgent needs in our community, and inspire a spirit of service in return. Our members, volunteers, donors, and staff demonstrate the power of what we can achieve by giving back together.
DID YOU KNOW? YOUR DOOR COUNTY YMCA... Barker Child Development Center is the largest & only licensed day care in Sturgeon Bay. Youth in Government and Rotary Interact programs provide 30-50 teens a year with life skills, public speaking, civic duty, government processes & community service opportunities.
Summer Foods program provides 450+ lunches daily in both Door & Kewaunee counties during the summer.
Provides 29% of familes enrolled at Barker with financial assistance for child care.
Provides over 300 children with scholarships to participate in programs such as, summer camp, youth sports & swim lessons.
Has taught over 300,000 swim lessons and water safety instructions to adults and children in both Door & Kewaunee Counties over the past 30 years. Has 400 or more After School Kids Club volunteers totaling program provides care 1,500 hours of their and learning to over time to help youth, 55 children per year adults and families in the in the Door County community every year. community
Provided $230,000 from the Annual Campaign in subsidized membership fees to cover 1,200 of our members so they can access a safe, supportive and healthy community regardless of financial means. It is our goal to be accessible to anyone who would like to live a healthy life.
Support the Y & our community. Consider donating to the Annual Campaign. Call 868-3660, 743-4949 or visit DoorCountyYMCA.org
please cut out and turn in to site supervisor
INQUIRY/ENROLLMENT Today’s Date: _____/_____/________
Phone: (
)
-
Parent/Guardian:__________________________________________________________________________________________________________ Address:_____________________________________________________________________________________________________________________ Email:______________________________________________________ Child’s Name:_______________________________________________ Day’s Requested: M T W TH F
Program:__________________________________________________ Date of Birth:_____/_____/________
Male - Female
Requested Care Start Date: _________________________________
GETTING REGISTERED Registration for any program is done by completing this enrollment form and contacting the site supervisor. *Paperwork should NOT be sent to any school offices or teachers.
22
Door County YMCA Our Mission: We engage and connect all people in pursuit of well-being and a vibrant, healthy and welcoming community.
www.DoorCountyYMCA.org