2010-11 Before and After School Program
Laugh, Learn and Grow with the
Bullitt County School-Age Child Care Program! The YMCA of Greater Louisville, in partnership with Bullitt County Public Schools, offers the School-Age Child Care Program — where your child will learn, grow and have a great time!
a ge s 5 –14
ymcalouisville.org Financial assistance available.
Bullitt County School-Age Child Care Program (502) 955-6433 ● (502) 543-3985
We’re Everywhere
School Sites
The YMCA Bullitt County School-Age Child Care Program is available to all Bullitt County Public School students from kindergarten through middle school.
Before- and After-School Care (Grades K-8) Cedar Grove Elementary Crossroads Elementary Freedom Elementary Maryville Elementary Mt. Washington Elementary Old Mill Elementary Pleasant Grove Elementary Roby Elementary Shepherdsville Elementary
Grow with Us We pride ourselves on providing a safe environment where your child can participate in fun activities that enrich, strengthen and expand their learning. Our activities are focused around literacy, arts and humanities, recreation, science & technology, academic support, healthy actions and fitness, character development and asset building. Our goal is to help your child build a healthy spirit, mind and body.
Daily Schedule Regular program hours are 6 a.m. until the start school and close of school until 6 p.m. Continuous care is also available from 6 a.m. until 6 p.m. when school is not in session, at select locations. Fall Break, Spring Break, Winter Break and Summer programs require a separate registration. In addition to planned activities and programs, each child will receive healthy morning and afternoon snacks. Breakfast is served for children in the before-school program.
Trained Staff Our outstanding staff members receive extensive hours of professional development training that exceeds state licensing requirements. All staff are CPR and First Aid certified and we meet or exceed state staff-to-child ratios.
Parental Involvement All our programs have an open door policy and parents are welcome and encouraged to take part in their child’s day. Each site will host special family events. Throughout the year, we distribute surveys to parents and participants. Your feedback is valuable and greatly appreciated!
visit ymcalouisville.org or email us at bullittcounty@ymcalouisville.org
YMCA Mission To put Christian principles into practice through programs that build a healthy spirit, mind and body for all!
Site locations may vary due to consolidations. All sites have minimum and maximum enrollment numbers. Feeder Schools Before- and after-school care is available at the site listed after your child’s school.
Brooks Elementary ª Freedom Elementary Lebanon Junction Elementary ªCedar Grove Elementary Overdale Elementary ª Maryville Elementary Bernheim Middle ª Cedar Grove Elementary Bullitt Lick Middle ª Shepherdsville Elementary Hebron Middle ª Freedom Elementary Zoneton Middle ª Maryville Elementary Mt. Washington Middle ª Crossroads Elementary Eastside Middle ª Pleasant Grove Elementary
Transportation provided by Bullitt County Public Schools and is subject to change. All sites have minimum and maximum enrollment numbers.
Weekly Rates First Child
Each Additional Child
4- or 5-day Before- or AfterSchool Only Before & After School
$48
$32
$60
$38
1-, 2- or 3-day Before- or AfterSchool Only Before & After School
$32
$25
$45
$30
Through August 2, 2010
August 3, 2010 throughout school year
$25 per day
$25 per day
Registration Fees Per Child In-service/Snow Day Only
$30 per child
$45 per child
In-service and snow days are included in total number of days attended for the week. No additional fees for early dismissal days. Weekly fees apply.
Registration Registration for the before- and after-school programs will continue throughout the school year based on space availability. All sites have minimum and maximum enrollment numbers and registrations are processed on a first-come, first-served basis. Completed registrations must be received at least 2 business days prior to your child’s start date. To register submit your registration form and non-refundable registration fee one of the following ways:
• Online at ymcalouisville.org through August 2nd
• Bring registration form to your Site Director
• Mail the registration form and fee to:
YMCA of Greater Louisville Bullitt County Family Branch P.O. Box 846 Shepherdsville, KY 40165
Mail must be post-marked one week prior to start date.
Payment Options All payments are to be made by bank or credit card draft. Automatic draft payments must be set up prior to the first day of attendance. Drafts will occur each Wednesday for the current week. Contact our office with questions.
In-Service & Snow Days Full day care available during in-service and snow days from 6 a.m. until 6 p.m. Site locations for full days will be Roby Elementary, Freedom Elementary and Pleasant Grove Elementary. In addition to completing the registration form, participants must be signed up to attend these days at the site of their choice. Details available at your site or at ymcalouisville.org. In-service and snow days are included in total number of days attended for the week.
Financial Assistance & 3rd Party Subsidies Through the Spirit Program, we strive to turn no one away due to an inability to pay. The Spirit Program is a sliding-scale income-based financial assistance program available through the YMCA. Call (502) 955-6433 or go to ymcalouisville.org for a Spirit Application. All sites are also eligible for third-party subsidy reimbursements provided by 4-C, Foster Care, United Way, etc. Valid contracts must be on file with our main office prior to the program start date. Spirit Program assistance is only available for those that do not qualify for 4-C or other third-party subsidies.
2010-11 School Year Bullitt County School-Age Child Care Program Registration Form
Please attach a recent wallet size photo and immunization certificate for each child.
Please print legibly and include your registration fee. Register Online through August 2nd at ymcalouisville.org. Program Start Date_ _____________________________________
E-mail Address to receive confirmation_ ______________________________________________________________
1st Child’s Name First _____________________________ Middle _____________________________ Last_____________________________ Date of Birth _ _____/______ /______ Gender: African American/Black
Race:
Alaskan
Native Asian/Pacific Islander
Caucasian/White
Hispanic
Native American
M
F
Age_ ________
Other
Physical Conditions/Special Needs_________________________________________________________ Medications/Allergies___________________________________________________________________ To better serve your child, please indicate if he/she has been diagnosed with any of the following: ADD/ADHD
Convulsions
Rhett Syndrome
Bleeding/Clotting Disorders
Down Syndrome Yes
Does this child have an IEP?
Autism
Chronic Health Problems
Aspergers
Fragile X
Asthma/Severe Allergies
Cerebral Palsy
Diabetes
Bipolar Disorder
Heart defect/disease
Tourettes
Other______________________________
No
YMCA Child Care Site___________________________________________________________________ School Attending_ ____________________________________________________________________ Attendance:
1-3 Days
Participation:
Before-School Care
4-5 Days
Grade in School (2010-11)_ ______________________________________________________________________ After-School Care
Before & After-School Care
In-Service Day Care
Snow Day Care
2nd Child’s Name First _____________________________ Middle _____________________________ Last_____________________________ Date of Birth _ _____/______ /______ Gender: African American/Black
Race:
Alaskan
Native Asian/Pacific Islander
Caucasian/White
Hispanic
Native American
M
F
Age_ ________
Other
Physical Conditions/Special Needs_________________________________________________________ Medications/Allergies___________________________________________________________________ To better serve your child, please indicate if he/she has been diagnosed with any of the following: ADD/ADHD
Convulsions
Rhett Syndrome
Bleeding/Clotting Disorders
Down Syndrome Yes
Does this child have an IEP?
Autism
Chronic Health Problems
Aspergers
Fragile X
Asthma/Severe Allergies
Cerebral Palsy
Diabetes
Bipolar Disorder
Heart defect/disease
Tourettes
Other______________________________
No
YMCA Child Care Site___________________________________________________________________ School Attending_ ____________________________________________________________________ Attendance:
1-3 Days
Participation:
Before-School Care
4-5 Days
Grade in School (2010-11)_ ______________________________________________________________________ After-School Care
Before & After-School Care
In-Service Day Care
Snow Day Care
1st Parent/Guardian Name______________________________________________________________ Relationship to Child_____________________________________ Date of Birth ______ /______ /_ _____ Mailing Address_ _______________________________________________________________________ City_______________________________________ State_____________ Zip_______________________ Home Phone___________________________ Cell Phone_ _________________________ Work Phone __________________________ Employer_____________________________________________________ 2nd Parent/Guardian Name_ ____________________________________________________________ Relationship to Child_____________________________________ Date of Birth ______ /______ /_ _____ Mailing Address_ _______________________________________________________________________ City_______________________________________ State_____________ Zip_______________________ Home Phone___________________________ Cell Phone_ _________________________ Work Phone __________________________ Employer_____________________________________________________ Insurance Company _________________________________________________________________________________________ Policy Number_ __________________________________________________ Name of Physician_ _________________________________________________________________________________________ Physician Phone__________________________________________________ Yes! I would like to learn more about FREE or LOW-COST health insurance for my children and teens. Emergency Contact and Authorized Pick-Up Information Please give the names and phone numbers of people to contact in an emergency and/or names of persons authorized to pick up your child/children. Anyone picking up your child/children must be 18 years of age or older. A Photo ID is required at pick-up. Name_______________________________________________ Relation to child_ __________________________________ Phone 1_____________________________Phone 2____________________________ Name_______________________________________________ Relation to child_ __________________________________ Phone 1_____________________________Phone 2____________________________ The YMCA has permission for my child(ren) to be photographed and/or interviewed for promotional purposes: My child(ren) have permission to participate in basic health and fitness evaluations: Yes, I would like to make a charitable donation to The Spirit Campaign: Check here if either parent is: I currently receive a:
$10
Yes $25
Yes
No
No $50
$100
Other/please contact me
YMCA Employee
Spirit Program discount
4-C
Other 3rd party subsidy discount
You must choose one of the three options below in order to process your registration. All drafts will occur each Wednesday for the current week. Contact our office for questions. I am currently on automatic draft. Please use the information on file to draft my account for my registration fee(s) and to set up my weekly payments. Account ending in ____ ____ ____ ____.
EFT
Credit Card
I am authorizing a NEW bank draft from my checking account and I have attached a voided check. I am authorizing a NEW credit card draft and I have provided all the information below:
Credit Card Type:
Name as it appears on card ____________________________________________________________ Card Number_ _______________________________________ Expiration Date_ _______________
Billing Street Address___________________________________________________________________________________________________________________________Billing Zip_ _______________
Visa
MasterCard
Discover
I have the legal authority to sign up my child/children named on this form. I understand that this is an application and the named child’s/children’s participation is contingent upon space being available in this program. I also understand that once my application is confirmed, I must complete payment by the deadline. I understand that the YMCA prohibits staff members from being alone with children they meet in YMCA programs outside of the YMCA. This includes but is not limited to baby sitting, tutoring, sleep-over’s, etc. This health history is correct as far as I know and the child/children herein described have my permission to engage in all activities and field trips except as noted by me. A photo of each child and a copy of each child’s current immunization certificate will be on file with the YMCA prior to my child/children attending the program. Failure to comply with the above could result in the loss of child care space. In the event I cannot be reached in an emergency, I hereby give permission to the director of the program or designee to secure emergency medical services, including transportation and a physician. I also give permission to the attending physician to order injection, anesthesia or surgery for my child/children as named above. Medical and accident insurance is the responsibility of the parent or guardian. To the best of my knowledge; the information on this form is complete and accurate. I have read and agree to these terms and conditions.
Signature_______________________________________________________________________________________ Date Signed________________________