Paperwork Packet ECS Aftercare

Student Information

Student Name(Required)

First Last

Student Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Grade Entering in Fall 2025(Required)

3rd Grade

4th Grade

5th Grade

Registered Aftercare Option(Required)

Select the aftercare option that you have already registered and paid for.

5 Day Care Mon-Fri

3 Day Care Tues-Wed-Thurs

3 Day Care Mon-Wed-Fri

Parent/Guardian 1 Name(Required)

First Last

Parent/Guardian 1 Phone Number(Required)

Parent/Guardian 1 Email(Required)

Parent/Guardian 2 Name(Required)

First Last

Parent/Guardian 2 Phone(Required)

Parent/Guardian 2 Email(Required)

Emergency Contacts

Fill in emergency contact information – can be a parent/guardian, relative, family friend, etc. You CAN include the same parent that you previously listed above in the emergency contact list if applicable. We will reach out to Emergency Contacts in the order provided.

Emergency Contact #1 – Name(Required)

First Last

Emergency Contact #1 – Relationship to Child(Required)

Emergency Contact #1 – Phone Number(Required)

Emergency Contact #2 – Name(Required)

First Last

Emergency Contact #2 – Relationship to Child(Required)

Emergency Contact #2 – Phone Number(Required)

Emergency Contact #3 – Name(Required)

First Last

Emergency Contact #3 – Relationship to Child(Required)

Emergency Contact #3 – Phone Number(Required)

Student Medical and Wellbeing History

Medical Conditions(Required)

Complete the following chart by selecting Yes/No. Please comment on any “Yes” answers below.

	Yes	No
Asthma or other respiratory problems
Gastrointestinal disturbances
Diabetes
High blood pressure
Bleeding or blood abnormalities
Neurological problems or epilepsy
Dizziness or fainting episodes
Migraines
Heart problems
Disorders of urinary or reproductive tract
Knee, hip or ankle injuries and/or surgeries
Shoulder, arm, or back injuries and/or surgeries
Muscle Spasms
Head injury
Child greatly affected by heat
Child gets cold easily
Stroke

Use this space to expand on any "Yes" responses above.

Other Medical/Health Consideration(Required)

Complete the following chart by selecting Yes/No. Please comment on any “Yes” answers below.

	Yes	No
Any allergies, such as food, medication or seasonal?
Will child carry medication for allergies?
Does child have special dietary needs, such as vegan/vegetarian?
Is child taking any medication? If Yes, explain below.
Does child need to take any medications between 3:15p-6p?

Use this space to expand on any "Yes" responses above.

Include information on side effects of any medication, if they will need to take it during program hours, etc.

Child Wellbeing(Required)

Complete the following chart by selecting Yes/No. Please comment on any “Yes” answer below.

	Yes	No
Does your child have a mobility impairment?
Is your child sensitive to sights, sounds or other sensations?
Is your child comfortable with water?
Has your child ever been treated for attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (ADHD)?
Has your child ever been treated for emotional or behavioral difficulties or an eating disorder?
Has your child experienced a significant life event that continues to effect the child’s life?
Does your child receive 1:1 support during the school day?

Expand on any "Yes" responses above and list any medical, physical or emotional medical concerns that are not mentioned above and provide ways we can accommodate and support your child.

Please note: Our aftercare program does not have direct one-on-one paraprofessional support that may be available to a student during the school day. Please contact us to discuss further if needed.

Sunscreen/Bug Spray Permission(Required)

When weather and activities permit, Venture Outdoors staff may occasionally provide sunscreen or bug spray for students. I give permission for Venture Outdoors staff to assist my child in applying sunscreen and bug spray as needed.

Yes

No

Is there anything else you would like us to know about your child's wellbeing or that you would like staff to know about working with your child? This information is used to support your child. Ex. Do they need 5-10 mins of transition time before pickup or when changing activities?

Today's Date(Required)

Signature(Required)

Student Release Information

The pick up window for aftercare is 5-6PM daily. A late fee of $1/minute/child will be charged for late pick ups beginning at 6:01PM.

Release List(Required)

List out up to five individuals who may pick up the student at the conclusion of each day. Please include yourself (if you’ll be picking them up). Note: any individual picking up the student will be asked to show photo ID.

Name

Phone #

Relationship to Student

Pickup Schedule(Required)

Will your student be picked up by Parent/Guardian #1 on Monday, Wednesday, & Friday and Parent/Guardian #2 Tuesday & Thursday? (This is for information purposes only, you are not locked into this schedule.)

Student Contract

At Venture Outdoors, we strive to create meaningful and healthful experiences for children in the outdoors. In order to do so, we foster an environment where safety and wellbeing are of utmost importance. Please review and discuss the following guidelines with your child prior to the program. We will review this contract during the program and have students sign their understanding and agreement.

Paperwork Packet ECS Aftercare

2025-2026 ECS Aftercare Student Wellbeing Paperwork Packet

Student Information

Emergency Contacts

Student Medical and Wellbeing History

Student Release Information

Student Contract

Consent and Understanding