Paperwork Packet ECS Aftercare

2023-2024 ECS Aftercare Student Wellbeing Paperwork Packet

Parents: please complete this form within 1-2 weeks of registering your child for the Venture Outdoors aftercare program at ECS Intermediate (and prior to the first day of school). We may contact you for additional information. This form takes about 15 minutes to complete.

Step 1 of 5

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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 2023(Required)

3rd Grade

4th Grade

5th Grade

Registered Aftercare Option

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 Name(Required)

First Last

Parent/Guardian Phone Number(Required)

Parent/Guardian 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.

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
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 other allergies, such as food, medication or seasonal?
Will child carry medication for allergies?
Does child have special dietary needs, such as vegan/vegetarian?
Does child have muscle spasms?
Is child taking medication? If Yes, explain below.

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?
Has your child ever been treated for attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (AD/HD)?
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 affect the child’s life?
Does your child receive 1:1 support during the school day?
Is your child comfortable with water?

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

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?

Acknowledgment(Required)

By selecting this box, I hereby acknowledge that the above information is true and accurate to the best of my knowledge.

Today's Date(Required)

Month

Day

Year

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

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.

Behavior Guidelines(Required)

We understand and agree to the Behavior Guidelines.

I will treat myself, others, and equipment with respect.

I will speak highly of my fellow peers and Venture Outdoors staff.

I will keep my hands to myself.

I will set a positive example for others because I am a role model.

I will always remain with my group and Venture Outdoors staff at all times.

I will ask Venture Outdoors staff for their permission to use the restroom, get a drink of water, or go elsewhere.

I agree to accept the instructions that are given to me by Venture Outdoors staff and follow them the first time.

Conduct Violation(Required)

We understand and agree to the Conduct Violation Code.

If I act in such a way that does not follow the behavior guidelines, I understand that there may be consequences for my actions, including verbal warnings, parental contact, or suspension/dismissal from the program. My parent may need to come pick me up from the program in the event that I need to be sent home in the middle of a program.

I will seek to understand why I acted the way I did and work with Venture Outdoors staff to make better behavior choices.

Behavior Response Guidelines(Required)

We have reviewed and understand the behavior responses guidelines. We understand no refunds will be issued in the event of suspension or termination from the program.

We want to make aftercare a fun and enjoyable space for all children and staff. We expect students to treat themselves, fellow students and staff, and equipment with respect and care. Below outlines our team’s behavior response actions. While every situation is different, these are the guidelines we follow and will work with the child and parent on a case-by-case basis.

No refunds will be issued for student suspensions or terminations.

Level 1 Behaviors

Level 1 behaviors warrant the following responses in order if unresolved:
1. Verbal warning
2. Parent communication
3. Parent/child meeting with staff
4. Suspension (1-day)
5. Termination from program

Behaviors:
• Misuse of food or equipment
• Littering
• Excessive touching/personal space violation
• Not following directions
• Teasing (name calling, isolation)
• Profanity
• Lying/dishonesty
• Disrespecting staff or others
• Disregarding cell phone/electronics policy

Level 2 Behaviors

Level 2 behaviors warrant the following responses in order if unresolved:
1. Parent communication and suspension (1 day)
2. Termination

Behaviors:
• Physical aggression (hurting self, shoving/slapping, kicking furniture or equipment)
• Verbal aggression (yelling/screaming)
• Bullying (repeated verbal, physical targeted behavior)
• Out of bounds (leaving the group/property)
• Stealing

Level 3 Behaviors

Level 3 behaviors results in immediate parent contact and termination from the program.

Behaviors:
• Threats
• Fighting
• Vandalism/destruction of property
• Having drugs, alcohol, knife, gun or other weapon

Parent Signature(Required)

We agree to the Behavior Guidelines and Conduct Violation Policy.

As a parent, I have read and understand this conduct contract. I have discussed these expectations with my child, who has agreed to follow them while in the program. I understand that I will not receive a refund if my child is suspended/dismissed from the program for violation of this contract.

Consent and Understanding

Transportation(Required)

I give permission for my child to be shuttled by Venture Outdoors staff in a Venture Outdoors company vehicle.

On occasion, we may transport students in a Venture Outdoors company vehicle to travel for off-site Half Day adventures. We will notify you ahead of time when we plan on shuttling the students. Students are expected to follow the same behavior guidelines outlined in the student contract.

Program Waiver(Required)

I will complete an Acknowledgment & Assumption for Risk for my child.

In addition to this paperwork packet, you must complete a Venture Outdoors Acknowledgement & Assumption of Risk Form for your child. Venture Outdoors staff will send this form to you to complete via a digital link.

Cancellation Policy(Required)

I agree to the cancellation policy.

I understand cancellation of service must be done via email to Lo@ventureoutdoors.org two weeks prior to my child’s departure from the program. I understand I will be responsible for paying for two weeks of care from the date written notification was received.

Payment Policy(Required)

I agree to the payment policy.

I understand the payment is based upon enrollment, not the actual attendance of my child. Fees will be collected in monthly payments throughout the school year. Payment is automatically charged through a subscription on our website.

I understand if payment has not been made, my child(ren) will not be able to participate. If financial hardship is the reason for non-payment, I will contact Lo@ventureoutdoors.org

Payment/Return Fee Policy(Required)

I agree to the payment/return fee policy

I understand that a late fee of $25.00 will be assessed if payment is 5 or more days late.

I understand that if my bank or creditor returns my payment for any reason, I will be charged $10.00 per return.

Refund Policy(Required)

I agree to the refund policy.

I understand that refunds will not be issued for reasons of personal schedule conflict or change of plans. Restrictions due to medical reasons will require documentation.

Late Pick Up Policy(Required)

I agree to the late pick up policy.

I understand that my child must be picked up by 6:00pm. I will be charged a late fee of $1.00 per minute per child beginning at 6:01pm.

Part Time Care Policy(Required)

I agree to the part time care policy.

I understand that if I registered for a part-time care option, my child CANNOT attend aftercare on any other days (with the exception of the Friday half day adventures).