PLAYSCHOOL PARENT MANUAL 2014-2015

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PLAYSCHOOL PARENT MANUAL

Revised 3/31/2014

2014-2015

(AGES 3 - 5)

Sharron Baucom Dale City Rec Center 14300 Minnieville Road Dale City, Virginia 22193

703-670-7112

Veterans Memorial Park 14300 Veterans Drive

Woodbridge, Virginia 22191 703-491-2183

Ben Lomond Community Center 10501 Copeland Drive

Manassas, Virginia 20109 703-792-8320

Chinn Aquatics & Fitness Center

13025 Chinn Park Drive Woodbridge, Virginia 22192

703-730-1051

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Table of Contents PHILOSOPHY .................................................................................................................................. 4

CURRICULUM ................................................................................................................................ 4

PARTICIPANT QUALIFYING SKILLS ........................................................................................... 4

PRESCHOOL CHILD FIND PROGRAM ........................................................................................ 4

CHILDREN WITH SPECIAL NEEDS ............................................................................................. 5

HOURS ............................................................................................................................................. 5

MONTHLY FEES ............................................................................................................................. 5

PAYMENT ........................................................................................................................................ 5

CANCELLATIONS ........................................................................................................................... 6

TRANSPORTATION POLICY/FIELD TRIP POLICY .................................................................... 6

STUDENT ARRIVALS AND DEPARTURES .................................................................................. 6

LATE FEES ...................................................................................................................................... 6

FOOD POLICY ................................................................................................................................. 7

HOLIDAYS & SCHOOL CLOSINGS ............................................................................................... 7

INCLEMENT WEATHER ................................................................................................................ 7

EMERGENCY SITUATIONS ........................................................................................................... 8

COMMUNICATION ........................................................................................................................ 8

LINES OF AUTHORITY .................................................................................................................. 8

HEALTH .......................................................................................................................................... 8

POLICY FOR ADMINISTERING MEDICATION ........................................................................... 8

MEDICATION .................................................................................................................................. 9

POLICY FOR OVER-THE-COUNTER SKIN PRODUCTS ............................................................. 9

DISCIPLINARY STEPS ................................................................................................................... 9

BEHAVIORAL GUIDANCE ............................................................................................................. 9

FORBIDDEN STAFF ACTIONS .................................................................................................... 10

PROGRAM DISMISSAL POLICY ................................................................................................. 10

SUSPECTED CHILD ABUSE POLICY ........................................................................................... 11

MISCELLANEOUS INFORMATION ............................................................................................. 11

ONLINE REGISTRATION SYSTEM ............................................................................................. 12

DAILY SCHEDULE AND CURRICULUM .................................................................................... 18

PLAYSCHOOL CALENDAR 2014-2015 ........................................................................................ 19

AUTHORIZATION FORM ............................................................................................................ 20

REGISTRATION INFORMATION ................................................................................................ 21

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WELCOME!

Veterans Memorial Park Playschool staff would like to welcome you and your child into our program. Thank you for registering with us! Please take the time to look through this Playschool Manual and complete the attached forms. Please collect and turn in the following paperwork by your child’s first day of Playschool:

The attached Authorization Form (second-to-last page of Manual), Registration Form (last page of Manual),

School Entrance Health Form

Your child’s birth certificate, proof of birth letter or passport (we

must view original) You may return the paperwork to the Teachers/Front Desk Staff at the Veterans Memorial Park. Our staff is excited about working with you and your children this school year. We thank you for choosing the Playschool program at Veterans Memorial Park. We offer play-oriented activities that offer choices and freedom of expression. Our curriculum includes letter and number recognition, colors, shapes, art, music and movement, and more. Your questions and concerns are important to us. Please don’t hesitate to contact us. Front Desk Information 703-491-2183 Leslie Stone Park Manager 703-491-2183 [email protected]

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PHILOSOPHY The Playschool program is designed to provide exciting group experiences for children ages 3 to 5 in a positive and safe environment. The Playschool program provides opportunities for your child to develop a positive self-concept; to stimulate creativity; to encourage curiosity; to promote physical development; to perfect communication skills and to develop basic learning skills. Playschool is a subsidiary of the Prince William County Department of Parks and Recreation and therefore has no religious affiliation.

CURRICULUM Play is a child's primary vehicle to learning. Young children respond well to small group and individual activities. Our play-oriented activities offer choices and freedom of expression. Letters, numbers, colors and shapes are incorporated with daily creative art, music and movement.

PARTICIPANT QUALIFYING SKILLS The PWC Department of Parks and Recreation aims to provide the best overall Playschool program possible. Children enrolled in the PWC Department of Parks and Recreation Playschool must be the program age by September 30, 2014. We recommend that your child meet each of the following skills prior to enrollment:

1. Ability to participate in an environment with an age-specific staff to child ratio. 2. Potty training is required in our 3 – 5 year old classes. 3. Able to make the transition from leaving parent within one month. 4. Be able to participate in our staff to child classroom ratios. 5. Be able to participate for the duration of the class. 6. Able to follow simple/single instructions. 7. Able to eat and dress independently. 8. Respect others and their property.

PRESCHOOL CHILD FIND PROGRAM In cooperation with the Prince William County Public Schools, our preschool inclusion program serves children who are exhibiting delays in several areas of development and who require class-based special education services. The Child Find program is currently offered at Sharron Baucom Dale City Recreation Center and Chinn Aquatics and Fitness Center. They are served by a Preschool Special Education teacher who is based at our playschool. The special education teacher works with the playschool staff to meet the child’s specific needs in the least restrictive environment.

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CHILDREN WITH SPECIAL NEEDS Prince William County Department of Parks and Recreation programs are inclusion based activities. We make every effort to work with families to mainstream children with special needs into any of our programs. If you are requesting any type of accommodation for your child, you must submit a written request form found on line at www.pwcparks.org. At minimum, this request must be received, at least 15 business days prior to the start of the program. Dependent upon the request and/or type of accommodation requested, participation in a program may be dependent on scheduling and/or contracting specialized staff, which could impact days/times child can attend the program.

HOURS All of the Department Parks and Recreation Playschool programs are partial day

programs; there are no full day options. Each playschool site offers a variety of

programs with varied days/times.

(For specific information regarding Daily Schedules and Curriculum, Holidays, Teacher Workdays and Half-Days, and Inclement Weather please see related sections).

MONTHLY FEES A $10/month multiple child discount will be given for each additional child in the same family. (The monthly fee will be full price for the first child). Siblings may be registered in any of Veterans Memorial Park Playschool programs.

TIME DAYS AGES FEES

9:30a – 12:30p T-Th 3 years $137 month

9:30a – 12:30p M-W-F 4-5 years $184 month

9:30a – 12:30p M – F 4-5 years $232 month

PAYMENT Monthly fees must be paid at the Front Desk, by telephone, or online by the first of the month. NOTE: See pages 11 -15 for instructions on how to pay online.

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A $15.00 late fee will automatically be added to your account if payment is not received by the 1st of the month. Unpaid space will be made available to the next child on the waiting list beginning the 5th of each month. If you have to leave the program for any reason and then want to re-enroll at a later date the $40.00 registration fee will apply with the full month tuition.

CANCELLATIONS A written request is needed 2 weeks before cancellation date to process all cancellations. In the case of a refund, a $25 administrative fee will be charged.

TRANSPORTATION POLICY/FIELD TRIP POLICY All transportation to and from the center will be provided by the child’s parent/guardian. The Prince William County Department of Parks and Recreation does not offer any off-site field trips or provide transportation of any kind for our Playschool Program. At no time is a teacher permitted to transport the children.

STUDENT ARRIVALS AND DEPARTURES An adult must accompany each child into the Playschool room on arrival. Each child must be signed out daily. Please be prepared to show identification. A child will not be released to anyone but parent or legal guardian without written permission. A custodial parent shall be admitted to any child day program. Such right of admission shall apply only while the child is in the child day program (63.2-1813 of the Code of Virginia). Children will be released outside the classroom. Any extended visits or anyone not on the authorized pick up list must be pre-approved from the Program manager.

LATE FEES If you are late to pick up your child/children at dismissal time, you will be charged a late fee of $5.00. After 15 minutes, it is an additional $5.00 per minute. At this time, your child will be escorted to the Front Office and supervised by the Program Supervisor or the Manager on Duty. Late fees must be paid when you pick up your child. If we have not received a phone call, a teacher will make every attempt to contact a parent/guardian/emergency contact. If unable to do so within 1 hour of dismissal time, the child will be turned over to the Prince William County Police Department. This same procedure will be followed if the child is not picked up for emergencies including but not limited to inclement weather or natural disasters. If you are running late, please contact the front desk at 703-491-2183. Please make every attempt to be on time; the teachers have very little time between classes. Repeat offenders may be removed from the program at any time at Program Supervisor’s discretion.

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FOOD POLICY Snacks will be provided each day by the Playschool program. The center follows the most recent nutritional requirements of the United States Department of Agriculture when selecting snacks. Children are allowed to receive second helpings of snacks. A current snack menu is posted in each classroom. Please advise us of any food allergies your child may have or any food your child may not have for religious reasons. All food brought in for parties or celebrations must be in original store bought food container.

HOLIDAYS & SCHOOL CLOSINGS A Playschool calendar for the 2014-2015 school year is included in this manual. We follow the Prince William County School calendar for scheduled school closings.

INCLEMENT WEATHER We follow the Prince William County School policy on Inclement Weather:

School Closed – Playschool Closed School Delayed – Morning Playschool Closed School early release – Afternoon Playschool Closed

We have built in days into our schedule that will help us accommodate days missed due to inclement weather. If there are days missed that go beyond this allotment, the Prince William Department of Parks and Recreation will then make decisions as what further action needs to be taken, up to and including refunds and or proration of fees. Any adjustment in fees or refunds would be applied during the month of May. The chart below shows the days already built into the schedule and that will not be made up due to inclement weather.

Number or days program meets

Number of days that would not be made up

due to inclement weather

Days that would be subject to make up/refunds/proration

One Day Per Week One day Anything beyond 1 day

Two Days Per Week Up to Two days Any time missed beyond 2 days

Three Days Per Week Up to Three Days Any time missed beyond 3 days

Four Days Per Week Up To Four Days Any time missed beyond 4 days

Five Day Per Week Up to Five Days Any time missed beyond 5 days

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EMERGENCY SITUATIONS In an Emergency Situation, the Playschool staff will make every effort to speak with parents/guardians directly. If unable to do so, the designated Emergency Contacts will be contacted. This facility has an Emergency Preparedness Plan that includes procedures for staff to follow in the case of an emergency. The Emergency Preparedness Plan is available to the public upon request. To request a copy, please call the Front Desk at 703-491-2183.

COMMUNICATION If you need to contact staff immediately, or would like to leave a message with the staff, please call the Front Desk at 703-491-2183.

LINES OF AUTHORITY If you have any concerns or questions, please consult the Lead Teacher of your child’s program. If the answer/action is unsatisfactory, please contact the Park Manager, Leslie Stone at 703-491-2183 or email [email protected].

HEALTH Playschool staff will do their best to maintain a healthy environment. Parents can contribute to this effort by keeping sick children home. Teachers should be notified of an absence lasting three days or longer. Please keep your child home if he/she has:

1. A temperature over 100F (must be fever free for 24 hours before returning to school)

2. Recurrent vomiting or diarrhea 3. Any communicable disease

All allergies or medical conditions, which may limit activities, should be brought to the attention of the staff. If your child becomes ill while attending Playschool, parents will be notified in order for pick-up as soon as possible.

POLICY FOR ADMINISTERING MEDICATION If your child requires prescription and/or nonprescription medication, a Medication Authorization form must completed by a parent/guardian and/or physician. A qualified Prince William County Department of Parks and Recreation staff will administer all age appropriate medication in accordance with the labeled instructions and in accordance with the Medication Administration Training (MAT). Over the Counter Medication (OTC) that will need to be administered for less than 10 days require parent/guardian authorization on the Medication Consent form. OTC medications and prescription medications that will need to be administered for more

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than 10 days require authorization from both parent/guardian and a physician on the Medication Consent form. When authorization for medication expires, the staff shall notify the parent/guardian that the medication needs to be picked up within 14 days or the parent/guardian must renew the authorization. Medications that are not picked up within 14 days will be appropriately disposed of by the Program Administrator or Program Director.

MEDICATION All medication must be: In the original container with the prescription label or direction label attached. Labeled with the child’s name, the name of the medication, the dosage amount and

the time/times to be given. Any utensils needed to administer must be labeled with child’s name.

POLICY FOR OVER-THE-COUNTER SKIN PRODUCTS The staff does not administer Sunscreen, Diaper Ointment/Cream or Insect Repellent. If you feel your child needs any of the above items applied, it must be done before they arrive.

DISCIPLINARY STEPS Non-Physical Misbehavior: (examples include yelling at teachers, grabbing toys from other children, repeatedly not following instructions):

We use the quit thinking time system. We will explain to the child why they are in the quit thinking time, count 1-2-3, then quit thinking time is used.

If it happens more than once during the day, we will notify the parent. Physical Misbehavior (examples include hitting, kicking, biting):

Immediate notification of parent (serious bite could mean immediate dismissal from program).

Conference with Lead Teacher and parent along with written warning. Program Director will also be notified.

Subject to dismissal by both Program Director and lead teacher. NOTE: The Disciplinary Steps may be modified based on the severity of a child’s behavior.

BEHAVIORAL GUIDANCE In order to promote the child’s physical, intellectual, emotional, and social well-being and growth, staff shall interact with the child and one another to provide needed help, comfort, support and:

1. Respect personal privacy;

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2. Respect differences in cultural, ethnic, and family backgrounds; 3. Encourage decision-making abilities; 4. Promote ways of getting along; 5. Encourage independence and self-direction; and 6. Use consistency in applying expectations.

Behavioral guidance shall be constructive in nature, age and stage appropriate, and shall be intended to redirect children to appropriate behavior and resolve conflicts.

FORBIDDEN STAFF ACTIONS Our program staff is forbidden to do the following:

1. Use physical punishment, such as: striking a child, roughly handling or shaking a child, restricting movement through binding or tying, forcing a child to assume an uncomfortable position, or using exercise as a punishment;

2. Enclose a child in a small confined space or any space that the child cannot freely exit himself; however, this does not apply to the use of equipment such as cribs, play yards, high chairs, and safety gates when used with children preschool age or younger for their intended purpose;

3. Allow punishment by another child; 4. Separate a child from the group so that the child is away from the hearing and

vision of a staff member; 5. Withhold or force food or rest; 6. Use verbal remarks which are demeaning to the child; 7. Punish a child for toileting accidents; 8. Punish a child by applying unpleasant or harmful substances.

PROGRAM DISMISSAL POLICY Dismissal may result from serious disciplinary challenges such as, but not limited to, profanity, failure to abide by program rules, stealing, and lying, the following procedure will be followed:

First Offense - Warning (Teacher will talk to child & notify parent)

Second Offense - Conference with parent, child, Teacher, & Program Director

Third Offense - Subject to dismissal from program. This policy can be modified at the discretion of the Program Administrator and/or Program Director based on the severity of a camper’s behavior. Refunds will be denied for such circumstances. Dismissal may also result from carrying a balance due of fees, repeated late payments, and/or non-payment. Payment is expected by established registration dates (see page 5 for “Procedures and Payment”). Playschool staff will give parents a verbal and written reminder that payment is past due. If payment is not made by the first of the month, Program Director makes one more contact to collect fees. If payment is not made from that communication, their child’s spot will be forfeited.

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SUSPECTED CHILD ABUSE POLICY All Playschool staff members are familiar with the procedures for identifying and reporting child abuse and neglect. The Playschool Staff is required by law to report any suspicion of child abuse or neglect to the Social Services Office.

MISCELLANEOUS INFORMATION Please pack a spare set of clothes each day. Make sure your child is dressed in comfortable, easy to care for clothing that is

appropriate for the prevailing weather. Please label all belongings brought to school. Lost items will be kept in the

classroom for a short time. Children are to wear closed-toe shoes every day. We celebrate Birthdays and Holidays. (Please let us know if your child is not

allowed to participate) Any food must be in original store bought food container.

ALL POLICIES AND PROCEDURES ARE SUBJECT TO CHANGE.

For Additional Information

Contact the Front desk at 703-491-2183.

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ONLINE REGISTRATION SYSTEM Pay program balances on-line for Prince William County Department of Parks & Recreation Activities!

Pay Program Balances On-Line For

Prince William County Department of Parks & Recreation

Activities!

If you are a new user to our online registration system contact our office at (703) 792-7060 or

[email protected] to request an email containing your username and password. You will be

instructed to update your information the first time you log in.

Log in to www.pwcparks.org

Select Classes & Camps

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Select Classes & Camps Registration

Enter your User Name and Password

Click Log In

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Once logged in, click on My Account

Click on Pay Old Balances

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To determine program name and start/end dates look under columns labeled Description and When.

Click on the picture of the shopping cart to the left of the program you wish to apply a payment to.

The selected program will be added to your shopping cart for payment. You can select Add Another to add additional programs, View Shopping Cart to view selections, or Proceed to Checkout to make payment.

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When you are done selecting programs click on Shopping Cart ( ) located on the right hand corner of screen.

Click on Proceed to Checkout to make payment. You will be prompted to enter your credit card payment information and print a receipt.

Tip: If you need to get back to

Shopping Cart at any time

during the payment process click

on “shopping cart” in the right

hand corner of the screen.

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Enter your Payment Type and Billing Information

Click Finish to complete your transaction and generate a confirmation receipt.

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DAILY SCHEDULE AND CURRICULUM

Sample Schedules and Subject to Change

3’s T/TH 4-5’s M/W/F 9:30 – 10:00 Arrival Play 9:30 – 10:00 Exploration 10:00 – 10:15 Circle Time 10:00 – 10:15 Circle Time

10:15 – 11:15 Exploration (Activity & Craft)

10:15 – 10:45 Gym / Music & Movement

11:15 – 11:30 Snack Time 10:45 – 11:30 Activities & Craft 11:30 – 12:15 Outside / Gym 11:30 – 11:50 Snack Time

12:15 – 12:30 Story Time & Goodbye 11:55 – 12:20 Outside / Music & Movement

12:20 – 12:30 Story Time & Goodbye

4-5’s M – F 9:30 – 10 :00 Arrival / Exploration / Manipulatives 10:00 – 10:30 Gym / Music and Movement 10:30 – 10:45 Circle Time 10:45 – 11:30 Activities / Crafts 11:30 – 11:45 Snack Time 11:45 – 12:15 Outside Play / Music & Movement 12:15 - 12:30 Story Time & Goodbye

Our curriculum "BOOKS THROUGH THE ALPHABET" will include letters, numbers, colors, shapes and concepts. They will be introduced through books, arts and crafts, nursery rhymes, games and music.

Circle time will include the day, date, weather, games, songs, sign language, and the theme of the day will be introduced.

Our hands-on activities are in a learn-and-play environment, will help promote social, emotional and physical development.

A monthly newsletter will be sent home to inform you of our activities.

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PLAYSCHOOL CALENDAR 2014-2015

September 2 First Day of Playschool for M-F classes and T/Th classes

September 3 First Day of Playschool for M/W/F classes

October 13 Playschool Closed – Professional Learning Day

November 3 Playschool Closed – Teacher Work Day

November 4 Playschool Closed – Teacher Work Day

November 11 Playschool Closed – Veterans Day

November 26 No Afternoon Playschool – Schools have Half Day

November 27-28 Playschool Closed – Thanksgiving Break

December 22-January 1 Playschool Closed – Winter Break

January 5 Playschool Reopens

January 19 Playschool Closed – Martin Luther King Day

January 23 No Afternoon Playschool – Schools have Half Day

January 26 Playschool Closed –Teacher Workday

February 16 Playschool Closed – Presidents Day

March 30-Apr 3 Playschool Closed – Spring Break

April 6 Playschool Closed – Teacher Workday

May 25 Playschool Closed – Memorial Day Holiday

June 11th Last Day of Playschool for T/Th classes

June 12th Last Day of Playschool for M/W/F classes and M-F classes

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AUTHORIZATION FORM I HAVE READ THE PARENT’S MANUAL AND I AGREE WITH THE

POLICIES AND PROCEDURES OF THE PROGRAM. I AUTHORIZE VETERANS MEMORIAL PARK STAFF TO SEEK

MEDICAL CARE FOR MY CHILD SHOULD AN EMERGENCY OCCUR WHEN THE PARENT CANNOT BE LOCATED IMMEDIATELY UNLESS THE PARENT STATES IN WRITING AN OBJECTION TO THE PROVISION OF SUCH CARE ON RELIGIOUS OR OTHER GROUNDS.

I UNDERSTAND THAT IF MY CHILD BECOMES ILL I WILL BE

CONTACTED BY THE CENTER; I WILL ARRANGE TO HAVE HIM/HER PICKED UP AS SOON AS POSSIBLE IF SO REQUESTED BY THE CENTER.

I WILL NOTIFY VETERANS MEMORIAL PARK WITHIN 24 HOURS OR

THE NEXT BUSINESS DAY IF MY CHILD OR A MEMBER OF THE IMMEDIATE HOUSEHOLD DEVELOPS ANY REPORTABLE COMMUNICABLE DISEASE, AS DEFINED BY THE STATE BOARD OF HEALTH.

I WILL NOTIFY VETERANS MEMORIAL PARK IMMEDIATELY IF MY

CHILD OR A MEMBER OF THE IMMEDIATE HOUSEHOLD DEVELOPS A LIFE-THREATENING DISEASE.

Child’s Name:

Parent’s Name:

Parent’s Signature:

Date Signed:

PARTICIPATION AGREEMENT The PWC Department of Parks and Recreation assumes no liability for injuries or damages arising from the result of participation. Due to the strenuous nature of some activities, the participant is urged to consult his/her physician concerning the ability to participate. All activities present inherent risks and hazards, which the participant assumes. I hereby approve of my child’s participation in this Recreation Program.

Parent/Guardian Signature: Date Signed:

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PWC DEPARTMENT OF PARKS AND RECREATION

2014-2015 PRESCHOOL-AGED

REGISTRATION INFORMATION

Date entered care:

Program Attending: _________________________________________ Date left care:

CHILD'S NAME: Childs Birthday: _______________

ADDRESS:

MOTHER FATHER

NAME: NAME:

ADDRESS: ADDRESS:

PLACE OF

EMPLOYMENT:

PLACE OF

EMPLOYMENT:

WORK PHONE: WORK PHONE:

HOME PHONE: HOME PHONE:

CELL PHONE: CELL PHONE:

E-MAIL: E-MAIL:

Previous Daycare Programs and School Attended:

If this child attends this center and another school/program, give name of school/program:

HEALTH/MEDICAL INFORMATION

My child has allergies: Yes No

My child is allergic to the following:

No medication needs to be administered to my child during program hours. (initial)

I request the medication(s) described below be administered during program hours, by a PWC Department of Parks and

Recreation, and agree to furnish said medication(s) in the original Pharmacy-labeled container(s).

(1) Medication: Dosage: Time:

(2) Medication: Dosage: Time:

Parent/Guardian Signature: Date Signed:

My child may not have the following food for religious reasons:

PHYSICIAN’S INFORMATION

Please fill out the required information below:

Physician’s Name: Telephone #:

SWIMMING RELEASE

YES, my child has permission to swim during program hours and has completed the swim level listed below.

SWIM LEVEL:

NO, my child does not have permission to swim during program hours.

Parent/Guardian Signature: Date Signed:

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INCLUSION INFORMATION:

My child does NOT have any special needs or need any accommodations. (see below)

My child has special needs. (check below)

To request any type of accommodation for your child, you must submit a written request form (available at

pwcparks.org/camps) to the site manager at least 15 business days prior to the start of the program.

ADD Developmental Delay Autism Spectrum Disorder Speech/Language Only

ADHA Diabetic Physical Disability Visual Impairment

ADHD Hearing Impairment Learning Disability Asthma

Additional

Comments/Other:

VIDEO/PHOTO AUTHORIZATION

I give PWC Department of Parks and Recreation permission to include my child in Program photographs/videos. I

understand that these become the property of the PWC Department of Parks and Recreation.

Parent/Guardian Signature: Date Signed:

EMERGENCY CONTACTS AUTHORIZATION

The PWC Department of Parks and Recreation has my permission, in an emergency, to call 911 and/or send my child to a

hospital/urgent care facility, and the medical personnel have my authorization to provide treatment, which a physician

deems necessary for the wellbeing of my child. The PWC Department of Parks and Recreation will make every

reasonable attempt to contact the Parent/Guardian/Emergency Contacts.

NOTE: EMERGENCY CONTACTS CANNOT BE THE PARENTS/GUARDIANS. PER VIRGINIA

STATE LICENSING REQUIREMENTS, YOU MUST LIST AT LEAST TWO EMERGENCY

CONTACTS.

NAME: Phone #: Relationship:

ADDRESS:

NAME: Phone #: Relationship:

ADDRESS:

NAME: Phone #: Relationship:

ADDRESS:

Parent/Guardian Signature: Date Signed:

DISMISSAL AUTHORIZATION

Every day at dismissal time, the Parent/Guardian/Authorized Alternate picking the child up MUST SIGN THEM OUT.

No child will be permitted to leave program area with persons other than a Parent/Guardian/Authorized Alternate listed

below. Identification must be presented at time of pick up.

Parent/Custodian

Name:

Parent/Custodian

Name:

Authorized

Alternate:

Authorized

Alternate: