Summer SPLASH

Summer SPLASH - Vacation Bible School Information

Doc #1

04/13/11

© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.

Page 1

Summer SPLASH Vacation Bible School 2011

Ages

• Kindergarten – 5th grade children are welcome

Dates/Times

• July 11 – 14th / Monday – Thursday

• 9 AM – 4 PM. Children are allowed to come earlier and leave later, as approved. Children enrolled in Harvest Christian Daycare may come up to 10 hours.

Theme

• Strong in the Lord and in the Power of His Might

• Put on Your “Son”-Screen (In Christ Armor)

• Beach/Vacation/Ocean/Surfing Theme

Location

Monday – Thursday Morning

• Harvest Christian Daycare and Learning Center / Spirit of Faith Family Church

• 4070 22nd

Ave SW, Cedar Rapids, IA 52404

Wednesday Night

• Wednesday night Bible Surf’n Splash Rally @ Spirit of Faith Family Church*

• *Optional. We invite parents and guardians to bring children to the mid-week Rally if you are not committed to another church.

Thursday Afternoon

• Wasserbahn Waterpark Resort and Clarion Inn of the Amana Colonies

• 2211 U Avenue, Williamsburg, IA, 52361

• Phone: (319) 668-1175

• Fax: (319) 668-2853

Program Fees

• $35 Registration Fee. This fee covers:

� Registration Processing


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� Supplies

� Meals & Snacks

� Water park fee

� NOTE: you are required to bring a sack lunch for your children on Monday and Thursday. The costs for those lunches are not included in the registration fee.

• $80 program fee

� Daily child care services

� VBS Fee

• Children who are already enrolled in HCD’s Summer FUN program are only required to pay $10 to cover the cost of the water park.

Registration Applications / Payments

• Please visit our website at www.soffc.org for additional flyers, information sheets, applications, etc.

Registration Deadline

• To register, you must pay the $35 registration fee. Registrations will be granted on a first-come, first-serve basis.

• The remainder of the program fee, $80, is due by Wednesday, June 15th, 2011

• If the $80 program fee is not paid by June 15th, spots will not be reserved and may

be filled with others if there is a waiting list.

Refunds or Transfer Policies

• Please confirm your plan to attend ahead of time.

• All registration fees and payments are non-refundable and non-transferable

• All reservations are non-transferable unless approved by SOFFC/HCD

General Dress Code

• No secular band t-shirts

• No t-shirts with negative or questionable connotations

• No tank tops, spaghetti straps or string ties (girls)

• No cut-offs with slits up the side (girls)

• No halter or tube tops (girls)


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• No shirts that reveal the stomach

• No bikinis or 2-piece swimsuits for girls. T-shirts must be worn over swimsuit. Boys can wear swim trunks with a t-shirt as well.

• Modest shorts, if worn, must be no shorter than mid-thigh

• All clothing must be appropriate

Medical Information

Medical Staff

• There is a nurse consultant available during VBS if needed.

Medications

• Only medication prescribed or ordered by a physician/dentist will be administered. The Medication Permission Form will need to be filled out by the parent or legal guardian and a doctor’s note must be received. All medication must be supplied in the original container, properly labeled, and will be administered only by authorized personnel.

• Over-the-counter medication may only be given upon a written physician order with instructions for administration including dosage and frequency.

• All medication will be kept in an area inaccessible to the children or refrigerated as required.

General Information

Schedule

• Please see attached daily schedule

• There will be a Bible Surf’n Splash Rally on Wednesday PM at Spirit of Faith Family Church.

• Thursday is Big Splash day! We will be spending the afternoon at the waterpark. We will return by 4 PM. The waterpark we are going to is Wasserbahn Waterpark Resort and Clarion Inn of the Amana Colonies.

Vacation Bible School Registration Form

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Please include all the forms in this packet when turning in your application including:

• Registration Form – Doc #2

• Parent Contract Agreement – Doc #3

• Parental Emergency Medical Consent Form – Doc #4

• Health Assessment Form – Doc #5

• Medication Permission (if needed) – Doc #6

• Copy of Immunization Record

Child Information Child’s Name (last, first, middle)

Social Security # Age Birth date

Address

City State Zip

Gender: � Male

� Female

If languages other than English are spoken in the home, please list below:

Parent Information (Father) Father’s Name (last, first, middle)

Social Security # E-mail Address

Address (if different from child’s)

City State Zip

Phone

( )

Work Phone Ext.

( )

Cell Phone

( )

Employer

Job Title

Address

City State Zip

Marital Status of father: � Never Married � Married � Divorced

� Separated � Widowed � Remarried


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Parent Information (Mother) Mother’s Name (last, first, middle)

Social Security # E-mail Address

Address (if different from child’s)

City State Zip

Phone

( )

Work Phone Ext.

( )

Cell Phone

( )

Employer

Job Title

Address

City State Zip

Marital Status of mother: � Never Married � Married � Divorced

� Separated � Widowed � Remarried

Emergency Contact

Emergency contact information will be used when the parents cannot be reached.

Name

Relationship Home Telephone

( )

Home Address

City State Zip

Work Address

City State Zip

Work Phone

( )

Cell Phone

( )

Pager Number

( )

Name


( )

Home Address

City State Zip

Work Address

City State Zip

Work Phone

( )

Cell Phone

( )

Pager Number

( )


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Name


( )

Home Address

City State Zip

Work Address

City State Zip

Work Phone

( )

Cell Phone

( )

Pager Number

( )

Allergy/Food Exemption Information

Nature of Allergy/Food Exemption:

FOODS CHILD SHOULD AVOID REACTION

ALLERGIES OTHER THAN FOOD REACTION

Date Signature of Parent(s) or Legal Guardian


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Release Authorizations

Facility Name/Address:

TRAVEL RELEASE

I/We do _____, do not_____, give consent for (name of child)________________________________ to

participate in field trips with the above named program. I/We do reserve the right to be notified before

each field trip that involves travel out of town. I release the program of any liability unless negligence is

proven.

Restrictions:


PHOTOGRAPHY/VIDEOTAPING RELEASE

I/We do _____, do not_____, give consent that the above named program may take

photographs/videotapings of our child (name of child)_____________________________________,

and I/we consent that the program may use the photographs/videotapes of our child in promoting the

purpose of the Center. We understand that no financial benefits from the use of the

photographs/videotapes are obligated to be paid to us.

Restrictions:



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Topical Agent Permissions

I hereby give you, Harvest Christian Daycare & Learning Center permission to use the

following on my child, when appropriate. Check all

(Name of Child) that are approved.

Sunscreen

Insect Repellent

First Aid Cream / Spray

Lotion – Jergens Ultra Healing Lotion

Sunburn relief spray/lotion/gel

Vaseline

Other:

Other:

Parent(s) or Guardian(s) Signature Date


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Pick-up Authorizations

Child’s Full Name:

Child’s Age:

I hereby give permission for my child to leave the center with the following persons identified below. It is my responsibility to notify the center in writing of any changes to this authorization.

Name

Relationship Telephone

( )

Address

City State Zip

Name

Relationship Telephone

( )

Address

City State Zip

Is there a court order prohibiting contact with my child by any person? � YES � NO

If yes, please provide a photocopy of the order.

Name of prohibited person

Relationship

Is there any child custody order of which we need to be aware? � YES � NO

If so, please advise:

Name(s) of person(s) who may not pick up my child:

Signature(s) of Parent(s) or Guardian Date


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Program Schedule

My Child, ____________________________ is registering in Harvest Christian Daycare/Spirit of Faith Family Church’s Vacation Bible School from July 11

th – 14th.

Schedule: M T W TH F (circle days)

Care will be provided from AM / PM to AM / PM

AM / PM to AM / PM

Note: This application form alone does not ensure final registration. The non-refundable registration fee of $35 and all the paperwork completely filled out is required to guarantee a child’s enrollment and must be included with the application. If VBS is full, we will refund the registration fee, unless you desire to remain on a waiting list. The remainder of the program fee, $80, is due by Wednesday, June 15

th, 2011.

If the $80 program fee is not paid by June 15th, spots will not be reserved and may be filled with others if

there is a waiting list.

Harvest Christian Daycare/Spirit of Faith Family Church enrolls children of any race, color, ethnicity, nationality, religion or gender. All children are offered all rights, privileges, and program generally afforded or made available to children at the daycare/church. It does not discriminate on the basis of race, color, ethnicity, nationality, religion or gender in the administration of its educational policies, admissions policies and other daycare programs.

Declaration:

I have read and understand this application. I affirm that all the information in this application is true and accurate to the best of my knowledge. I understand that providing false information could be reason for rejection of this application or dismissal of my child from VBS. I also understand I may be asked to provide additional information, if necessary.

Father or guardian’s signature Date

Mother or guardian’s signature Date

Please send in all required paperwork and payments to:

SOFFC / HCD Attn: Vacation Bible School PO Box 8355 Cedar Rapids, IA 52408 Email: info@harvestchristiandaycare.com Telephone: 319-390-4077

Vacation Bible School Parent Contract Agreement

Doc #3

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This contract is an agreement between:

Parent Names

and Harvest Christian Daycare & Learning Center to provide care for:

Child(s) Name(s)

on

Date

1) I agree that Harvest Christian Daycare and Learning Center is not responsible for clothes that become soiled or torn during recess or activities.

2) Harvest Christian Daycare & Learning Center will make every attempt to prevent your child from being exposed to sickness or an infectious disease, however I understand that Harvest Christian Daycare is not responsible for any illness that may child may contract while at the center. In addition, Harvest Christian Daycare & Learning Center is not liable for accidents or financial obligations pertaining to health care.

3) It is agreed that any changes to your child’s schedule for the week will be communicated prior to the change. A week’s notice is requested.

4) I agree to pay a Registration fee, as stated below, at the time of registration.

5) None of the fees identified are refundable.

6) HCD’s Vacation Bible School program will be Monday through Thursday, from 9:00 a.m. until 4:00 p.m.

7) Harvest Christian Daycare & Learning Center’s hours of operation are Monday through Friday, 6:30 a.m. until 6:00 p.m.

8) I agree to pay a per family Late Pickup fee of $10.00 for every 15 minutes any child is left at the center after the center’s closing.

9) I agree to pay a NSF fee of $20.00 if I have a declined payment. Harvest Christian Daycare will then have the option to refuse service until payment is made in its entirety.

10) Photographs taken of children involved in Harvest Christian Daycare’s program may be used for promotional purposes unless denial has been made in writing by a parent or guardian.

11) Legal authorities may be contacted for children left at the daycare more than one hour after closing time of the daycare.

12) This Agreement may be terminated by Harvest Christian Daycare at any time and for any reason. A child may be disenrolled by the daycare without prior notice if, in the sole opinion of the daycare, it is in the best interest of the child or the daycare to disenroll the child.

13) Both parents/legal guardians of the child must sign below as an agreement to meet the terms stated above.

Vacation Bible School Parent Contract Agreement

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14) Failure to comply with the terms set form in this Agreement other supplied paper work, at Harvest Christian Daycare’s discretion, result in immediate termination of child’s enrollment.

1) Registration $35.00 Child’s hours are from AM to PM

2) Program Fee $ 80.00 Late Pick-Up fee is $10 every 15 minutes over.

NSF fee – maximum allowed by state law.

Father or guardian’s signature Date

Mother or guardian’s signature Date

Harvest Christian Daycare Date

1 copy – Office

1 copy – Parent / Guardian

Vacation Bible School Parental Emergency Medical Consent Form

Doc #4

04/13/11


Page 1

This form must be COMPLETEY filled out and presented upon registration. Registrations will not be returned if this form is not completely filled out.

Child’s Full Name Date of Birth

This form allows parents and guardians to authorize the provision of emergency treatment for above

named child who becomes ill or injured while under program authority when parents or guardians

cannot be reached.

In the event reasonable attempt to contact me at ________________________(phone number) or

______________________(phone number) have been unsuccessful, I hereby give consent for the

administration of any treatment deemed necessary by Doctor _________________(physician) at

______________________(phone number) or Doctor ______________________(dentist) at

______________________ or in the event the designated practitioners are not available, then by

another licensed physician or dentist; and the transfer of the child to_________________________

(preferred hospital).

1) Parent(s)/Guardian(s)/Custodian(s) with whom the child resides:

Name: Relationship to child

Address Home phone

Cell phone

Employer Email address

Work phone Work hours

Name Relationship to child

Address Home phone

Cell phone

Employer Email Address

Work Phone Work hours

Vacation Bible School Parental Emergency Medical Consent Form

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2) Medical Contact Information:

• NOTE: We are required by DHS to have the full contact information for the physician AND the dentist for EVERY child registered.

Physician Name Dentist Name

Street Address Street Address

City, State City, State

Phone Number Phone Number

Date of last Tetanus Known Allergies

Present Medication

Insurance Company Policy Holder’s I.D

This consent will be in effect for one year beginning (date) :

Signature Parent/Guardian date Signature Parent/Guardian date

Summer SPLASH Vacation Bible School Health Assessment Form

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HEALTH STATEMENT

___________________________________________________________________________

Child’s Full Name Birth Date

1. Significant illnesses and surgeries child has had (give age at time):

________________________________________________________________________________

________________________________________________________________________________

2. Any special health-related needs of child (allergies, medications, injuries, etc.):

________________________________________________________________________________

________________________________________________________________________________

PHYSICAL ASSESSMENT

1. Is there any defect of vision, hearing or speech of which the VBS program should be aware, or could compensate by appropriate action?

________________________________________________________________________________

________________________________________________________________________________

2. Is this child subject to any conditions which limit classroom activities or physical education?

___________________________________________________________________________

___________________________________________________________________________

3. Is this child subject to any condition which may result in an emergency situation?

___________________________________________________________________________

___________________________________________________________________________

Summer SPLASH Vacation Bible School Health Assessment Form

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4. Is this child subject to any mental or physical condition for which he/she should remain under periodic medical observation?

___________________________________________________________________________

___________________________________________________________________________

5. Other information you would like to share:

Parent’s Signature________________________________ Date _____________________

Vacation Bible School Medication Permission Form

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NOTE: This form only needs to be filled out and returned if child is on medication.

I, (Name of Parent) give permission to

(Name of caregiver) to give my child (Name of child ) the following medicine (Name of medicine ) for (Problem or illness ) on at (Date or dates) (Time or Times) in the amount of (Amount or amounts) by (Body location and method of use) Side effects of the medicine to watch for (Possible side effects) This medicine has been prescribed by (Name of Doctor) The telephone number of the doctor is By (Signature of parent or legal guardian) (Date)

Medication prescribed or ordered by a physician/dentist will be administered by Harvest Christian Daycare when this form is filled out by the parent or AND a doctor’s note is received. All medication shall be supplied in the original container, properly labeled, and will be administered only by authorized personnel. Over-the-counter medication may only be given upon a written physician order with instructions for administration including dosage and durations. Medication will be kept in an area inaccessible to the children or refrigerated as required.

Summer SPLASH - Vacation Bible School Supply List

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What to bring:

• Surf/Hawaiian attire (optional)

• Bible (optional)

• Notebook

• Pens / pencils

• Swimsuit. We are asking girls to bring a one-piece swimsuit and also bring a t-shirt that can be worn over the swimsuit, and boys can wear swim trunks with a t-shirt on as well.

• Swim towel (for Wednesday and Thursday afternoons)

• Change of clothes. Please make sure that your participant has a change of clothes each day of VBS. If they wear their change of clothes that is kept at HCD, they need to bring another set the following day. We have many fun (and sometimes messy!) activities planned that involve whipped cream, water, and many other fun things that children are going to need a change of clothes!

• Sunscreen – we have some sunscreen on hand, but we are asking parents to provide a bottle of sunscreen as well.

• Sack Lunch on Monday and Thursday

What NOT to bring:

• Cell phones

• Radios

• MP3 players

• Game systems, video games (PSP’s, gameboys, etc)

• CD players

• Comics, magazines, secular books

• Matches or lighters

• Prank materials

• Skateboards, roller blades

• Electronics

Please note, all unapproved items will be confiscated and returned at the end of VBS.

Summer SPLASH - Vacation Bible School Rules and Regulations

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Please read carefully all rules and regulations. This form must be signed and returned with your registration. No one will be permitted without this agreement.

General Rules

1) No cell phones (cell phones will be collected and returned at the end of the day).

2) Children are required to be involved in all the activities.

3) Children are required to obey all Summer SPLASH Staff and Volunteers.

4) Children are not allowed to be unattended at any time.

5) Children who are ill must not attend while they are ill.

6) No violent activity including extreme hitting, biting, or other physical violence.

7) No swearing or use of curse words or calling inappropriate names.

8) No destroying of property (you will be held responsible for all damages and cost incurred).

Discipline Policy

• 1st time – verbal warning given

• 2nd

time – timeout

• After 3 timeout’s, meet with Daycare Director

• Continued disobedience may result in dismissal from VBS. The child’s parent or guardian will be contacted to pick-up the child.


Summer SPLASH - Vacation Bible School Schedule

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Daily Schedule Monday & Tuesday

9:00 – 9:20 Ride the Waves Workout

9:20 – 9:40 Praise and Worship

9:40 – 9:50 Educational Lesson (Summer Theme)

9:50 – 10:00 Dune Buggy Draw

10:00 – 10:15 Bathroom Break

10:15 – 10:50 Bible Surf Morning Rally (Praise song, Lesson, Scripture Bee)

10:50 – 11:10 Games

11:10 – 11:45 Outdoor Time

11:45 – 12:00 Bathroom

12:00 – 12:30 Lunch

12:30 – 1:30 Free / quiet time

1:30 – 2:10 Life Skills Class

2:10 – 2:25 Snack

2:25 – 2:40 Bathroom

2:40 – 3:00 Bible Splash (Scripture Memory Verse)

3:00 – 3:15 Art

3:15 – 3:45 Wet & Wild Activity / Beach Carnival

3:45 – 4:00 Praise & Power Recap / Creative Time

Summer SPLASH - Vacation Bible School Schedule

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Wednesday







10:50 – 11:10 Games


11:45 – 12:00 Bathroom

12:00 – 12:30 Lunch

12:30 – 1:30 Free / quiet time

1:30 – 2:10 Life Skills Class

2:10 – 2:25 Snack

2:25 – 2:40 Bathroom

2:40 – 3:00 Bible Splash (Scripture Memory Verse)

3:00 – 3:15 Art

3:15 – 3:45 Water sports Activity

3:45 – 4:00 Praise & Power Recap / Creative Time

7:00 – 8:30 Bible Surf’n Splash Rally @ SOFFC (optional)

Thursday








11:45 – 12:00 Bathroom

12:00 – 12:30 Lunch

12:30 – 1:00 Travel to Water Park

1:00 – 3:30 Water Park

3:30 – 4:00 Return from Water Park

Summer SPLASH - Vacation Bible Schoolharvestchristiandaycare.com/HCD_Summer_Splash... · 2011. 4. 16. · Summer SPLASH - Vacation Bible School Information Doc #1 Summer SPLASH Vacation

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