2022 Summer Kimball Cubs Club Registration:

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Kimball Cubs Club School Age Child Care Program provides child care for children ages 3 (completely toilet trained) through 5th grade. Cubs Club will be open Monday through Friday 6:30 a.m. to 5:30 p.m. We will remain closed on Friday, July 1 and Monday, July 4. Our first day of summer programming will begin on Monday, June 6, and our last day of summer programming will end on Friday, August 19.

Please fill out a google doc form for EACH child in your family needing child care throughout the summer months. We are happy you have chosen to spend some memorable moments with us this summer. We look forward to an exciting summer, filled with tremendous experiences only Kimball Cubs Club can offer.

Please reach out if you have any questions or concerns: holly.barthel@kimball.k12.mn.us or 320-557-5893 (work cell) or 320-398-7700 ext. 2555 (work office)

Best Regards,

Holly Barthel
Kimball Cubs Club Coordinator
School Age Child Care
Kimball Area Public School District

Email *

1- Parent/Guardian Name (Last, First)

2- Parent/Guardian Name (Last, First)

Child's First Name:

Child's Last Name:

Child's Date of Birth:

YYYY

In the Fall of 2022 My Child Will Be Attending:

Preschool

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

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My Child's T-Shirt size:

YXS

YXL

Other:

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My Child Will Be Attending:

Full-Time (4-5 days a week)

Part-Time (1-3 days a week)

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Daily Rates are as followed:

More than 5 hours per day at a rate of $33 per child, per day

5 hours or less per day at a rate of $17 per child, per day

Both options listed above

PLEASE NOTE: DROP-IN RATES (less than a 24 hour notice) - $40 per child, per day

Other:

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My Child's Weekly Schedule Will Be:

The Same Every Week

Different Every Week

Alternate Every Other Week

Other:

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My child will be attending on Mondays from: (Drop-off and Pick-Up Time)

My child will be attending on Tuesdays from: (Drop-off and Pick-Up Time)

My child will be attending on Wednesdays from: (Drop-off and Pick-Up Time)

My child will be attending on Thursdays from: (Drop-off and Pick-Up Time)

My child will be attending on Fridays from: (Drop-off and Pick-Up Time)

I give the Program Coordinator, Holly Barthel, permission to charge my debit/credit card on my rSchool Today account for our summer enrollment fee of $40 per child ($50 per child after enrollment deadline-April 15th, 2022.) This will help cover costs for T-shirts, afternoon snack, field trip expenses, bus expenses to and from each field trip and Cubs Club water bottles that will remain at our facility over the summer months.

Yes

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In checking each box, I understand and agree to the following: (please check each box you agree to)

I understand that it is my responsibility to walk up to the building/front door at Drop-off and Pick-up. Parents/Guardians will be responsible to sign their child(ren) in at each Drop-off and Pick-up. Parents/Guardians will be allowed inside our entry way ONLY in order to make this happen.

Drop-ins require at least a 24 hour notice to avoid our Drop-in rate. Drop-in rates are paid at the time of Pick-up. Cubs Club needs at least a 24 hour notice if there are schedule changes in your child's weekly/daily schedule in order to be reimbursed for the daily change.

No electronic devices, cell phones, toys or stuffed animals from home are allowed.

I agree to keep my credit/debit card on file up-to-date and prepay every Monday for that current week of care written down on my monthly contract. If a payment is not paid in full on Monday, I understand there will be a $5 late processing fee per day, per child.

If payments are more than two weeks past due, your child will be dismissed from our School Age Child Care Program.

I understand that Cubs Club closes at 5:30 p.m. A $25 late fee per child will occur along with a $1 per minute per child after 5:30 p.m.

I understand I must give a two week written notice of withdrawal from the program and that I am still responsible for my monthly contract in those two weeks and the charges accrued during this period.

I grant permission for my child's picture to be taken and used for promotional purposes. Such as our school website, our local Tri County Newspaper and/or our Cubs Club Facebook Page.

I give staff permission for my child to go on field trips/walking trips off Kimball School grounds.

I give Kimball Cubs Club staff permission to apply parent provided sunscreen.

I give permission for my child to watch PG movies.

After three documented behavior occurrences occur, your child will be dismissed from our summer Cubs Club program.

I understand this is a School Age Child Care Program. Staff are not responsible for diapering of your children. After three accidents occur consistently, a child will be dismissed from our program.

My child will only be released to their Parents/Guardians or anyone who is authorized on my release forms and are at least 16 years of age. Please notify Holly Barthel if anyone other than an authorized person is to pick-up your child. A form of picture I.D. will be required at our front door. No child will be released to a person under the influence of alcohol or drugs, even if the person is authorized to pick your child(ren) at least 16 years of age.

I agree to release Kimball Cubs Club School Age Child Care Program, District 739 and its employees of any liability for accidents or injuries. I understand that I will be responsible for all medical expenses.

I understand that it is my responsibility to inform Holly Barthel if your child receives special services, has an allergy or takes medications.

By checking this box, I agree to recheck my current enrollment forms on file with Holly Barthel before the summer program begins. I will confirm all contact information is still correct and authorized personnel is up-to-date.

By signing this agreement I have read and agree to the 2022 Kimball Cubs Club Summer Program. *

By signing this agreement I have read and agree to the 2022 Kimball Cubs Club School Age Child Care Summer Program. *

If you have any comments, questions, or concerns please list below:

Option 1

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Option 1

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Thank you all for taking the time to complete this google doc form. I greatly appreciate it! We are looking forward to the best summer yet and we can't wait to have some fun in the sun!!!

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