PSF 2023 Family Application
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Email *
Student's First Name *
Student's Last Name *
Date of Birth *
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T-Shirt Size *
Parent Name (First and Last) *
Parent Contact Number *
Current Address *
Emergency Contact #1 -- Please include name, relationship to child, and phone number *
Emergency Contact #2 -- Please include name, relationship to child, and phone number *
Dietary Restrictions? *
What grade level will your child be entering in the 2023-2024 school year? *
What school does your child currently attend, 2023-2024? *
Does your child have any allergies? If yes, please specify. *
**PSF does not provide over-the-counter medication to campers** Will your child need to take any prescription medicine while at the camp? If yes, please specify. *
Does your child have asthma? *
Does your child have diabetes? *
Other health issues-- Please provide any medical information we should have to properly care for your child while at camp.
WAIVER-- In selecting I understand, as parent or legal guardian of subject camper, I hereby certify that my child is in good health and may participate in all activities. I grant permission for treatment deemed necessary for a condition that may result from participation in camp events or activities, including transport via medic/ambulance and/or medical or surgical treatment recommended by a medical doctor. I understand that every effort will be made to contact me prior to treatment. I also agree that I will be responsible for the cost of medical treatment. It is understood that in all matters relating to the operation of camp-sponsored activities, the school through its agents and employees stands in loco parentis to the student. *
I understand that cost of attendance for this summer camp is $100. This is a one-time fee and will cover the six weeks of the summer program. I understand that I can make payments but total cost is due by Friday, June 26, 2023. I can pay on here: https://www.flipcause.com/secure/cause_pdetails/MTQ4MzE2 *
The PSF Summer camp will run from June 26th- August 4th. The camp's hours will be from 8:15am-2:15pm. The camp will run from Monday- Thursday. Transportation is not provided, but parents can request support.  Parents are required to drop off and pick up their students during the designed time. I understand that every 15 minutes of tardiness will accrue a $35 late fee charge for pick-up. In addition enrichment opportunities will be available Friday - Sunday at different locations.   *
Attendance Policy: Students are expected to attend 80% of the program. The safety of each student is paramount to the staff of our programs. If a student will not be attending the program as scheduled, it is essential that the student’s parents send an email or text message to our site to report the student’s absence from the Program. To avoid miscommunication, please be sure to report the absence. You can communicate a child’s absence through our program directors at: 704-996-4447 or www.prodigalsonfoundation@gmail.com  *
Telephone Use by Students: Phones are not allowed during the program unless approved by the teacher.  The staff will be happy to convey messages to students when necessary, but it is not allowed for students to make or receive telephone calls during the program. Parents are welcome to call the program at any time to speak to the Directors about questions or concerns regarding their students. *

Permission for photographs, videos, or work samples

 

Permission allows the Prodigal Son Foundation and Sugar Creek 21st CCLC to publish photographs, videos, and sample work in the following ways; publications could include, but are not limited to school newsletters or web pages;  photographs, videos and sample work may be reproduced either in color or in black and white; the program will not use your child’s photographs, videos or samples of your child’s work for any purpose other than for the education of students, promoting the program, or for the general promotion of public education; any photographs taken by the program will be kept for no longer than is necessary for the above-mentioned purposes and will be stored and disposed of securely. This consent, if signed, will remain effective until such time as you advise the school otherwise.

 

Consent Form for Publication of Students’ Work or Photographs

I agree, subject to the conditions set out above, to the taking of photographs or videos of my child during school activities, to be used by the Prodigal Son Foundation and Sugar Creek 21st CCLC in educating students and promoting education. I also agree to the publication of photographs, videos or samples of work of my child. I will notify the Prodigal Son Foundation and Sugar Creek 21st CCLC if I decide to withdraw this consent.

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General Liability Waiver and Field Trip Permission Form and Release

Physical Activity and Field Trips are an integral part of the Innovative Learning experience.  In providing the best service possible for our students both on-site and off-site, we will maintain the same level of safety and order so that all students can enjoy their experiences.  In addition, the highest standards of our behavior and discipline policy remain in effect during all off-site trips or activities.  Therefore, the following statement has been set forth by the administration, staff, and representatives of Innovative Learning. 

This statement must be read, signed, and dated before any child may participate in physical activities and field trips. 

I/we, hereby grant permission for my/our child/children to participate in all physical activities and field trips as set forth by Innovative Learning as a part of its normal program.  I/we further grant permission for my/our child/children to be transported by Prodigal Son Foundation authorized and approved means of transportation by certified, capable personnel.  I/we further understand that my child/children will be supervised by Prodigal Son Foundation personnel, staff, and/or volunteers that have been approved for working with children while on field trips and while participating in physical activities.  I/we hereby release and hold harmless Innovative Learning employees, staff, volunteers, and its representatives from any and all liability for any injuries, incidents, or accidents that may occur as a result of physical activities and/or field trips.  

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BEHAVIOR MANAGEMENT POLICY: Students and staff of the program are asked to treat each other with respect, tolerance, kindness, and consideration. The rules and behavior expectations utilized by the program will be explained to the student clearly and reinforced in a consistent manner. Students will be given reminders and redirection in order to encourage positive behavior. A student who is unkind verbally will be asked to apologize. A student who uses supplies or equipment inappropriately will be restricted from using the supplies or equipment for a short period of time. Any activities where participants purposely exclude another student will not be allowed. Under no circumstances will a student be subjected to neglect, physical punishment, verbal abuse, or denial of restroom facilities. Parents will be notified if a student exhibits unusual emotional or physical behavior that threatens the well-being of the student or others in the program. If a student has specific behavior issues, every effort will be made to implement a behavior management program consistent with efforts being made at the student’s home and school. If a student’s behavior indicates that the Program is not able to meet his or her needs, the program directors will contact the student’s parents to arrange a meeting. A parent or staff member may also request an appointment. With the parent’s permission, school staff and other professionals providing services to the student may be asked to attend the meeting. Within ten days of the meeting, in keeping with the conclusions of the meeting, an action plan will be developed that establishes reasonable, attainable objectives for the student. A copy of the plan will be given to the staff and to the student’s parents. A log will be kept of the student’s progress. If the Program Directors feel the program cannot accommodate the student’s needs, or if the objectives established for the student are not met, the program reserves the right to terminate the student’s participation in the Program with two weeks’ notices. Any student who does not accept the physical boundaries of the Program, or exhibits behavior that threatens his or her wellbeing, or the wellbeing of others, is subject to dismissal without notice. Any inappropriate behavior by a parent, including verbal abuse of a student or staff member, or confrontations with staff members in the presence of a student, is grounds for termination of the family’s participation in the After School Program without notice. A suspension or termination decision may be appealed by contacting the President.   *
What is your family's annual salary range? *
Are you interested in applying for our financial scholarship? *Please note: any applicant interested in financial scholarship support will be required to submit proof of income. *
Have your students attended a PSF  before? 
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Are you able to pay the registration fee of $100 dollars? 
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A copy of your responses will be emailed to the address you provided.
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