The Arc of McLennan County Summer Camp Enrollment Agreement
Camp dates are Monday, June 3, 2024 - Friday July 26, 2024 (with the exception of the holidays of Juneteenth (June 19th) and July Fourth. Hours of operation are Monday - Friday 7:30 a.m. - 5:30 p.m.
Sign in to Google to save your progress. Learn more
Email *

Child's full name

 *

Child prefers to be called

 *

Date of birth

 *
MM
/
DD
/
YYYY
Sex *
Name of school district and campus *
Current grade *
Home address *
Parent/Guardian phone *

Child will attend camp (please check all that apply)

IMPORTANT NOTE: MOST FIELD TRIPS WILL BE TAKEN IN THE MORNINGS

 *
Required

Parent/Guardian 1 name

 *

Parent/Guardian 1 relationship to child?

 *

Does Parent/Guardian 1 have primary custody?

 *

Does child reside with Parent/Guardian 1?

 *

Parent/Guardian 1 phone

 *

Parent/Guardian 1 employer and department

 *

Name of Parent/Guardian 2

Parent/Guardian 2 relationship to child?

Does Parent/Guardian 2 have primary custody?

Clear selection

Does child reside with Parent/Guardian 2?

Clear selection

Parent/Guardian 2 phone

Parent/Guardian 2 employer and department

Prefer to be contacted first? 

 *

Parental marital status

 *

Is there any custody information we should know?

Name of pick-up person 1

 *

Phone number of pick-up person 1

 *

Name of pick-up person 2

Phone number of pick-up person 2

Emergency contact 1 name

 *

Emergency contact 1 relationship to child

 *

Emergency contact 1 phone

 *

Do you authorize your child to leave with emergency contact 1?

 *

Emergency contact 2 name

 *

Emergency contact 2 relationship to child

 *

Emergency contact 2 phone

 *

Do you authorize your child to leave with emergency contact 2?

*

Emergency contact 3 name

 *

Emergency contact 3 relationship to child

 *

Emergency contact 3 phone

 *

Do you authorize your child to leave with emergency contact 3?

*

My child may NOT leave with the following people:

 *
I give consent for my child to be transported and supervised by The Arc's employees (please check all that apply): *
Required
I give consent for my child to participate in field trips. *
I give consent for my child to participate in the following water activities (check all that apply): *
Required

List any eating problems or food allergies

 *

What type of foods does your child like to eat for a snack? 

 *

How does your child get along with other children? 

 *

When/if you discipline your child, how do you do this? 

 *

What makes your child upset?

 *

How do you suggest we calm your child?

 *

Does your child (check all that apply) 

 *
Required

List any stimulus to which your child may be sensitive

 *

Please give any further information that you believe will be helpful to staff in understanding and caring for your child.

 *

Is your child diapered?

(PLEASE NOTE: PARENTS MUST SUPPLY DIAPERS AND/OR FEMININE HYGIENE PRODUCTS.)

 *

Would you like staff to work on toilet training?

 *

Is your child toilet trained?

 *

List names and ages of any siblings enrolled in The Arc.

 *

Diagnoses:

 *

Chronic or recurrent illnesses or disorders: 

 *

Allergies (food, medication, bees, etc):

 *

Date of last tetanus:

 *
MM
/
DD
/
YYYY

Any allergies not previously disclosed:

 *

If your child takes medication, please state the name of the drug and dosage.

 *

If medication needs to be given during program hours list time(s) and method.

 *

List any other medications that The Arc staff may administer to your child.

(i.e., Tylenol, Aspirin, etc.)

 *

What should we (you) do if your child has a problem related to his/her medical condition during program hours?

 *

What are the signs of problems that may occur?

 *

Physician's name

 *

Physician's phone number

 *

Preferred hospital

 *

Insurance company

 *

Policy holder ID/Group number

 *
Medical Consent:

In the event that my child may require medical and/or surgical care while I am out of the city or unable to be reached, I hereby give my consent to medical and/or surgical treatment to above named hospital and physician or his/her designee to provide this care.

I agree to pay all the costs and fees contingent on any emergency medical care and/or treatment for my child as secured or authorized under this consent.

(Name entered below recognized as consent.)

 *

I understand that I am enrolling my child in The Arc’s Summer Day Camp Program being held at 4901 Lakewood Dr., Waco, Texas 76710. I will update my child's file information as changes occur.

(Name entered below indicates understanding.)

 *
I understand that there is a $25.00 non-refundable registration and an annual Arc membership fee of $20.00 that must be current or paid at time of enrollment for attendance in Summer Day Camp. 

(Name entered below indicates understanding.)
 *
I understand that I am responsible for payment of weekly camp fees in the amount of $250.00 for full days (7:30 a.m.-5:30 p.m.) or $125.00 for half days (up to 5 hours, i.e. 7:30 a.m.-12:30 p.m.). These weekly fees are due the Friday prior to attendance week for all campers.

(Name entered below indicates understanding.)
 *
I understand that in the event of any absences during camp hours, I will be responsible for fees for time reserved, not actual time spent at camp (no per diem for care). Should my child be absent during a day, or several days, the fee is still the same for the entire week.

(Name entered below indicates understanding.)
 *
I understand that I am responsible for notifying The Arc ahead of time when my child WILL NOT be attending the program by calling 254-756-7491. Voicemail is available to leave a message. 

(Name entered below indicates understanding.)
 *
I will give seven (7) days' notice in writing prior to withdrawal from the program during which time I will be responsible for payment of fees.

(Name entered below indicates understanding.)
 *

I understand The Arc staff will assume full responsibility, as deemed reasonable, for my child from the time she/he arrives at the until my child leaves. If a medical emergency arises, The Arc staff will first attempt to contact me. If I cannot be reached, the staff will contact my child's doctor. If the emergency is such that immediate hospital attention is necessary, an ambulance or emergency vehicle may take my child to the hospital.

(Name entered below indicates understanding.)

 *
I understand that I am responsible for notifying The Arc ahead of time when my child WILL NOT be attending by calling 254-756-7491. Voicemail is available to leave a message.

(Name entered below indicates understanding.)
 *

I agree to adhere to the Policies and Procedures of The Arc’s After School Program as stated here and give my child permission to participate fully in this program.

 *
Required

PHYSICAL ASSESSMENT

TO BE COMPLETED BY PHYSICIAN OR HIS/HER DESIGNEE (form must be forwarded to your child's physician for completion)

 *
Captionless Image
Required

RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

This is a release. Read it carefully before signing. By signing this release, you are giving up your and your child’s rights to sue The Arc of McLennan County, a Texas nonprofit corporation, its agents, officers, volunteers, employees and any parties that operate, administer, co-organize or provide transportation to or from the activities described below (collectively, the “Released Parties”) or expect the Released Parties to be legally responsible or pay for any damages or medical expenses if your child is injured or killed, becomes ill or your child’s belongings are damaged as a result of your child’s participation in the activities described below.

Voluntary Participation. I acknowledge that my child (“Child”), and I have voluntarily chosen to:

(a) participate in THE ARC OF MCLENNAN COUNTY Summer Camp Day Program, a day program administered by the Released Parties, which may include numerous activities including, but not limited to, sports, hikes, arts and crafts, science experiments, cooking projects and field trips to various locations by bus including bowling alleys, sporting events, movies and fairs, any activities incidental thereto 

(b) be present at or use, as applicable, facilities, other locations, equipment and/or transportation provided by the Released Parties or others in connection with my participation in such activities. (The activities in clauses (a) and (b) are referred to collectively as the “Activity”).

Acknowledgement and Acceptance of Risks. My Child and I understand that certain risks are inherent in the Activity, and that these risks cannot be eliminated, altered or controlled. My Child and I understand that the risks that contribute to the unique character of the Activity can also be the cause of my Child’s injury, illness or death or damage to my Child’s belongings. My Child and I voluntarily elect, with knowledge of the risks involved, for my Child to participate in the Activity. My Child and I acknowledge and willingly assume all risks and hazards in the Activity and in the use of the Released Parties’ facilities and/or equipment.

Release. 

I am the parent or legal guardian of my Child. In consideration for my Child being permitted to participate in the Activity, my Child and I voluntarily agree and promise not to make a claim against, sue or attach the property of the Released Parties, and my Child and I release, waive, discharge and hold harmless the Released Parties for all demands, actions or claims of liability arising out of their negligence, fault, recklessness or any other act or omission that causes my Child’s illness, injury, death and/or damage to me or my Child’s property as a result of my Child’s participation in the Activity and in the use of the Released Parties’ facilities and/or equipment.

Knowing and Voluntary Execution. I have read this document in its entirety. I understand that by signing this document, my Child and I are assuming all the risks of the Activity. I understand that this is a release of any and all claims. I understand that this is the entire agreement between us and the Released Parties and that it cannot be modified or changed in any way by oral statements by any Released Parties or by us. I voluntarily sign my name as evidence of the acceptance by me and my Child of all the provisions in this document and our agreement to be bound by them.

(Name entered below recognized as acknowledgement and consent.)

 *

Media Release. 

I give permission for The Arc of McLennan County to have my child appear in any media coverage and use for publicity and fundraising purposes photographs of my child.

(Name entered below recognized as acknowledgement and consent.)

VIDEO CAMERA POLICY

To ensure the safety and security of our clients, staff and facility, The Arc of McLennan County has been equipped with video cameras in all classrooms and parking lots. To ensure compliance with The Arc policy, cameras will be monitored by the Executive Director, Program Director and Office Manager.

PROCEDURE:

1. Video cameras will not be used in areas of The Arc where clients and staff have a “reasonable expectation of privacy”, i.e. private offices and restrooms.

2. Notice of video cameras will be posted at The Arc facility.

3. The cameras will be constantly on and recording 24 hours a day, 7 days a week.

4. In the case of a reported incident, video will be reviewed to better determine the nature of the specific incident.

ACKNOWLEDGEMENT:

I acknowledge The Arc’s video camera policy and am aware that The Arc’s facility and grounds have video cameras in operation in all common areas, classrooms and parking lots.

(Name entered below recognized as acknowledgement.)

 *

THE ARC OF MCLENNAN COUNTY POLICIES AND PROCEDURES

ENROLLMENT IN THE ARC'S SUMMER DAY CAMP CONSTITUTES AN UNDERSTANDING THAT YOU WILL ABIDE BY THE POLICIES LISTED AS FOLLOWS:

EXPECTATIONS:

PARENTS MAY EXPECT THAT

1. Their children are cared for in a safe, supportive environment.

2. They may visit with the Program Director(s) about concerns related to their child or the program.

3. They will be told about any misbehavior on the part of their child, and to visit with the Program Director in order to bring about improvement in the situation.

4. They will be regularly informed by the Program Director about program activities.

THE PROGRAM EXPECTS THAT PARENTS WILL

1. Pay fees on time as explained in the Payment Policy.

2. Keep the child's records up to date, such as Enrollment Forms and Release Forms.

3. Pick up child(ren) on time - by 5:30 P.M.- afternoon closing time.

4. Contact the Program Director if their child will not be attending on a scheduled day.

5. Pay attention to any communications from the Program Director regarding their child's behavior and cooperate in efforts to bring about improvement in the situation.

CHILDREN MAY EXPECT

1. To have a safe, supportive and consistent environment.

2. To use all equipment, materials and facilities on an equal basis.

3. To receive respectful treatment.

4. To have discipline that is fair and non-punitive.

5. To receive nurturing care from staff members who are actively involved with them.

THE PROGRAM EXPECTS THAT THE CHILDREN WILL

1. Be responsible for their actions.

2. Respect the rules that guide them while at The Arc.

3. Remain with the group and childcare staff at all times.

4. Take care of materials and equipment properly and return them to their place when done, or before taking out new ones.

TAX STATEMENTS

The Program does not provide an itemized statement for tax purposes. We suggest that you keep a record of your monthly checks as an accurate account of your childcare expenses.

REGISTRATION AND ENROLLMENT

The Arc encourages children of all backgrounds to attend and does not discriminate on the basis of sex, race, color, creed, national origin or ethnic background.

Registration: The parent must complete an enrollment form and submit it with a $25.00 non-refundable registration/enrollment fee to The Program Director. Registered children who cannot be immediately enrolled will be placed on a waiting list.

Eligibility: A child may be registered for enrollment in The Arc at any time there is an opening. Children must be in Special Education classes in local schools.

Openings: When openings occur, parents of registered children are contacted for enrollment on a first-come basis for the available time according to the date of registration receipt.

Enrollment: Parents of registered children will be contacted regarding open enrollment in The Arc.

If the parents wish to enroll their child(ren), the parents will be provided with enrollment forms in print or online. Prior to the child's first day of attendance, the parent(s) will complete all forms and submit them to the Program Director. A completed set of forms is required for each child enrolled in The Arc.

Upon enrollment, parent(s) must make a non-refundable enrollment fee and first week’s tuition fee. Parent(s) must sign and return a program registration agreement.

Children will be allowed to attend The Arc only after all forms have been completed and returned, and payments have been submitted. If the parent has not submitted completed forms after the date when the child was scheduled to start attendance, the parent will be responsible for payment of weekly fees in order to reserve the enrollment spot until such time as the completed forms are returned.

Good communication is important in building a relationship between center staff and parents! Please keep your child’s caregiver informed about any significant events happening in your child’s life. We will keep you informed of significant happenings at our center by posting notices on the door. We will also provide verbal and/or written daily reports when you pick up your child, when needed.

ENROLLMENT FORMS

The Arc requires forms to be kept current. The parent must provide new information to The Arc regarding information on forms such as: emergency persons, names, employers, phone numbers, arrival/departure changes.

For the protection of your child as well as the other children in care, your child must have all vaccinations required by the Texas Department of Health. You must provide an immunization record upon enrollment and provide updates to that record whenever your child receives more immunizations, and/or parents must sign a form specifying that records are on file at their child’s school.

State law requires vision and hearing screenings for four-year-old children. Please provide copies of your child’s screening results or sign a form specifying that records are on file at your child’s school.

We will also ask you to sign a statement acknowledging receipt of a copy of this parent handbook, which obtains our operational policies. If we need to change any of these policies, you will be notified of the changes in writing before the change takes effect.

AFTERNOON CLOSING TIME

The Arc closes at 5:30 P.M. Parents whose children remain past 5:30 P.M. must pay overtime fees as follows: 5 - 15 minutes overtime - $5.00 per child. Each additional 1 - 15 minutes - $5.00 per child. Late fees are paid directly to the caregiver who must stay late. Childcare services may be withdrawn if three (3) overtime charges occur.

ABSENCES

If your child will not be attending The Program because of scheduled appointments, vacations, illness or other planned absences, please notify The Arc in advance. If your child is ill or becomes ill and you pick up your child from school, please call The Arc and note the absence. Absentees without prior notification may be mistaken for a missing child and unnecessary concern and time spent in searching for the child may occur. If a child does not arrive as intended, the Program Director will contact the parents. If the parents cannot be reached, the Program Director will contact the child's emergency persons.

RELEASE OF CHILDREN

Children will be allowed to leave The Arc with persons other than the parent only if permission has been given to The Program Director on the enrollment form or in writing by the parent. If a one-time exception is made to this schedule, the parents should provide The Arc with this information in advance.

DISTRIBUTION OF MEDICATIONS

Whenever a child is to be given a prescription or over-the-counter medication, the parent must provide a completed, signed medication authorization form to The Program Director. Medication must be provided in the original or duplicate container, or a container accompanied by the doctor's directions. If medication is to be kept at The Program for treatment of a chronic condition, no more than a one-month supply should remain at The Program at any time.

HEALTH AND SAFETY POLICY

If your child has a known medical condition (asthma, diabetes, seizure disorder, etc.), please be sure the director knows what to do if a problem should occur during Program hours. Please make sure that any medication is available and that the appropriate forms for its use have been completed. There is no licensed nurse on site nor any licensed health care professional on call. If a child has any one of the following conditions, the parent will be notified to pick up the child immediately: Contagious Disease, Fever over 100 degrees Fahrenheit, Vomiting or Diarrhea, Accident Requiring Medical Attention.

A list of communicable diseases is posted at site and will be reported as appropriate and as mandated by state guidelines.

In case of accident or illness, the parents of the child will be called immediately.

In serious cases, the child will be taken to one of the local hospitals by emergency vehicle for treatment and the parents will be called as soon as possible.

In the case of someone appearing on the premises with a firearm, the emergency number (911) should be called, and children should be taken out of danger and given aid.

Caregivers are to make every effort to keep a child from getting into a car with a parent under the influence of drugs or alcohol. They should call the police to give the child and parent a ride home. Caregivers should not under any circumstances give transportation to a parent who appears to be impaired by drugs or alcohol because The Program insurance does not cover this type of transportation.

The Arc is required to report suspected cases of child abuse. This includes the reporting of parents who appear to be impaired by drugs or alcohol. The Arc may have pets as classroom mascots and/or as visitors. All required safety standards will be met per childcare guidelines. The Arc does not require employees (i.e., caregivers) to present proof of vaccines, including TB, as McLennan County does not require it.

INSURANCE

The Arc carries minimal liability insurance but has no financial resources of its own. Families are encouraged to provide their own insurance coverage. Many families are covered by the parent's policy at work and/or their own private policies.

SNACK

We serve nutritious snacks during camp. Parents may want to provide a treat in honor of a child's birthday. In this case, they should contact The Arc to determine the number of children to be served and plan the date.

CHILD'S PERSONAL PROPERTY

Parents are responsible for diapers and feminine hygiene products when such are needed by their child. These can be sent daily or weekly in the child's backpack. Children's personal property, coats, clothing, school bags, etc. must be labeled and also must be cleared from the childcare room after each session of The Arc. Although The Arc attempts to help children stay organized, The Arc cannot be responsible for lost personal property.

It is recommended that your child not bring electronic games or devices to The Arc. Should your child elect to do so, you and your child assume full responsibility if the device is lost or broken.

NOTE: A child has the privilege of playing with an electronic device/tablet which is the property of The Arc, for a limited amount of time, as long as the device is handled properly. If a child destroys or damages the device, he/she loses ALL privileges to play with such devices, unless a parent is willing to replace the damaged device.

VISITORS AND OBSERVATIONS

Parents and community members who are pre-screened are welcome to occasionally observe at The Arc. For liability and supervision reasons, it is not possible for children who visit The Arc to take part in activities. We are always looking for ways to improve our program and we welcome your suggestions.

DISCIPLINE AND DISCHARGE

All children are entitled to a pleasant and harmonious environment at The Arc. We cannot serve children who display chronically disruptive behavior. Chronically disruptive behavior is defined as verbal or physical activity which may include, but is not limited to, such behavior that: requires constant attention from the staff, inflicts physical or emotional harm on other children, abuses the staff, ignores or disobeys the rules which guide behavior during the school day and Program time. If a child cannot adjust to The Arc's setting and behave appropriately, then the child may be discharged.

Reasonable efforts will be made to assist children to adjust to The Arc's setting. Disruptive behavior will be dealt with in the following manner:

1. The misbehaving child will be given a five-minute time-out in order for him/her to cool off and think about his/her actions.

2. If a second, 10-minute time-out is given to the child in a single day, an incident report will be written by the caregiver. This report is to be given to the parent or guardian to read and sign. The report will be returned by the caregiver to the Program Director where it will remain with the child's enrollment information.

3. If a child receives three written behavior-related incident reports, the child will be suspended effective at the end of the day of the third report. During the first week of the suspension, the parents, caregivers and Program Director will meet in a conference setting in order to determine the conditions for reinstatement. Parents will be responsible for payment of tuition during the period of suspension or until the child is withdrawn from The Arc or is discharged.

4. If the child is reinstated in The Arc's summer camp yet receives a fourth behavior-related incident report, the Program Director may suspend the child immediately, if necessary, notifying the parent to come and get the child. Parents will continue to be responsible for payment of tuition during the period of suspension or until the child is withdrawn from The Arc.

5. If the severity of a problem is great enough that it could endanger the safety of the child or other children enrolled in The Arc's summer camp, discharge will be effective immediately after the Program Director consults with The Arc Executive Director.

6. A child may be discharged if he/she is picked up late three (3) times.

7. A child may be discharged for non-payment of fees.

PROCEDURES FOR QUESTIONS AND CONCERNS

If you have a question or concern that cannot be addressed by your child’s caregiver, please contact the director to arrange a meeting or call The Arc office at (254)756-7491 to discuss your concern(s).

PROCEDURES FOR REVIEWING STANDARDS AND REPORTS

A copy of the minimum standards is available for review in The Arc office. Our most recent Licensing inspection report is always posted on the bulletin board in the entryway. You may also review the standards and our compliance history at

www.txchildcaresearch.org.

PROCEDURES FOR CONTACTING CHILDCARE LICENSING

We are regulated by the Department of Family and Protective Services. You can find out more about the regulation of childcare facilities by visiting their website at ww.txchildcaresearch.org.

You may contact the local Licensing office by calling (254) 526-9011. You may report the suspected abuse or neglect of children by calling the child abuse hotline at 1-800-252-5400.

EMERGENCY EVACUATION PLAN

In the event of fire, the children will be safely evacuated to the parking lot across the street at Friends for Life, 5000 Lakewood Drive. In the event of a tornado threat, the children will be moved to an inner room with block walls.


(Typed name below indicates you have read and agree to abide by the above policies and procedures.)

 *

PARENTAL STATEMENT

I have discussed and been given the Policies and Procedures of The Arc of McLennan County's Summer Camp. 

(Name typed below recognized as consent.)

 *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms