2023 C-FC 4-H Afterschool Summer Program Registration

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4-H Afterschool 2023 Summer Program Registration Information

Students in Grades K-6 during 2023-2024 school year
C-FC School
May 30, 2023, to August 18, 2023
Monday – Friday
7:00 a.m. – 5:30 p.m.

$110/week per student

4-H Afterschool Summer now has part-time rates available!

3 days $84.00 a week/per student. Must select three days of the week and maintain those throughout the summer.

1-2 days a week $30 a day/per student. You must select the days of the week and maintain those throughout the summer.

Full time students receive priority for registration.

Students must bring their own sack lunch each day if lunch is not available at school. Students will participate in school breakfast, if available at school. Morning (if no breakfast) and afternoon snacks are provided. 4-H Afterschool summer staff is custodial care and mandatory reporter trained college and high school students. All 4-H Afterschool summer students will also enroll in Buffalo County 4-H and enter exhibits at the Buffalo County Fair – fair fees are included in registration. At least one day a week at the Scenic Valley Swimming Pool will be likely; a pool pass will be required. Participation in Cochrane-Fountain City Summer School is strongly encouraged.

The summer program may be limited to 40 full time students if all staff positions are able to be filled. A waitlist will be established based on student priority, if necessary.

In order to finalize 4-H Afterschool Summer registration, a deposit per student equal to one week’s fees must be paid by March 15, 2023. This deposit is nonrefundable after March 15, 2023. The deposit will be applied to the last week of participation in 4-H Afterschool Summer Program. A $10 4-H enrollment fee per student for insurance is also required summer; include fee with your deposit. You will receive invoices to your email via QuickBooks. Please send checks only made payable to 4-H Afterschool to: 4 H Afterschool, UW Madison Division of Extension Buffalo County, PO Box 276, Alma, WI 54610 or send to school with your child in a sealed envelope marked 4-H Afterschool Summer (preferred).

Please complete one registration form per student. Thank you.

Email *

Parent/Guardian Name *

Contact Phone for Registration Purposes *

Contact Email for Registration Purposes *

Student First and Last Name *

Student Current Grade: *

Which registration rate is requested? Priority will be given to full-time students. *

$110 per week per student (Monday - Friday; 5 days)

$84 a week per student (3 days per week, must be the same days each week all summer)

$30 a day per student (1-2 days a week, must be the same day(s) each week all summer)

Check the days of the week your child will attend. *

Monday

Tuesday

Wednesday

Thursday

Friday

Required

Estimated Time of Arrival Each Day: *

Time

Estimated Time of Departure Each Day: *

Time

Will your child participate in the Cochrane-Fountain City Summer School program?

Yes

Not sure

Clear selection

Please include any comments or additional information 4-H Afterschool should know about your registration.

If you would like to request a request for part-time rates, partial scholarship, payment plan or request for reduced rates, please explain your need for financial support in 2-3 brief sentences below. Thank you.

4-H Afterschool Summer Program Contract -- READ THE FINE PRINT PLEASE *

Check each box to signify that you have read each item in the contract.

4-H Afterschool Summer Program will run from May 30, 2023 to August 18, 2023. The program is housed at the C-FC School. Hours are 7:00 a.m. to 5:30 p.m., Monday through Friday.

C-FC 4-H Afterschool Summer Program will be closed July 3 and July 4, 2023.

Contracts must be fulfilled for the entire length of the 4-H Afterschool Summer Program.

Parents/Guardians will be billed for summer program based on this contract regardless of attendance. Payment is due in advance of each week’s care on Monday. First payment will be due May 30, 2023. Failure to pay will jeopardize children’s participation in the program. The nonrefundable deposit will be applied to the last week of participation in the 4-H Afterschool Summer program.

Students must bring their own lunch each day unless school lunch is available. Morning and afternoon pre-packaged snacks are provided daily.

I understand it is my responsibility to obtain a Scenic Valley Swimming Pool summer pass for my child before the summer program begins

I verify that all the information provided above is accurate to the best of my knowledge, and I have read, understood and agree to abide by the above contract and all 4-H Afterschool policies, including those established in the 4-H Afterschool Summer Plan to comply with COVID-19 protocol.

Required

Signature *

Please type your full legal name in the text box below. This will certify as your legal signature.

An EEO/AA employer, University of Wisconsin-Madison Division of Extension provides equal opportunities in employment and programming, including Title VI, Title IX, the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act requirements.

Please make requests for reasonable accommodations to ensure equal access to educational programs as early as possible preceding the scheduled program, service, or activity. For communicative accommodations in languages other than English, please contact oaic@extension.wisc.edu. For communicative accommodations based on a disability, please contact Heather Lipinski Stelljes at: heather.stelljes@wisc.edu for the public.

A copy of your responses will be emailed to the address you provided.

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