2020 Friday Childcare Student Information Enrollment Form
To help accommodate families during virtual days for elementary instruction, Barren Beyond the Bell will offer childcare services at five elementary schools.  The deadline for the application will be September 25.

There are limited numbers of classes available at each location.  All students who are accepted into the program who want scholarships will first be asked to apply for state assistance with Benefind.  Then, additional scholarship opportunities may be applied to your account.

During the day, students will have access to the following:
 - staff to help with virtual instruction  
 - devices as needed for homework or enrichment  
 - art & STEM projects
 - outdoor and indoor playtime
 - Grab N Go breakfast and sack lunch provided by the cafeteria staff

We have applied to open childcare centers at all elementary schools, but we are awaiting word from the Kentucky Childcare Licensing and Regulation Board.    

After the September 25th deadline, enrollment will be confirmed via email by a school site coordinator.  


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Email *
Are you a Barren Co. School Employee?
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STUDENT First Name *
STUDENT Middle Name
STUDENT Last Name
STUDENT Address *
Which school will your child be attending: *
STUDENT Date of Birth *
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STUDENT Gender *
STUDENT Age *
STUDENT Grade *
Are immunizations up to date? (You are required to submit a copy to the center before your child can attend. ) *
Emergency Contact Name and Phone Number (Please list in order to be called 1, 2, 3 etc...) *
Current/Preferred Doctor Information (Must include Name, Address & Phone Number) Please include all three. *
Current/Preferred Dentist (Must include Name, Address & Phone Number) Please include all three. *
Preferred Hospital (Must include Name, Address & Phone Number) Please include all three. *
Emergency Medical Authorization:  A parent/guardian must provide Barren Beyond the Bell consent for emergency medical treatment to be initiated for their child in the event of an emergency.  A parent/guardian may also refuse to grant consent.  If you would like to deny consent, please contact Sonya Davis (sonya.davis@barren.kyschools.us) *
In the event reasonable attempts to contact me or a second parent/guardian at the members listed in my emergency contact information have been unsuccessful, I hereby give my consent for: the administration of any treatment by a physician or dentist listed in the parent handbook, or in the event the designated preferred physician is not available, by another licensed physician or dentist. *
Please list any medical conditions that our facility needs to know about the student. *
Please list all individuals who are authorized to pick up the student in order of preference.  Include the relationship to the student and phone number. *
I give permission for my child's image, voice, or written comments to be included in evaluations, pictures, newsletters and marketing pieces associated with the program. Barren Beyond the Bell may use these indefinitely, without limitation or obligation for the purpose of promoting Barren Beyond the Bell programs. *
We may show PG rated movies in our program.  Do you consent for your child to watch? *
I give permission for my child to use all of the equipment and participate in all activities of the childcare programs. *
I understand that Barren Beyond the Bell assumes no responsibility for injuries or illnesses which may occur as a result of my child's physical condition or resulting from his/her participation in any athletic event, sports programs, and the use of any equipment, exercise or other activities. *
I acknowledge on behalf of myself and my dependents that I assume the risk for any injuries or illnesses which may result from activities.  I hereby release and discharge Barren Beyond the Bell, its agents, servants, and employees from any and all claims for injury, illness, loss or damage, which my child may suffer as a result of his/her participation in the childcare programs. *
I understand that Barren Beyond the Bell is not responsible for personal property lost or stolen while participating in the program.  My child is responsible for all of his/her belongings.  I understand that due to COVID-19 there will be NO lost and found. *
I understand that Barren Beyond the Bell is not responsible for anything that occurs as a result of false information given by a parent or guardian. *
I agree to read the contents of the 2020-2021 Parent Notebook and agree to all the terms that are covered in the manual.  I understand that my signature indicates that I have been previously made aware of all policies, procedures, and guidelines referenced in the notebook concerning this program.  I have read and fully understand these policies and authorization statements.  I do hereby give such authorization as indicated and document my understanding of specific policies. *
By signing electronically below, you agree to acknowledge and adhere to all of the policies and procedures associated with these programs.  These policies and procedures are outlined in detail in the 2020/2021 Family Handbook. *
I understand that the Barren Beyond the Bell program will follow the local school schedule.  If the children are scheduled to be off from school for the day our child care programs will NOT be available. *
I understand that under no circumstances will my child bring their own toys or other personal items, which include but are not limited to personal electronic devices, cell phones, card games, etc. If my child does so, the staff will hold the item and return it to the parent/guardian at the end of the day. *
I understand that my child(ren) must be signed in and out of the program daily.  This is a program requirement and must be done every day.  If someone else picks up my child, they will need to complete the sign in/out sheet and also provide staff with identification. *
I understand that if my child will be absent from the program, I need to call or email Barren Beyond the Bell staff prior to the start of the program. *
I understand, that the Barren Beyond the Bell program is financially self-supporting through fees collected from parents of each child enrolled. The After School Program receives no Federal or State money to sustain services.  Weekly tuition payments must be paid in full every Friday of the week the child attends. If not paid the account will be assessed a Late Payment Fee of $5.00. Because we staff based on the days you choose to attend, we must charge the fee for attendance if you sign up for a particular day and do not show up. *
I understand I will need to fill out the Parent Notebook for Barren Beyond the Bell.  I also understand that all paperwork will need to be complete before my child can attend the program. *
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Please print the name and phone of the person completing this form: *
A copy of your responses will be emailed to the address you provided.
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