2022-2023 Friday Afternoon Extended Care After School Program Enrollment Form

2022-2023
Friday Afternoon Extended Care

Kindergarten-12 Years Old
The program provides children with a safe, structured learning environment as well as a place to learn, play and socialize. Students have the opportunity to participate in organized activities. The overall goal is to promote student success in and out of the classroom. Friday Afternoon Extended Care will be available on student contact days excluding early release days.

Semester tuition for the afternoon care includes the option to participate in organized activities, snacks, and field trips. Friday Extended care is available on a drop-in basis, if space is available.

Friday Extended Care Hours:

Friday Afternoons: 1:15-4:00 p.m.

A late fee of $1.00 per minute per child will be charged for children picked up after 4:00 p.m.

Schedule:
- First Friday: RMDS
- Second Friday: Foothills Recreation Center
- Third Friday: Park/Rockclimbing
- Fourth Friday: Columbine Library
Cost:
- Semester Tuition: $150.00
  - There is no reduction in fees or refunds for days missed.
  - Includes snacks, activities, and field trips.
- Drop-In: $15.00
  - Includes snacks and activities. Depending on space availability. Drop in not available on Foothills and Rockclimbing days.
General:
- Any pick-up changes or early pickups, contact the after school phone: 720-525-9194
- Upon arrival, text the after school phone, staff will send your child to you.
- If your child missed a school day due to illness or any absence, they may not attend the program that day.
Student Registration
Student Name #1

First Name Middle Name Last Name
Nickname/Prefer to be called:
Name
Birth Date

Month Day Year
Date
Age
Grade
Student Name #2

First Name Middle Name Last Name
Nickname/Prefer to be called:
Name
Birth Date

Month Day Year
Date
Age
Grade
Student Name #3

First Name Middle Name Last Name
Nickname/Prefer to be called:
Name
Birth Date

Month Day Year
Date
Age
Grade
Pick-Up Authorization Form

To provide maximum safety for the children during after school program, we ask you to fill out this form to inform the staff who is allowed to pick up your child at the end of the day. Please provide three people who are authorized by you to pick up your child if you, the parent, cannot pick your child up:
#1: Authorized Person Name

First Name Last Name
Relationship:
Text/Phone Number:

Area Code Phone Number
#2: Authorized Person Name

First Name Last Name
Relationship:
Text/Phone Number:

Area Code Phone Number
#3: Authorized Person Name

First Name Last Name
Relationship:
Text/Phone Number:

Area Code Phone Number
After School Activities:

I understand that my child will participate in all field trips and Friday Afternoon Extended Care activities during 2022-2023 school year. Please check each activity below to acknowledge that your child will be participating in all Friday Afternoon Extended Care activities and off campus activities.
Walking Off-Campus Permission Form
I ___________________________ hereby give consent for my child to participate in the event on Mondays and Wednesdays with Rocky Mountain Deaf School. In consideration of my child’s voluntary participation in this activity and related activities, I understand that:

My child will be walking off-campus with their group with their club/sports leader/teacher/supervisor.

D’Evelyn Fields and outside the campus
Disc Golf Field
Large Field next to RMDS, across from D’Evelyn
Harriman Lake Park and Trail

Rocky Mountain Deaf School and Jeffco School District are relieved of any or all liability for accidents or injuries connected in any way with the activity program.

It is the responsibility of the parent or guardian to provide insurance protection for the student while participating in activities.

My child will follow the COVID-19 safety and its guidelines.

By signing this consent form, I hereby release and discharge the Jefferson County School District, Rocky Mountain Deaf School, and their/its successors, heirs, assigns, directors, officers, employees, supervisors, agents, attorneys, and representatives, from any and all actions causes of action, claims, demands, losses, damages, costs, attorney fees, judgments, liens, indebtedness, and liabilities whatsoever, known or unknown, suspected or unsuspected, past, present or future, with regard to all matters that could have been raised in action on the merits regarding the aforementioned activity in which I and my child have elected to voluntarily participate.
My child has my permission to go on walking off campus trips. Parent Signature:

Clear
Date

Month Day Year
Date
Friday Afternoon Extended Care Field Trip/Bus Permission:
During the Friday Afternoon Extended Care, your child will be riding the activity bus:
- Foothills Recreation Center: 6612 S. Ward St. Littleton, CO
- Columbine Library: 7706 W. Bowles Ave. Littleton, CO
- Earth Treks: 1050 W Hampden Ave. Ste 100 Englewood, CO
Your child will leave RMDS at 1:15 p.m. and return at 3:45 p.m.

I ________________hereby give my consent for my child ________________________ to participate in the events outlined on the previous page (other than any exceptions I have listed below) with Rocky Mountain Deaf School. In consideration of my child’s voluntary participation in this activity and related activities, I understand that:
- Transportation for these trips is provided by the RMDS Activity Bus driven by a trained staff member, or a JeffCo Public Schools Bus. Therefore, I give those persons permission to transport my child.
- Rocky Mountain Deaf School and JeffCo School District are relieved of any or all liability for accidents or injuries connected in any way with the activity program.
- It is the responsibility of the parent or guardian to provide insurance protection for the student while participating in activities.
By signing this consent form, I hereby release and discharge the Jefferson County School District, Rocky Mountain Deaf School, and their/its successors, heirs, assigns, directors, officers, employees, supervisors, agents, attorneys, and representatives, from any and all actions, causes of action, claims, demands, losses, damages, costs, attorney fees, judgments, liens, indebtedness and liabilities whatsoever, known or unknown, suspected or unsuspected, past, present, or future, with regard to all matters that could have been raised in action on the merits regarding the aforementioned activities in which I and my child have elected to voluntarily participate.
During Friday Extended Care, I'm aware that my child is participating in:

1st Friday: RMDS 2nd Friday: Foothills Recreation Center: 6612 S. Ward St. Littleton. Will return to RMDS at 3:45 p.m. 3rd Friday: Explore at different local parks or Earth Treks 1050 W. Hampden Ave. Englewood. Location of local parks will be communicated with the families. 4th Friday: Columbine Library: 7706 W. Bowles Ave, Littleton. Will return to RMDS at 3:45 p.m. Friday Afternoon Extended Care Field Trips, will ride the activity bus: 1:15-4:00 p.m. Local parks, Earth Treks, Columbine Library & Foothills Recreation Center
My child can participate in the trips and ride the activity bus. Parent Signature:

Clear
Date

Month Day Year
Date
Friday Afternoon Extended Care Registration:
I have filled out, read, understood and will abide by the registration and enrollment agreement.
Signature

Clear
Date

Month Day Year
Date
I would like to enroll my child(ren) in:
Friday Afternoon Fees Options:

Semester Tuition: $150.00/semester Drop in Childcare: $15.00/one Friday
Due to RMDS:
Your child can drop in on any Friday. Select the date(s) you would like for your child to stay after school.

Month Day Year
Date
Drop-In #2 Date

Month Day Year
Date
Drop-In #3 Date

Month Day Year
Date
Drop-In #4 Date

Month Day Year
Date
Payment Information:
- Semester Tuition is due before August 18, 2022. Payment may be made in cash, credit or through the parent Jeffco Connect account.
- If payment is not received before August 18th, the student cannot participate and will be sent home.
- The drop-in payment is due one hour before the daycare begins.
- There is no reduction in fees or refunds for days missed.
Additional Comments or Anything you would like for the Friday Afternoon Extended Care team to know:
Should be Empty:

2022-2023

Friday Afternoon Extended Care

Student Registration

Pick-Up Authorization Form

After School Activities:

Walking Off-Campus Permission Form

Friday Afternoon Extended Care Field Trip/Bus Permission:

Friday Afternoon Extended Care Registration:

I would like to enroll my child(ren) in:

Payment Information: