2022-2023 Elementary After School Program Enrollment

2022-2023 After School Program Enrollment

For PreK-5th for children living in the 74127 community or that attend Wayman Tisdale.
The Common Good will have TWO after school programs this year for elementary students. PreK-3rd will be held at The HUB Learning Center and 4-5th grade will be at Wayman Tisdale.

Open to students PRE-K - 5TH GRADE

Starts September 6th

Monday - Friday (school days)

LEARNING CENTER at The HUB
PreK-3rd
2:45pm-5:30pm
* If your child does not attend Tisdale, you will need to provide transportation to The HUB.

C.H.A.M.P.S. at Wayman Tisdale
4th-5th
2:45pm-5:40pm

Your child will not be confirmed to be in the program until they receive a confirmation email from us.

Please Note: The Learning Center After School Program at The HUB is only for children that live in the 74127 community and/or those that attend to Wayman Tisdale Fine Arts Academy.
Parent / Guardian: *

First Name Last Name
Parent / Guardian email: *
Please enter a valid email address.
Relation to Child(ren): *
Parent / Guardian Phone Number: *
Please enter a valid phone number.
Please enter your child(ren)'s information below. *
Number of children you are registering on this form:

Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Parent / Legal Guardian #2:

Full Name Relation to Child
Parent / Legal Guardian #2 Phone Number:
Please enter a valid phone number.
Parent / Legal Guardian #3:

Full Name Relation to Child
Parent / Legal Guardian #3 Phone Number:
Please enter a valid phone number.
Parent comments/concerns:
List of People who CAN pick up my child. Please list NAME, CHILD, RELATION TO CHILD, PHONE #. *
Person who CANNOT pick up my child and why. Note: If you have a restraining/protective order against this individual, please bring it upon pickup on the first day of programming so we can make a copy for our records.
Do you have a restraining/protective order on this person?
Additional Person who CANNOT pickup my child and why.
Do you have a restraining/protective order on this person?

Other After School Activities

Wayman Tisdale provides many after-school programs for its students. The Common Good encourages students to sign up for and attend other programs in addition to ours!
Does your child participate in any other after-school programs, or are you planning to enroll them in any other after-school programs? *

Yes No
If you marked yes, please name the child (if you are registering multiple children) and the program(s):
What days do they attend or plan to attend other after-school programs?

Monday Tuesday Wednesday Thursday Friday

LEARNING CENTER/C.H.A.M.P.S. PARENT INFORMATION SHEET/POLICIES

Program Mission

To foster a love for learning in children, help them reach their full potential, and create a safe space for them to develop social and emotional skills that facilitate success in life.

Program Description

The Learning Center is located at the HUB and runs Monday-Friday from 2:45-5:30pm for Pre-K-3rd Grade students. As a class, students will eat a healthy snack, be active in our gym, and participate in different group activities each day.

C.H.A.M.P.S. is located at Wayman Tisdale and runs Monday-Friday from 2:45-5:40pm for 4th/5th Grade students. As a class, students will eat a healthy snack, be active in the gym, learn leadership skills, and participate in different group activities each day.

Holidays and Bad Weather

The Learning Center and C.H.A.M.P.S. follow the Tulsa Public Schools holiday calendar. The Learning Center and C.H.A.M.P.S. will also be closed if Tulsa Public Schools is closed for bad weather or holidays.

Check-in/Check-out Procedures, Transportation, Authorization for Pick-up

Pre-K-3rd Grade students attending Learning Center from Wayman Tisdale Fine Arts Academy will be bussed by a TPS school bus to the Northwest Tulsa HUB every day after school where they will be checked in by their Learning Center teacher. No child is permitted to walk to the HUB from Wayman Tisdale Fine Arts Academy. The parent/guardian of students who choose to walk will be notified immediately and expected to pick the child up from the HUB.

If your child will not be attending Learning Center, please do not let them ride the bus to the HUB and pick them up from the HUB. They must be picked up from school.

Parents/legal guardians for both Learing Center and C.H.A.M.P.S. will identify on their child’s registration form who can and cannot pick up their child. The Learning Center is dedicated to the safety of the children in our programs and will be requiring adults to show their ID upon pickup.

If a parent or legal guardian wishes to add more people to the “Can pick up” or “Cannot pick up” list, they will need to provide the notice in writing, by delivery or email to jrogers@cgtulsa.org. This policy is in place to maintain the safety of the children in our programs.

The Learning Center and C.H.A.M.P.S. use a checkout system to ensure that every child is picked up by a safe and approved individual. Children will not be allowed to leave HUB programming without an approved individual. Upon pick-up, a staff member or volunteer will require that each individual show proper identification to ensure they are on the approved pick up list. We take very seriously the safety of the children in our programs and will not release a child to any individual we do not recognize without a proper identification card.

Late Pick-up Policy

The Learning Center closes at 5:30pm and C.H.A.M.P.S. closes at 5:40pm. Therefore we ask authorized adults to arrive by the time our programs close. If an on-time arrival is unlikely on occasion, parents will need to call the Learning Center at (539) 867-3692 so a staff member can speak to the child about the delay. Three late pickups without notifying the HUB will result in your child’s enrollment being discontinued.

Attendance Policy

The program manager will be in contact with Wayman Tisdale Fine Arts Academy every day to maintain daily attendance information. If a child does not attend school, they cannot attend our program the day the absence occurred. If a child has chronic absenteeism from school (10 percent or more of school days, or around 18 days during a school year) we will unenroll them from our program. We are a partner with Wayman Tisdale Fine Arts Academy and want to encourage good attendance at school. Since we cannot confirm the attendance of children who attend Virtual Academy or other schools, parents/guardians of those children will be asked to make sure their child is attending their school, and to not send them to the HUB if they did not attend.

If a child misses three days in a row, or five total days without explanation, the program manager will remove them from Learning Center programming.

Sending Home Policy

The HUB reserves the right to send students home early from after-school program if staff believe that they are endangering others, or if they continuously show disrespect to other students and staff. If a student is asked to leave the HUB due to behavior/safety issues three separate times, they will be permenantly removed from the after-school program. This policy is in place to ensure the safety of all who enter the HUB.

Other After-School Activities

Wayman Tisdale provides many after-school programs for its students. The Common Good encourages students to sign up for and attend other programs in addition to ours!

Staff

Our staff is dedicated to promoting the well-being of your child. All staff members have passed a background check and are CPR and First Aid certified.

Supervision

Children will be well supervised, and trained staff and volunteers will remain with children at all times.

Care of Children Who Are Ill

Children who become ill while in our care may be sent home if:

• The child’s illness is keeping him or her from comfortably taking part in activities,

• The sick child needs more care than the staff can provide without affecting the health and safety of other children, or

• Other children could get sick from being near the sick child.

• See our Covid-19 Response form to learn about our policies and procedures around Covid-19.

Emergency Preparedness

The Learning Center has developed and practices emergency plans for:

• Serious injuries or illnesses

• Lost or abducted child

• Poison exposure, including exposure to toxic substances

• Potentially violent situations in the program, including individuals with threatening behaviors and intruders on campus

• Natural disasters, including tornado, blizzard, flood, or earthquake - The Learning Center will not be in session if Tulsa Public Schools cancels school for bad weather.

• Fires

• Disruption of utilities, including loss of electricity, gas, water

Security

Entrances are protected from unauthorized visitors by remaining locked from the outside. During enrollment parents can write the names of adults who are not allowed to pick up their child(ren).

Methods of Communication

·       Feel free to share any concerns or questions that may arise.

·       You may call the HUB at any time at (539) 867-3692.

·       You can request a meeting with Jane Rogers, the program manager at any time.

Weapons

There are no weapons permitted at the facility. The HUB has a “No Weapons on Site” policy.

Confidentiality

Every child’s information will be kept confidential. The Common Good will not share a child or a family’s personal information unless child abuse or neglect is reported or suspected.

Review and Revision of Policies, Plans, and Procedures

The policies and procedures are revised and updated as we learn new information and as we receive input from families, so feel free to provide input or ask questions at any time.

I have gone over these policies and by signing this I agree to follow the policies set forth.
Signature of Parent/Guardian: *

Clear
Date *

Month Day Year
Date

Has your child(ren) previously been enrolled in HUB programming? *

Yes No

MEDICAL RELEASE AND AUTHORIZATION FORM
Family Physician: *
Physician Phone #: *
Please enter a valid phone number.
Physician Address:

Street Address

Street Address Line 2

City

Postal / Zip Code
Allergies (Please list child's name and allergy): *
Currently taking the following medication & reason for taking medication (Please list child's name and medication):
Medical Insurance Company:
Policy #:
Phone Number:
Please enter a valid phone number.
Family Dentist:
Dentist Phone Number:
Please enter a valid phone number.
Dental Insurance Company:
Policy #:
Phone Number:
Please enter a valid phone number.
Prescription Insurance Company:
Policy #:
Phone Number:
Please enter a valid phone number.
In case of emergency, I hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any.

Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs.

This authorization and permission form is valid for all The Common Good activities for the 2022-2023 school year.
Parent / Guardian Name: *
Parent / Guardian Signature: *

Clear
Date *

Month Day Year
Date

Release Form for Media Recording

I, the undersigned, do hereby consent and agree that The Common Good, its employees, Board members, volunteers, and agents have the right to take photographs, videotape, or digital recordings of me and use these in any and all media, now or hereafter known, and exclusively for the purpose of advertising or promoting The Common Good or any entities with which we partner. I further consent that my name and identity may be revealed therein or by descriptive text or commentary.

I do hereby release to The Common Good, its Board, employees, volunteers, and agents all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used.

I understand that there will be no financial or other remuneration for recording me, either now or in the future.

I also understand that The Common Good is not responsible for any expense or liability incurred as a result of my participation in this recording.

I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.

For children under 18 years of age, Parent/Guardian Name signature is required:
Parent/Guardian Signature: *

Clear
Date *

Month Day Year
Date

THE COMMON GOOD

RELEASE OF LIABILITY FORM

In consideration of my child participating in The Common Good’s Learning Center activities. We/I, do for ourselves (myself) and for and on behalf of my/our child-participant do hereby release, forever discharge and agree to hold harmless The Common Good and its employees, Board members, volunteers, and agents thereof from any and all liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and child-participant that occur while said child is participating in the activity sponsored by The Common Good.

Furthermore, We/I and for and on behalf of our/my minor child-participant if under the age of 21 years hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participating in recreation and work activities involved therein.

The undersigned further hereby agree to hold harmless and indemnify The Common Good, its employees, board members, volunteers, and agents, for any liability sustained by The Common Good as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereof.
Parent / Guardian Full Name: *
Parent / Guardian Signature: *

Clear
Date *

Month Day Year
Date

COVID-19 RESPONSE

This Year we will check each student for symptoms of COVID-19 and do a temperature check during check-in to ensure a safe and healthy experience for students and staff.

We will not allow a child to attend programming if they are showing the signs of COVID-19:
- Cough
- Shortness of breath or difficulty breathing
- Fever
- Chills
- Muscle Pain
- Headache
- Sore Throat
- New loss of taste or smell
We ask that parents/ legal guardians check their child for the signs of COVID-19 each morning before sending your child to the HUB. If your child shows signs of COVID-19, or if they have been around friends or family who show signs for or have tested positive for Covid-19, please do not send them to the HUB until they have been seen by a physician and have tested negative for COVID-19.

THE COMMON GOOD’S COMMITMENT TO SAFETY
- Constant Hand Sanitization. Hand sanitizers will be available in each room and campers will be asked to use them when entering and exiting every room and during mealtimes.
- Rigorous Daily Cleaning. Facility and equipment sanitization will be completed multiple times daily.
- Lowering Health Risk. Require campers to stay home if they have fever or have been exposed to Covid-19.
- Daily Checks. Daily temperature checks will be administered and staff will monitor campers.
- Spreading Out. Social distancing will be practiced at meals and when possible.
By signing this form, I agree to check my child each morning for the signs of COVID-19 before sending them to HUB programming. I agree to not send them to HUB programming if they are showing signs of COVID-19 or if anyone they have been in contact with has been exposed to COVID-19.
Parent/Guardian Signature: *

Clear
Date *

Month Day Year
Date

Should be Empty:

2022-2023 After School Program Enrollment