2023 Charger Club Registration
Fill out the form carefully for registration for summer childcare
Child 1 Name
*
First Name
Last Name
Child 1 Grade (2023-2024)
*
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Child 2 Name
First Name
Last Name
Child 2 Grade (2023-2024)
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Child 3 Name
First Name
Last Name
Child 3 Grade (2023-2024)
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Child 4 Name
First Name
Last Name
Child 4 Grade (2023-2024)
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Parent/ Legal Guardian #1
*
First Name
Last Name
Relationship
*
Relationship to Child
E-mail
*
example@example.com
Mobile Number
*
Format: (000) 000-0000.
Other Number
Format: (000) 000-0000.
Parent/ Legal Guardian #2
First Name
Last Name
Relationship
*
Relationship to Child
E-mail
example@example.com
Mobile Number
Format: (000) 000-0000.
Other Number
Format: (000) 000-0000.
Emergency Contacts
List contacts who would care for this child in case a parent or guardian cannot be reached. We will call 911 for assistance if we are unable to reach you or your designee.
Emergency Contact #1
*
First Name
Last Name
Relationship
*
Relationship to Child
Phone Number
*
Format: (000) 000-0000.
Emergency Contact #2
*
First Name
Last Name
Relationship
*
Relationship to Child
Phone Number
*
Format: (000) 000-0000.
Emergency Contact #3
First Name
Last Name
Relationship
Relationship to Child
Phone Number
Format: (000) 000-0000.
Summer Monthly Schedule
Please set your child's(ren) schedule for the entire summer. Leave dates blank or "No care" for any unscheduled days. Contact Andrea Hoglin (ahoglin@stjohns-savage.org) for special situations or changs.
June Monthly Schedule - Use the calendar to set your child's schedule.
*
Rows
Monday
Tuesday
Wednesday
Thursday
Friday
June 19 - 23
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
June 26 - 30
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
July Monthly Schedule - Use the calendar to set your child's schedule.
*
Rows
Monday
Tuesday
Wednesday
Thursday
Friday
July 3 - 7
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
July 10-14
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
July 17-21
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
July 24-28
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
August Monthly Schedule - Use the calendar to set your child's schedule.
*
Rows
Monday
Tuesday
Wednesday
Thursday
Friday
7/31-8/4
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
8/7-8/11
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
8/14-8/18
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
8/21-8/25
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Full Day
Half Day AM
Half Day PM
No Care
Keycards - Please indicate how many cards you need issued to your family. There is a $20 charge for any lost keycards.
Please Select
1 Card
2 Cards
Summer Field Trip Shirts
Rows
YS
YM
YL
AS
AM
AL
AXL
Child #1
Child #2
Child #3
Child #4
Back
Next
Administration of Medications
***This is not a substitute for any form of written documentation regarding a child's medication needs on behalf of a physician or medical prescriber, etc.
Child #1 Name
*
First Name
Last Name
Health Concerns: List Medication Name, what it is for, and any dosing, time, routine information
*
Child #2 Name
First Name
Last Name
Health Concerns: List Medication Name, what it is for, and any dosing, time, routine information
Child #3 Name
First Name
Last Name
Health Concerns: List Medication Name, what it is for, and any dosing, time, routine information
Child #4 Name
First Name
Last Name
Health Concerns: List Medication Name, what it is for, and any dosing, time, routine information
If medication is prescribed for your child, which MUST be taken during Charger Club hours, written instructions by physician or medical prescriber must be provided to staff, along with written permission allowing staff to administer the medication. Medication must be in original container, properly labeled with the child's name, date, amount and frequency of dosage. PLEASE double check the expiration date. As parents or legal guardians, you are responsible to check the expiration date before giving to Charger Club. This procedure is also applicable to over the counter medications including cough syrup, acetaminophen, etc. Also, if any health or medical changes occur, the parent/legal guardian is responsible to reach out and communicate with the Charger Club staff. By signing this form, I understand that statement above and am giving permission to the Charger Club staff to administer the medication to my child. Please type name below as electronic signature.
Date
-
Month
-
Day
Year
Date
In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical treatment. In the event of an emergency, if you are unable to reach me at the above listed numbers, please contact: (list name and phone number for Emergency Contact below)
Date
-
Month
-
Day
Year
Date
Medical Emergency Contact
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Back
Next
Field Trip Consent Form & Indemnity Agreement
I grant permission for my child to participate in Charger Club Field Trips. These activities will take place under the guidance and direction of the Charge Club Director and staff from St John the Baptist Catholic School in Savage, MN. I understand and agree that as a parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ("student/participant"). Further, I hereby warrant that to the best of my knowledge, my child is in good health and assume all responsibility for the health of my child. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St John the Baptist Catholic Church, Savage, MN, its officers, directors, employees and agents, and the Archdiocese of Saint Paul and Minneapolis, its employees and agents, chaperones, or representatives associated with the event and activities (hereinafter "Releases"), from any claim, including but not limited to all claims relating to communicable disease, arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate Releasees for reasonable attorney's fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of Releasees.Rev 7.2021
As a parent or guardian I agree to all of the above-stated considerations and conditions.
Date
-
Month
-
Day
Year
Date
I am willing to chaperone field trips with Charger Club, if needed. The Charger Club Director will contact you with paperwork requirements and the various field trip dates.
Yes
Back
Next
Charger Club Handbook Receipt and Acceptance of Terms
Please review information provided in the 2023 Charger Club Information Packet as well as the most recent Parent/Student Handbook.
I have reviewed the supplemental information provided in the 2022-2023 Kids Care Information Packet
Yes, I have read the information and agree to abide by the guidelines set forth within it.
Credit will not be given for absences
Yes, I understand
Payments will be processed through my FACTS financial account. I understand that past due accounts 1) may result in cancellation of child care services, 2) may affect my child's enrollment status at St. John the Baptist Catholic School, and 3) may be turned over to a collection agency.
Yes, I have read and understand.
All requests for schedule changes or cancellations must be made IN WRITING to the Charger Club Director with a two week notice.
Yes, I understand
Drop-In Care should be scheduled with Charger Club Director and is granted on a space-available basis. I agree NOT to send my child to the program without prior approval.
Yes, I understand
I agree to escort my child to the Parish Center and to sign my child in upon arrival each morning and sign out at the time of departure from the site when applicable.
Yes, I understand
All Charger Club families will be issued one or two access cards. All cards need to be turned in with the cancellation of Charger Club services or at the end of the school year. Cards not returned, lost, or damaged will incur a $20 fee,
Yes, I understand and agree
Under the laws of Minnesota, both parents have the right to pick up their chil(ren) unless a court document restricts that right. The enrolling parent who chooses not to include the child's other parent on the Authorized Pick Up list, must file an official court document.
Yes, I understand
I give my consent to and exchange of information between Kids Care staff and other St. John's School professional staff whenever it would be beneficial to my child.
Yes, I understand and give consent
I give permission for my child to be included in photos or videos of program activities that may be used in school publicity such as newsletters, brochures, websites and videos, and any media coverage such as newspaper or television.
Yes, I understand and give permission
I give permission for my child to go on walking field trips within 1 mile radius of St. John's.
Yes, I understand and give permission
I have listed on this form and/or in the FACTS Family Portal two people (other than parents) who are authorized to pick up my child and/or take responsibility for my child in the case of illness or emergency.
Yes, I have done this.
Medication will be administered under limited circumstances, when prescribed or authorized by a physician. All medications must be given to Charger Club Staff in its original container and accompanied by an Administration of Medication Form authorizing Charger Club Staff to give the medication.
Yes, I understand
I give permission to Charger Club Staff to make whatever emergency measures are judged necessary for the care and protection of my child while under the supervision of the program staff. In case of medical emergency, I understand that my child will be transported to the nearest hospital by ambulance if the local emergency resource (police or fire rescue squad) deems it necessary. I will be responsible for the cost of transportation. It is understood that in some medical situations, the staff will need to contact the local emergency resources before the parent and/or another adult acting on the parent's behalf arrives onsite.
Yes, I understand and agree
Behavior Guidelines
Charger Club participants will use respectful behavior at all times that will help peers, self, and staff feel safe, respected, and valued. Some examples of respectful behavior include: recognizing and being sensitive to others' feelings; demonstrating courtesy to others; acknowledging the effort of others; honoring the materials, equipment, and property of Charger Club and of others; listening to others' thoughts and ideas; respecting and honoring other's personal space.
Kids Care participants will comply with guidelines set forth by St. John the Baptist Catholic Church and School under Kids Care program and within the Parent/Student Handbook.
Yes, I understand and have communicated the above information to my child(ren).
Failure to abide by these guidelines may result in suspension or possible for termination of care.
Yes, I understand and agree
As parent or guardian, I hereby certify that the information provided is accurate at the time of enrollment. I understand it is my responsibility to update and make corrections to enrollment forms as needed. I understand I am responsible to contact Charger Club promptly with any changes to the information on this form. Please type name below:
Continue
Continue
Should be Empty: