Parent/Guardian Safety Agreement/Enrollment for the 29th Street Community Center’s 2023 Summer Program

The 29th Street Community Center is hosting a summer program for Pre-K-8th grade students for six weeks, beginning on Wednesday, July 5th, and ending on Friday, August 11th. The program is from 9:00 am to 4:00 pm and breakfast, lunch, and snacks will be provided each day. Our summer program will provide indoor and outdoor activities from STEAM, Arts and Crafts, Creative Movement, as well as mentoring for all age groups.

We are asking parents or guardians to review and to fill out the following form for each child prior to starting any programs. Below are a few guidelines that we ask you to accept and follow when you are participating in programs or in the building.

*We will be limiting our enrollment numbers within groups. Our maximum enrollment will be 65 (run on a first come first serve) which means even though this form was submitted does not guarantee a spot within the program. 

We are asking each parent to donate snacks (no nuts, peanut butter, candy) or a one-time $10 donation during the first week of camp to provide snacks to all campers during the summer. 

Please answer the following questions. This information will be used to determine whether the benefits of this program are being made available to all people on a non-discriminatory basis. Further, the information being collected is a requirement by funders of this program, and part of our continued efforts to remain in compliance with their guidelines. 

Remaining in compliance is the only way that we are allowed to effectively conduct this service and continue to provide this FREE program to you, your child(ren), and this community. 

The 29th Street Community Center prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived from any public assistance program. 

None of this information will be shared outside of our program. We report demographics in terms of numbers, and not attached to identifying information. 

Thank you for your understanding. If you have feedback about how we can make this from more inclusive, please share it in the space provided at the end. 

Behavioral Contract Plan

All children in grade levels will be given three warnings per day before they are asked to leave for the day. If a student is asked to leave, the parent/guardian will be contacted if pickup is required.

Fighting

• There will be a zero-tolerance for fighting. Once a fight occurs, a phone call will be made to the parent/guardian of the student(s) involve; the student(s) involved must go home.
• After a fight occurs, student(s) must talk to Center management to get to the root of the issue at hand through a short conversation. If the Center staff think they need to talk to the family further than the initial phone call for the student(s) to go home, then they shall do so and keep track of the student(s) behavior.
• After two fights in one week, a student will not be allowed back in the Community Center. A meeting must be completed with the student, parent/guardian, and Center management.

Language/Conduct

• No cursing or profanity will be tolerated at any time.
• No bullying or aggressive behavior will be tolerated at any time.
• All Center space, equipment, and staff must be respected at all times.
• Lastly, all loose items (including water bottles) brought to the Center by the child will be the responsibility of the child and not the 29th Street Community Center.

Sexual Misconduct

• Explicit sexual conduct will not be tolerated.

Community Center Safety Guidelines to Maintain a Healthy Environment 

To maintain a safe working space for children and staff, we will adhere to all local, state, and national regulations. Please note mask are optional for staff and students

Our staff will:

• Conduct temperature checks and screenings for all staff and youth enrolled in programming each day
• Arrange tables and seats at a minimum of six feet apart
• Disinfect and clean commonly touched areas throughout the day (water cooler, soap/hand sanitizer dispensers, doorknobs, light switches
• Disinfect and clean the building each day
• When applicable, host activities outdoors in shaded areas (except on Code Red days)
• Post increased signage in restrooms on proper hygiene techniques

In the case of a Positive COVID-19 Case  

If a staff member or child tests positive for COVID-19, any child who came into contact with the positive individual will have their parent/guardian notified and testing will be recommended. The staff member or individual will be asked to stay home for 14 days and ensure that they have a negative test before returning. Temperature checks will continue to be conducted each day to monitor individuals who enter the building. If we receive notification in the middle of the day that a staff member or child that was in the building that day has tested positive, we will close the building for the day for cleaning and disinfecting.

If a staff member or child lives in a household with someone who has tested positive, we will ask that individual to stay home for 14 days and ensure that they receive guidance from their doctor before returning to the building.

If a child or staff member presents a fever of over 100.3 the first time, they will have 10 minutes to be able to cool down from the heat before taking a second temperature reading. If the reading continues to be over 100.3, they will be asked to go home and can return the next day. If the child or staff member presents a fever over 100.3 a second day in a row, we ask that they not return to the building until 14 days or present a negative test for COVID-19. 

For good and valuable consideration, the parties agree as follows:

I, as the parent or guardian, will follow the requirements for in-person attendance for small group instruction.

• I will not send my child to small
group Instruction if they are exhibiting any signs/symptoms of COVID 19 or have been exposed to someone with COVID 19 (or presumed to have COVID 19) in the past 14 days.

• I will review symptoms
with my child and monitor my child’s symptoms every day that my child attends in-person activities/events.

• If my child becomes ill during any in-person activity/event, I will ensure they are
picked up promptly. I will follow-up with an authorized health care provider/health department and comply with recommended quarantine or isolation as directed. If my child is ill, I understand that a release to return to in-person activity from an authorized health care provider will be required. 

Signs and Symptoms of COVID-19:
New onset cough or shortness of breath OR At least 2 of the following:
• fever of 100.4o or higher
• chills
• shivering
• muscle pain
• sore throat
• headache
• loss of sense of taste or smell
• gastrointestinal symptoms (nausea, vomiting or diarrhea)
Students must be free of fever for at least 24 hours without the use of fever-reducing medications.

After reading over these documents, I consent to the continued participation of my child in this program. I understand and acknowledge that City Schools cannot eliminate the risk of exposure to COVID-19 and by signing this Agreement, I fully and knowingly agree to ASSUME ALL RISKS associated with participating in the activity and the exposure to or the infection of COVID-19, including any risk of illness, bodily injury, permanent disability and/or death related, directly or
indirectly, to COVID-19.

As the legal guardian of the child(ren) named in this application:

I will allow staff members of the 29th Street Community Center to: 

 • give my child(ren) reading and math evaluations and assessments 

• access school records, including test scores, attendance, behavior and suspension records, and applicable information concerning services my child(ren) receives such as IEP records, 504 plans, etc.

• conduct and have students complete program evaluations as pre-determined by program funders

• communicate with teachers or other school staff about academic performance and behavior

• provide on-site minor care for injury or illness 

• provide immediate medical attention in an emergency by transporting my child(ren) to the nearest hospital or medical facility 

I give permission for my child(ren) to do or complete the following: 

• to be photographed or videotaped by the 29SCC or its partners (e.g. Johns Hopkins, Family League, etc.) for marketing, public relations, and educational purposes.

• to access the Internet in on 29SCC devices under 29SCC staff supervision. 

• to accompany 29SCC staff and their class on walking field trips in the community surrounding the 29SCC. Students will not travel unsupervised in the community during program hours. 

• to be escorted home by persons that I list on this application as authorized to give SAFE PASSAGE HOME. 

Liability 

I release the 29th Street Community Center, its partner organizations, and employees from any and all claims or liabilities for any damages or injuries that may be sustained in connection with this program or in transporting my child(ren) to and from or during the program. I understand that the program ends at 4:00 p.m. I will make sure someone picks up my child by 4:00 p.m. Monday through Friday. 

29SCC are not responsible for items lost during program. 

BEHAVIOR, ATTENDANCE, AND DROP OFF/DISMISSAL POLICIES 

I understand that with my support, my child(ren) must maintain a good attendance record, actively participate in all activities, and exhibit good behavior in order to remain in the program. 

Attendance and Lateness 

We understand that there may be issues out of your control; however, it is imperative that you remain in constant contact with the 29SCC program staff so that we are aware of your situation. If a leave of absence is necessary for any reason, then please be sure to inform the Youth Program Manager. 

Consistent absences will be immediately addressed. Children who do not attend the program regularly or who get picked up early may be dismissed so that their space can be given to a child on the waiting list. 

 

I agree to support my child by following all policies and procedures as outlined in this application, during 29SCC Family Meet and Greet, and in the 29SCC Family Handbook. I hereby agree to follow all policies in this application, and I certify that all information in this application is true to the best of my knowledge.