Teen Club 2024-2025

Parent/Guardian Information #1

Parent/Guardian Information #2

STUDENT #1

Student 4 Information

Liability Waiver

I hereby certify that my child(ren) is/are in good physical condition and do/does not suffer from any disability that prevents or limits his/her participation in all activities conducted by undefined. I acknowledge that undefined will not assume any responsibility or liability for personal injury or damages caused by the injury. In the event undefined is unable to reach a parent, guardian or any emergency contact, I hereby give permission for my child(ren) to be transported to the nearest hospital for treatment in case of an accident or emergency. I hereby further authorize(s) any of the staff or employees to provide for, approve and authorize health care at hospital.

Late Pickup Fee Policy

 

In order to be fair to our participants and staff, Midtown Community Services has enacted a late pick-up policy.

Pickup from After-School will be between 5 and 5:30pm.

Each time a participant is not picked by designated ending time, a $1.00 per minute fee will be charged. Registration for other programs will not be accepted until all outstanding late fees are paid. The late fee is due within three days. Payments can be made in person or online, an invoice will be sent.
Failure to pay late pick-up fees could result in your child’s suspension from the program.

*Note: Midtown Community Services shall make every reasonable effort to contact persons authorized by you to pick up your child. If we are unable to arrange pick-up within 30 minutes, we will request the assistance of the St. Louis Police Department.

Photo Release

I hereby grant and authorize undefined the right to take, edit, copy, publish, distribute and make use of any and all pictures or video taken of my child(ren) to be used in and/or for legally promotional materials and digital communications.

This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I understand and agree that these materials shall become the property of and will not be returned.

Text and Email Notifications I give the afterschool staff permission to contact me through the Text Message software and email for updates regarding programming, time/date changes, upcoming events, etc.

COVID-19 & Sickness Policy

Please help us by:
• Keeping your child home if they or anyone in the house is sick
• Keeping them at home if a classmate or anyone at home has tested positive with COVID-19
• Being as truthful as possible on health questionnaire
• Err on the side of caution and don’t send your child if you think they might be coming down with something.
If exposed, please notify Director
• You will be required to test after exposure.
• In order for the participant to return, a negative lab test will be required. Currently, Midtown will not accept home tests.
Midtown doesn’t have the option to just quarantine 1 classroom at a time if someone gets sick. We have to close down all of Midtown Youth Programs and potentially other Midtown programs.
We also have to contact the Health Department if we have a covid incident who will then in turn let your child’s school know.
We really hope you will help us make Midtown a safe place for your child, other families, and our staff.
Thank you for putting trust in our staff and continuing to support Midtown!

EMERGENCY PROTOCOLS

In the event of an emergency situation, Midtown Community Services has outlined the below response plan.  Please know that Midtown will make every attempt to notify you so it is vital that you keep your emergency contact information up-to-date.  Keep this letter with you so that you will know how to contact us in the event of an emergency.

 

Evacuation / Relocation

1.       If the emergency is confined to the immediate area at Midtown e.g. fire, and the children cannot stay on the premises, the children will be taken to St. Cronan’s Catholic Church across the street from Midtown.  The children and staff will remain at this location while you or your emergency contact is notified of the situation.

2.       If the emergency is more widespread and encompasses a larger area such as the neighborhood due to an environmental threat, e.g. flood, and the children cannot remain in the immediate area, they will be transported to City Greens Market at 4260 Manchester Ave, St. Louis, MO 63110.   The children and staff will remain at this location while you or your emergency contact is notified of the situation.

 

Notification

1.       Every effort will be made to contact you as soon as the children and staff are safe.  We will contact your alternate emergency contact if we cannot reach you.  Children will only be released to you or your alternate emergency contact during times of emergency.

2.       Midtown will not be open on days St. Louis Public School is not in session due to severe or winter weather.

 

Emergency Supplies

1.       Midtown will have emergency supplies on hand like blankets, food, flashlights.

 

PLEASE INTITAL BELOW THAT YOU HAVE READ AND UNDERSTAND MIDTOWN'S EMERGENCY PROTOCOLS.

MIDTOWN PARTICIPANT BEHAVIOR CONTRACT

Parents/Guardians: Please take a moment to review with your camper(s) the following and agree that you have read below.

Participants will arrive and remain at Midtown with a positive attitude, open to meeting new people and trying new activities.

Participants will work with their Group Leaders towards creating an environment that is safe and welcoming to all participants.

Participants will be aware that disrespectful behavior includes, but is not limited to, hitting, punching, kicking, biting, spitting, swearing, lying, and refusing to listen to Midtown staff.

Participants understand that doing intentional harm or bullying toward another participant, either physically or emotionally is grounds for dismissal from Midtown.
Participants understand that although the participant may be able to solve some conflicts on their own, the Midtown staff is always ready to listen and assist if there is a problem.  

Participants should understand that Midtown Staff need and want to help but can only do so if the participant is willing to share any concerns they are having with them.
Participants will remain with their group and partake in the activities as required.

Participants will use appropriate language and understand that the use of excessive, deliberate, profane language will not be accepted.

Participants will leave their cell phone and other electronic devices at home. Any outside items will be stored in the office. Participants should understand that if there is an emergency Midtown staff will be happy to allow them to use the phone and will pass on any urgent messages from home.

Participants will be respectful of the property and personal space of other participants and Midtown staff.
Participants will be respectful of Midtown buildings and any other location they might visit while attending Midtown.

Participants will not possess smoking materials, lighters, matches, illegal drugs, alcohol or weapons of any kind on Midtown property.

Behavior Management

For non-physically related offenses staff will use positive reinforcement to help participants adhere to this behavior contract. In case of continued behavior problems, the staff may implement the following consequences, depending on severity:

• Staff will redirect the participant to more appropriate behavior.
• Staff will remind the participant of the behavior guidelines and rules and be asked to reflect on how he/she can correct his behavior.
• A participant can lose out on special incentives, activities, or field trips.
• A participant may receive a necessary time out to calm themselves and correct his/her behavior.
• If a participant continues with inappropriate behavior, he/she will meet with the Youth Director to discuss the situation. At this time, a phone call to a parent or guardian will be made. 
• After the 2nd incident following a phone call home participant will be suspended for 1 day of Midtown Youth Program.
• After the 3rd incident the participant will be suspended for 1 week of Midtown Youth Program following a conference with parents and the Youth Director. A Behavior Correction form will be completed.
• All other offenses following the 3rd offense will result in the participant being removed from Midtown Youth Program.  
• In the case of a participant being physically violent (kicking, biting, punching, hitting, etc.):

1st Incident- Participant will need to be picked up from Midtown Youth Program early on the day of the offense and will automatically receive a 1-day suspension from Midtown Youth Program.  Parent/ Guardian and participant will need to meet with the Youth Director

After the 2nd physical incident participant will be suspended from Midtown Youth Program for a week and will need to fill out a Behavior Correction Form prior to returning.  

Following a 3rd occurrence the participant will be removed from Midtown for the remainder of Midtown Youth Program.  
If there are any safety and/or behavior concerns with off-site field trips or activities, a child may not be able to attend the function. If this happens, the parent is responsible for finding alternate child care.

No refund will be given for days that participants miss due to suspension and/or removal from Midtown Youth Program.

To help us have a great Midtown Youth Program we ask if you have any suggestions on behavior management for your child.