Welcome to the Sumner/Bonney Lake Recreation Department's Before & After School Program for the 2011-2012 School

Year! For Grades K-5 (full time Kindergarten only)

Thank you for choosing the Sumner/Bonney Lake Recreation Department as your choice for before and after school activities for your child(ren). The Before & After School Activities Club serves children who attend Bonney Lake, Crestwood, Daffodil Valley, Eismann, Emerald Hills, Liberty Ridge, Maple Lawn (at McAlder) and Victor Falls Elementary schools. Because of overwhelming response for before and after school care, the only plans available at our Maple Lawn at McAlder/Eismann site are 3-5 days per week. We will still offer 1-2 day weekly care as well as 3-5 day weekly care at our Victor Falls/Liberty Ridge, Emerald Hills/Bonney Lake Elementary, Crestwood and Daffodil Valley Elementary. All of our plans include the Sumner School District Wednesday late start mornings. The Daffodil Valley program will be located at Robert Miller Gymnasium for AM and PM. Robert Miller Gymnasium is located directly behind Daffodil Valley Elementary School. The Crestwood program will be located at Crestwood Elementary. Beginning with the 2011-2012 school year McAlder Elementary students will be permanently moved to Eismann Elementary. During the Maple Lawn remodel in the 2011-2012 school year, Maple Lawn and Eismann students will be at McAlder Elementary in the AM & PM. Emerald Hills and Bonney Lake/Elementary students will be at Emerald Hills Elementary AM and PM, Liberty Ridge and Victor Falls students will be at Liberty Ridge in the AM and PM. The students will be taken via Sumner School District bus to and from their respective schools and program sites. However, you must drop your child(ren) off at the AM site indicated and pick-up will be at the same site. Enclosed is a Parent Information Packet which includes a payment schedule, contact phone numbers, and answers to our most asked questions. Please thoroughly read all of the material included in this packet and promptly turn in all necessary paperwork. A 50% deposit of Septembers payment (except for Autopay registrants) and a fully completed registration form will reserve your spot. Your child will not be considered registered until all paperwork is completed, turned in and approved by the Recreation Department. We offer "autopay" and a savings of $50 when you sign up for this service. To receive your $50 savings, just sign the authorization form to charge your credit card for your monthly payment. You will receive a $5 savings each month per child. Your credit card will be charged on the first of each month. If you sign up for "autopay" you will not need to pay the 50% deposit at the time of registration. Your entire September child care amount will be charged on September 1. Note: When there is a school closure or delay due to poor weather conditions, the Recreation Department sponsored Before and After School Program will likewise be affected. For example, if school is two hours late, the Before and After School Program will not open until 8:30 AM (which is two hours later than usual). If schools are closed, our program will also be closed. If you have any questions, feel free to call the Recreation Department at (253) 891-6500 or visit us on the web at www.sumnersd.org/studentfamilyservices/parksrecreation/ Before & After Program Coordinator Rich Hanson [email protected] Recreation Department Secretary Alex Latham [email protected]

Please return this registration/information sheet to us at time of registration.

Child #1______________________________________ Child #2_____________________________________________ Parent(s) Name: _______________________________ Cell (M) __________________ Cell (F) _____________________ Address:_____________________________________________ City:_______________________ Zip: ______________ Mother's Place of Work: _______________________________ Father's Place of Work:___________________________ Home Mother's Work Father's Work Emergency Phone:______________________ Phone: Phone: Phone: Name Child #1: Sex (circle) M F Grade Age Birthdate School Attending Child #2: Sex (circle) M F Grade Age Birthdate School Attending Person(s) authorized to pick up/drop off child(ren) (include yourself ) Person(s) not authorized to pick up/drop off child(ren) (A copy of a court order will be required for parent listing) Please check your preference from available plans: #1 - $360 (AM/PM 3-5 Days/Week) #2 - $240 (AM/PM 1-2 Days/Week) #3 - $260 (AM Only 3-5 Days/Week) #4 - $185 (AM Only 1-2 Days/Week) #5 - $285 (PM Only 3-5 Days/Week) #6 - $210 (PM Only 1-2 Days/Week)

Before & After School Activities Club Registration

Letter of Agreement - Please sign below I give my child(ren) permission to participate in all Before & After School Activities Club programs. I give the Recreation Department permission to transport my child(ren) to and from site to school. I give the Recreation Department permission to call an ambulance, at my expense, in case of emergency. I understand that the Before and After Day Care organization does not provide any health or accident coverage for its participants. I understand it is my responsibility to provide my own accident/health insurance while participating in all Before & After School Activities Club events. I promise to pay all monies owed to the Recreation Department as a result of being a participant. (Please see attached payment information if there is another person responsible for payment or partial payment.) I understand that I will not be reimbursed for any fees unless I have given the Recreation Department at least one week advance notice of any change in program/schedule. Unless notified of any change the Recreation Department will continue to bill for Before & After School Activities Club services. I hereby assume all risks and hazards of the conduct of the program and release from responsibility any person providing transportation to and from activities. In case of injury, I do hereby waive all claims of legal actions, financial or otherwise, against the City of Sumner, the City of Bonney Lake, and the Sumner School District. In the absence of signature, payment of fee and participation in the program constitutes acceptance of the conditions set forth in the release. I grant full permission to use any photographs, videotapes, motion pictures, recordings, or any other records of this program for promotional purposes. If my child(ren) has any form of a cast or has been treated recently, I will provide a physician's statement that it is absolutely safe for my child(ren) to be active in the program. Our department will not be responsible for additional injuries sustained by your child(ren) because he/she was previously injured. If my child has an IHP, I understand that additional paperwork may be required before my child can participate. Parent/Guardian Signature ________________________________________________ Date ______________________________

Medical Treatment Authorization

As a parent or legal guardian, I authorize and consent to any examination, medical or surgical treatment rendered by my family physician listed below or, if my physician is unavailable, by any member of the medical staff of the nearest emergency medical facility. I understand that this authorization is given in advance of any specific diagnosis, treatment or hospital care deemed advisable by the aforementioned physicians in the exercise of their best judgement. It is understood that effort will be made to contact the undersigned prior to rendering treatment to the patient, but that none of the above treatment will be withheld if the undersigned cannot be reached. Child #1: Allergies to food or drug: ________________ Special medications or problems: _______________________________ Life threatening illness or condition: _______________ Description: _________________________________________ Family Physician ___________________________ Location______________________ Phone: ____________________ Child #2: Allergies to food or drug: ________________ Special medications or problems: _______________________________ Life threatening illness or condition: _______________ Description: _________________________________________ Family Physician ___________________________ Location______________________ Phone: ____________________ Parent/Guardian Signature __________________________________________________________ Date: __________________________ Start Date: _______________________ Recreation Department Approval: ___________________Initials: __________________________

Autopay - Credit Card Authorization I authorize Sumner/Bonney Lake Recreation Dept. to charge the credit card noted below for my monthly Before/After School Activities Club payment on the 1st of each month. Credit Card Number: ____________________________________Exp_________ Authorized Signature:________________________________________________ Date: ______________________________ Rec Dept. Employee Initials________
Before & After School Activities Club 2011-2012 Alternate Billing Information

For billing purposes, if anyone other than the parent/guardian listed on our Before & After School Activities Club registration form is to be responsible for monthly payments, it is necessary that we have the following information completed and signed by the responsible party. If this form is not completed and signed, the Parent/Guardian completing and signing the Registration Form will be considered fully responsible for monthly payments. PAYMENTS ARE ALWAYS DUE ON THE 20TH OF THE MONTH FOR EACH SUBSEqUENT MONTH. *A $25.00 LATE FEE WILL BE ASSESSED ON ALL LATE PAYMENTS* Child #1 ___________________________________________ Child #2 ________________________________________ Parent(s)/Guardian(s) Name(s) ________________________________________________________________________ Address_________________________________________ City _______________________ Zip _____________ Work Phone ____________________________Cell Phone______________________ Home Phone ________________ Portion of Payment Responsibility: ___________percent. Parent/Guardian Signature________________________________________ Date _________________

Change in Schedule/Status Form

(Please turn this form into our office ASAP if you have any schedule changes.)
Child _____________________________________________________ I am writing to make changes or comments in regard to (Circle One): Schedule Medication Address Payment/Account Program Site __________________

Comments_____________________________________________________________________________________ These changes will need to take effect on ________________________________________ I understand that if anything else changes, I will inform the Recreation Office as soon as possible. Parent/Guardian Signature _______________________________________ Date ___________________________

Before & After School Activities Club 2011-12 General Information

Monthly Plans & Fees: We offer six separate plans for before and after school care. Please note that the only available plans at Eismann/Maple Lawn are 3-5 days per week plans. All plans are available for Liberty Ridge, Victor Falls & Emerald Hills/Bonney Lake, Crestwood & Daffodil Valley Elementary schools. Fees for the programs are listed as follows: Please see the payment sheet at the back of the packet for fees for the months with fewer than 18 school days (December, April and June) 1) 2) 3) 4) 5) 6) $360 (AM/PM 3-5 Days/Week)* $240 (AM/PM 1-2 Days/Week) $260 (AM Only 3-5 Days/Week)* $185 (AM Only 1-2 Days/Week) $285 (PM Only 3-5 Days/Week)* $210 (PM Only 1-2 Days/Week) Changes in Schedule, Etc.: The Recreation Department must be notified, in writing, at least one week in advance of any program/schedule changes. If your child has dropped from the program and we have not been notified, we will continue to bill you if we cannot fill his/her spot with someone from our waiting list for that month. Without notification, we will not reimburse any fees. Please fill out the "Change in Schedule Status" form if you have any changes in your schedule, address, or other pertinent information. Drop it by our office or send it to our mailing address: 1202 Wood Ave., Sumner, WA 98390. Holidays: We do not conduct the Before & After School Activities Club on holidays. Vacation Breaks: Generally, we provide a vacation/break camp as an alternative during winter break and spring break. Space is limited. These camps are separate from the Before & After School Activities Club. Lunches: On early dismissal/no school days there are no school lunches available. Your child needs to bring a sack lunch. If you do not send a lunch with your child, you will be charged a $10 fee for providing a lunch. Also, there is not a microwave or refrigerator available. Afternoon Snacks: A light afternoon snack is provided. Please make sure to list any food allergy concerns on your registration form. When a child has a severe food allergy we will remove that snack item from our menu. School Expulsion: Our program complies with the disciplinary rules of the Sumner School District. If a student has been expelled from the school he/she attends, the student is also expelled from attending our Before & After School Club. He/she is welcome to return when he/she is re-instated to their school. Late Pick Ups: Any child picked up between 6:31 and 6:45 PM will be charged a late fee of $10. Later than 6:46 PM will be charged a $20 fee. Late fees are due at the time of late pick up. A second late pick up will be given a write up, (four write ups will be grounds for expulsion).

*3-5 days per week are the only plans available for Maple Lawn/Eismann site only. Payment Schedule: Payments are always due on the 20th of each month for the following month. We will not make any exceptions to this payment schedule. There will be a ten (10) day grace period. Failure to complete payment within that ten (10) day grace period will result in a $25 late fee. This will be strictly enforced. Please see payment sheet enclosed with this packet! Credits to Your Account: You are always welcome to make your payments in advance. Occasionally, parents will overpay. In such instances, we will credit your account for the following month. If you make your payments by check, put your child(ren)'s first and last names and the month of payment on the memo section of your check. Split Payment Information: A payment information form is enclosed in this packet to be completed by any person other than yourself responsible for making any portion of the monthly fees. Until this form is completed and signed by the other responsible person, the parent/guardian completing and signing the 2011-2012 Before & After School Activities Club registration will be considered fully responsible for all fees. Late Start/Inservice Days: The Wednesday late starts and State in-service days are included in the monthly fee if your child(ren) is/are registered to attend our Before & After School Activities Club programs.

Before & After School Activities Club 2011-2012 Sumner/Bonney Lake Recreation Department
First Day of School - Wednesday, September 7, 2011 Program Times: 6:30 AM to School Start and School Dismissal to 6:30 PM Holidays/Breaks (No Activities Club) November 11 - Veterans' Day November 24 - 25- Thanksgiving Break December 21 - January 3 - Winter Break January 16 - MLK Birthday February 20 - President's Day April 9 - 13 - Spring Break May 28 - Memorial Day
Please Note: Not all locations are open for early dismissal and teacher work days. Please call ahead to confirm which location your child will attend. All days may be subject to change.

Early Dismissal/No School Days - (Subject to Change) October 7 - Teacher Learning Day * Oct. 27 - Nov. 1 - Conferences/Early Dismissal November 23 - Elementary Teacher Work Day* January 30 - Student Waiver Day* February 17 - Friday prior to President's Day March 28 - Student Waiver Day* March 30 - Conferences/Early Dismissal April 2 - Conferences/Early Dismissal May 25 - Emergency Weather Make-up Day* May 29 - Emergency Weather Make-up Day* June 19 - Last Day of School/Early Dismissal *No School

Before & After Program Contact Information Rich Hanson (253) 891-6500 [email protected] Alex Latham (253) 891-6500 [email protected]

Important Phone Numbers - Please confirm your site phone number with the Site Director Sumner/Bonney Lake Recreation Department (253) 891-6500 Fax (253) 891-6515 Bonney Lake Elementary School (253) 891-4450 Crestwood Elementary School (253) 891-4550 Daffodil Valley Elementary School (253) 891-4600 Robert Miller Gym (253) 891-6507 Eismann Elementary School (253) 891-4650 Emerald Hills Elementary School (253) 891-4750 Site (253) 891-4770 Liberty Ridge Elementary School (253) 891-4800 Site (253) 891-4820 Maple Lawn Elementary School (253) 891-4400 Site (253) 891-4513 Victor Falls Elementary School (253) 891-4700 Transportation Department (253) 891-6400
Activities Club Rules/Regulations 1. All participants must abide by the Sumner School District's policies and procedures. 2. No swearing, pushing, shoving, or teasing. 3. All sports equipment is to be used within the gym floor lines. No playing near the art/quiet area table, storage room, or restrooms. 4. After reviewing a disciplinary situation thoroughly, the Before & After School staff will make all on-site decisions. These decisions will be reviewed by the program supervisor when possible. Disciplinary Policy When a child misbehaves, he/she will first get (age-appropriate) time-outs from activities, and the child will discuss their behavior with the staff and determine why they were in trouble. When time-outs and discussions do not work, the staff will follow the disciplinary policy: 1. First Written Warning: A written warning form will be signed by parent, child, and staff which will be recorded in a notebook. Alternate behaviors and problem solving will be discussed. 2. Second Written Warning: One-day suspension (both AM & PM). Parent and staff will discuss how to keep the problem from recurring and form a behavior contract for the child. 3. Third Warning: Child is expelled from the program for One week. 4. Final Written Warning: Expulsion Parental Note The Recreation Department will reserve the right to permanently excuse a child from our program for behavioral reasons. To assist us, parents will need to take responsibility to help reinforce good behavior.

Mail to: Recreation Dept. 1202 Wood Avenue, Sumner, WA 98390 September 2011 Student #1 ______________________________________ Student #2 ________________________ (25% Reduction) September 2011
____ $360 (AM/PM 3-5 Days/Week) ____ $240 (AM/PM 1-2 Days/Week) ____ $260 (AM Only 3-5 Days/Week) ____ $185 (AM Only 1-2 Days/Week) ____ $285 (PM Only 3-5 Days/Week) ____ $210 (PM Only 1-2 Days/Week) Total Enclosed $_______________ ___

Please clip and return coupons with your payments.

PAYMENT DUE AUGUST 20TH

February 2012 Student #1 ______________________________________ Student #2 ________________________ (25% Reduction) February 2012 Payments:
____ $360 (AM/PM 3-5 Days/Week) ____ $240 (AM/PM 1-2 Days/Week) ____ $260 (AM Only 3-5 Days/Week) ____ $185 (AM Only 1-2 Days/Week) ____ $285 (PM Only 3-5 Days/Week) ____ $210 (PM Only 1-2 Days/Week) Total Enclosed $_______________

PAYMENT DUE JANUARY 20TH

Receipt #_______

Receipt #__________

October 2011 Student #1 ______________________________________ Student #2 ________________________ (25% Reduction) October 2011 Payments:
____ $360 (AM/PM 3-5 Days/Week) ____ $240 (AM/PM 1-2 Days/Week) ____ $260 (AM Only 3-5 Days/Week) ____ $185 (AM Only 1-2 Days/Week) ____ $285 (PM Only 3-5 Days/Week) ____ $210 (PM Only 1-2 Days/Week) Total Enclosed $_______________

PAYMENT DUE SEPTEMBER 20TH

Receipt

March 2012 Student #1 ______________________________________ Student #2 ________________________ (25% Reduction) March 2012 Payments:
____ $360 (AM/PM 3-5 Days/Week) ____ $240 (AM/PM 1-2 Days/Week) ____ $260 (AM Only 3-5 Days/Week) ____ $185 (AM Only 1-2 Days/Week) ____ $285 (PM Only 3-5 Days/Week) ____ $210 (PM Only 1-2 Days/Week) Total Enclosed $_______________

PAYMENT DUE FEBRUARY 20TH

Receipt #__________

November 2011 Student #1 ______________________________________ Student #2 ________________________ (25% Reduction) November 2011 Payments:
____ $360 (AM/PM 3-5 Days/Week) ____ $240 (AM/PM 1-2 Days/Week) ____ $260 (AM Only 3-5 Days/Week) ____ $185 (AM Only 1-2 Days/Week) ____ $285 (PM Only 3-5 Days/Week) ____ $210 (PM Only 1-2 Days/Week) Total Enclosed $_______________

PAYMENT DUE OCTOBER 20TH

April 2012 Student #1 ______________________________________ Student #2 ________________________ (25% Reduction) April 2012 Payments:
____ $275 (AM/PM 3-5 Days/Week) ____ $185 (AM/PM 1-2 Days/Week) ____ $200 AM Only 3-5 Days/Week ____ $145 (AM Only 1-2 Days/Week) ____ $220 (PM Only 3-5 Days/Week) ____ $160 (PM Only 1-2 Days/Week) Total Enclosed $_______________

PAYMENT DUE MARCH 20TH

Receipt #_______

Receipt #__________

December 2011 Student #1 ______________________________________ Student #2 ________________________ (25% Reduction) December 2011 Payments:
____ $275 (AM/PM 3-5 Days/Week) PAYMENT ____ $185 (AM/PM 1-2 Days/Week) DUE ____ $200 (AM Only 3-5 Days/Week ____ $145 (AM Only 1-2 Days/Week) NOVEMBER ____ $220 (PM Only 3-5 Days/Week) 20TH ____ $160 (PM Only 1-2 Days/Week) Total Enclosed $_______________ Receipt #_______

May 2012 Student #1 ______________________________________ Student #2 ________________________ (25% Reduction) May 2012 Payments:
____ $360 (AM/PM 3-5 Days/Week) ____ $240 (AM/PM 1-2 Days/Week) ____ $260 (AM Only 3-5 Days/Week) ____ $185 (AM Only 1-2 Days/Week) ____ $285 (PM Only 3-5 Days/Week) ____ $210 (PM Only 1-2 Days/Week) Total Enclosed $_______________

PAYMENT DUE APRIL 20TH

Receipt #__________

January 2012 Student #1 ______________________________________ Student #2 ________________________ (25% Reduction) January 2012 Payments:
____ $360 (AM/PM 3-5 Days/Week) ____ $240 (AM/PM 1-2 Days/Week) ____ $260 (AM Only 3-5 Days/Week) ____ $185 (AM Only 1-2 Days/Week) ____ $285 (PM Only 3-5 Days/Week) ____ $210 (PM Only 1-2 Days/Week) Total Enclosed $_______________

PAYMENT DUE DECEMBER 20TH

June 2012 Student #1 ______________________________________ Student #2 ________________________ (25% Reduction) June 2012 Payments:
____ $275 (AM/PM 3-5 Days/Week) ____ $185 (AM/PM 1-2 Days/Week) ____ $200 (AM Only 3-5 Days/Week ____ $145 (AM Only 1-2 Days/Week) ____ $220 (PM Only 3-5 Days/Week) ____ $160 (PM Only 1-2 Days/Week) Total Enclosed $_______________

PAYMENT _ DUE MAY 20TH

Receipt #__________

Receipt #________