ST. ROSALIA ACADEMY AFTER SCHOOL CARE
PROGRAM INFORMATION
Director: Mrs. Gabriela Navarro
Dear Parents:
Welcome to the St. Rosalia Academy After School Care Program. Please take the time to read the following procedures and regulations regarding the program.
1. Children will only be released to a designated person on their release form. If there is a change to the release form, please submit the change to the office.
2. The program will be provided on full days of school, as scheduled on the school calendar. There will not be After School Care on early dismissal days.
3. Snack time takes place at about 3:15 P.M. and is $0.50 per child, per day. Anyone leaving before this time will not have to purchase a snack.
4. A weekly schedule is to be completed and placed in an envelope labeled as follows: Name, Grade, and Attention: After School Program. Payment and the weekly schedule are always due on the Friday prior to the week that the program is needed.
EXAMPLE: If the program is needed Monday 9/12/11 the payment and schedule are due Friday 9/9/11.
The charge for the program is $5.00 per hour, per first child, plus $0.50 for a snack. For the second, third, etc. sibling the charge is $3.00 plus $ 0.50 for a snack each.
EXAMPLE: If one child attends the program for three hours the charge is $15.50 (including snack). A late fee of $2.00 per every 5 minutes will be added for any pick up after 5:30 P.M. NO EXCEPTIONS
5. The program begins at dismissal time and ends promptly at 5:30 P.M. Again, anyone picking up a child after 5:30 P.M. will be assessed a late fee of $2.00 per every 5 minutes, NO EXCEPTIONS. When making out your schedule, please use the start time of 2:30 P.M.
6. Make checks payable to ST. ROSALIA AFTER SCHOOL CARE PROGRAM. Your cancelled check is your receipt. If a check is returned to us from the bank, you will be required to pay for all service charges. If the school receives two returned checks, checks will no longer be accepted.
7. We require advance scheduling in order to properly prepare for the children. However, in case of emergencies, you may call the school office to schedule After School Care on the day that it is needed.
8. If there is a change in your child’s schedule you must contact the school by note or phone to report the change.
If your child is scheduled for after school care and IS NOT going that day you MUST report this change to the school office at (412)521-3005 between the hours of 9:00 A.M. and 1:00 P.M. We will not accept a child’s verbal report that he or she is not attending aftercare on a scheduled day. Your call to the school ensures your child’s after school safety.
9. Your child/children will be removed from the program for lack of payment, discipline problems, or not following the policies in the St. Rosalia Academy handbook. The After School Care Program is considered an extension of the St. Rosalia Academy day. All the rules and regulations stated in the St. Rosalia Academy handbook will be strictly enforced. Please go over these rules with your child/children.
10. The program is held on the Terrace Floor of the School Building. When arriving to pick up your child/children, please:
· Use the Pre-School Entrance on Greenfield Avenue.
AND
· Use your cell phone to call Mrs. Navarro upon your arrival (doors will be locked for the safety of the children).
o If you do not have a cell phone, you will need to walk up to the first group of windows on the left side of the door in order to let Mrs. Navarro know that you have arrived.
11. A typical schedule for the program involves play time, snack time, and quiet activities or homework.
12. Children are not to bring toys or electronic devises from home. If you wish to donate appropriate toys or games for use of all children in the After School Care Program, please feel free to.
** COMPLETED SCHEDULES FOR AFTER SCHOOL CARE WILL BE SENT TO THE MAIN OFFICE **
** THE PHONE NUMBER FOR THE AFTER SCHOOL CARE PROGRAM IS: 412-973-8978 **
Saint Rosalia Academy
411 Greenfield Avenue, Pittsburgh, PA 15207
412-521-3005 Fax: 412-521-2763 e-mail: strosaliaacademy@gmail.com
ST. ROSALIA ACADEMY AFTER SCHOOL CARE
PROGRAM INFORMATION
Director: Mrs. Gabriela Navarro
Date of Application: ___________________________________________
Child’s Name: ___________________________________________________ Birth Date: _________________________
Mother/Legal Guardian’s Information Father/Legal Guardian’s Information
Name: ___________________________________________ Name: __________________________________________
Home Address: _________________________________ Home Address: _________________________________
___________________________________________________ ___________________________________________________
Home Phone: ___________________________________ Home Phone: ___________________________________
Cell Phone: ______________________________________ Cell Phone: ______________________________________
Employer Name: ________________________________ Employer Name:________________________________
Employer Address: _____________________________ Employer Address:_____________________________
Work Phone: ____________________________________ Work Phone: ____________________________________
E-mail address: _________________________________ E-mail address: __________________________________
Person(s) to be contacted in an emergency if parents/guardians are unavailable:
Name: ___________________________________________ Name: __________________________________________
Address: ________________________________________ Address: ________________________________________
___________________________________________________ ___________________________________________________
Home Phone: ___________________________________ Home Phone: ___________________________________
Cell Phone: ______________________________________ Cell Phone: ______________________________________
Work Phone: ____________________________________ Work Phone: ____________________________________
Relationship: ____________________________________ Relationship: ____________________________________
Person(s) to whom child may be released:
Name: ___________________________________________ Name: __________________________________________
Address: ________________________________________ Address: ________________________________________
___________________________________________________ ___________________________________________________
Home Phone: ___________________________________ Home Phone: ___________________________________
Cell Phone: ______________________________________ Cell Phone: ______________________________________
Work Phone: ____________________________________ Work Phone: ____________________________________
Relationship: ____________________________________ Relationship: ____________________________________
Name of child’s physician or source of medical care:
Name: ___________________________________________ Phone Number: ___________________________________
Address: ________________________________________
___________________________________________________
Special disability of child, if any:
Any special medical or dietary information necessary for management in an emergency situation –allergies (including medication reactions), medications, special conditions:
Any additional information on special needs of the child:
Health insurance coverage for child under family insurance policy or medical assistance benefits, if applicable: _______________________________________________________________________________________________
Policy or medical assistance number (required): ______________________________________________________
Please read the instructions below and complete as items apply.
Parent/Guardian’s signature required for each item below to indicate parental consent. Items not signed indicate that you do not want the treatment or activity for your child:
Obtaining emergency medical care: _________________________________________________ Date: _____________
Administration of minor first-aid procedures: _____________________________________ Date: _____________
Outdoor activities (weather permitting): ___________________________________________ Date: _____________
Signature of Parent or Guardian: ____________________________________________________ Date: _____________
**Please note: Should your home address, home/cell phone, employer, emergency contact and/or pickup persons change at any time, please inform us in writing so that we may keep this information current.