please print out these forms. fill them out by hand, sign ... · please print out these forms. fill...

HORNET CLUB

SUMMER PROGRAM INFORMATION SHEET

Please print out these forms. Fill them out by hand, sign with your original signature as

well as a copy of your driver’s license and return them at your earliest convenience. Do not

e-mail your forms back to us. At the top of the application form, please list your child's age

as of May 28, 2020.

1. Payments for the summer trip fees may be paid in installments if

registering during the school year. A payment schedule must be

established that will have this paid off by the last day of school. (For

example; 10 payments (one payment every week for next 10 weeks, with

first payment due 3/20/20 would mean 10 payments of $20.72 each

week). We also have options to pay half in March and the other half in

April or May. You can also pay the entire $207.20 any time before

summer. Your spot is reserved upon receipt of a completed registration

packet AND your first trip fee payment of $20.72, as well as a registration

fee of $30 (if you are new to our program). (If you are already in our

program you will pay reg. fee with new fall applications).

2. If I do not have an approved criminal record check, you will need to

get one IF you plan to chaperone one of our trips. Please turn in these

criminal records checks as soon as possible. It takes time to get them and

if left until the last moment, you risk being unable to attend a trip. Parent

chaperone tickets must be paid for at the door.

3. Given that insurance policy#, information, birth certificates, physical

exam forms and immunization forms are State requirements and are

requested here in this packet, please be advised that no child will be

allowed to begin attendance to the program IF these items are not in our

file.

4. I will need immunization records, physical exam forms, and birth

certificates for students attending from other Franklin County Public

Schools.

5. All fees paid for registration are non-refundable. If your child later

decides not to participate in the summer program or decides not to go

on a trip, the fees are non-refundable. Parents trip tickets purchased are

also non-refundable. You may, however, let someone else use your ticket,

if you can't attend.

6. All payments must be check or money order, NO CASH.

7. All ASP accounts must be paid in full before your child can attend the

summer program.

8. PLEASE NOTE: Weekly tuition fee for the summer program is $100/week.

No account may be more than one week behind. If you fall behind in your

payments, your child may be removed from the program. Please

remember that tuition payments are due regardless of whether your child

is present or absent and regardless of number of days in the week. (You

will not be charged on days that the program is closed (i.e. holidays))

9. Given that our staff’s primary duty at the pool must be monitoring the

safety of your children, please be advised that payments and account

inquiries need to be made at the school.

10. If you wish to withdraw your child from the program, you must give a

two weeks’ notice in writing and pay for the two weeks.

11. Your child must be brought into the building each morning and signed

in with the time and your name. The Hornet Club is not responsible for your

child until he or she is signed in and delivered to their instructor. Our doors

now stay locked at all times. If you need to pick up your child early and

arrive at one of the odd times that the door may be unattended, please

call us at 859-421-5788 and someone will be at the door to let you in.

12. Our colored shirts are worn on all major trips. Make sure that your

child's shirt is clean and ready to wear. If you are a divorced parent and

your child spends time with both parents, please consider ordering two

shirts (one of which you will have to pay). Please make sure that your

child's name is on the label in permanent marker.

13. Hornet Club will be closed July 4, 2020, for a federal holiday. You will

not be billed for that day’s tuition since the program will be closed.

14. All medications administered to children must be in the original

container with the child's name. A prescription medication form must be

filled out for every day medication is to be administered.

15. Tennis shoes (not sandals) are required for all trips and for playing on

the playground. FLIP FLOPS ARE NEVER ALLOWED as they are a danger

during active play. Sandals with ankle straps are allowed, but not

encouraged for other times.

16. Disrespect to the director or staff will not be tolerated. Please remind

your child that they must keep their hands to themselves. There is no

hitting, biting, kicking, spitting, pinching, cursing or bullying allowed. These

kinds of behavior are unacceptable and can result in your child's

dismissal from the program.

17. If your child wants to buy extra food from the concession stand at the

pool during a designated time, then he/she must bring their own money.

18. Sunscreen (must be Papa Free) should be provided for each child.

Mark your child's name on the outside of the container. Children who are

prone to burn should have an extra white t-shirt in their swimming bag to

put on over their swim-suit, especially 5-6 year olds. On swim days make

sure that your child brings his/her swimsuit, towel, sunscreen, and deck

shoes, if needed. Children will not bring floats, big canvas bags, or pool

toys to the pool. There is not enough room on the bus.

19. The latest pick-up daily is 5:30.

20. Children's shirt sizes are: small (6-8), medium (10-12), and large (14-

16). Adult sizes are Sm, Med, LG, XL, and XXL. If in doubt about size, order

the next larger size. The Hornet Club will purchase the first shirt for you.

22. Children of parents driving on trips may ride with their parents. No other

child can ride with you unless the other child's parent is with you. Parents

driving their children are not covered under the School’s Liability

coverage. Due to the School’s Liability Insurance, parents/siblings are not

allowed to ride on the buses.

23. Parents of children with continuous behavior issues will be expected to

accompany their child on trips.

24. Children should not bring personal items from home. Under no

circumstances may a child bring a CD player, iPod, i-Phone, net pads,

cell phones or Kindles to the summer program. Please see the director if

your split family needs to check in items with the ASP office.

25. All school rules and bus rules will be followed during the summer

program.

26. Trip chaperones must accompany their assigned children to the

bathroom on trips. No child is to go to a restroom without adult

supervision.

27. Our school is a smoke free campus. No parent or staff member may

smoke in front of the children or on school property.

28. Departure time for all trips is critical. We cannot wait for anyone.

29. Children who bring money for trips are responsible for their own money

except 6 year olds. Parents of 6 year olds, please give their money to their

instructor. Please put the money in a zip lock bag in small denominations

with your child's name on it.

30. Please do everything possible to register and have your paperwork

completed no later than May 15, 2020. Our office MUST have time to

establish our summer records in order to be prepared to receive your

child on the first day.

31. Please instruct your child that no child is to leave the

building/playground or their group without instructor being made aware

of their sign out/leaving.

32. Base fee policy- on days when program is open, your base fee is

payable whether you attend or not since we receive no federal or board

money to run the program. Our Staff still has to be paid and food and

snacks purchased.

33. My door is always open if you have a concern, please feel free to call

me at (502) 695-6760, Cell 859-421-5788 (Please use only if it is an

emergency and you cannot reach me by office #), or come into my

office.

To: Parents/Guardians

From: Marilyn Nichols, Director

Re: On-going invitation to share time with children/request

Date: March 15, 2020

As always, you have a personal invitation to help make our program the

best that it can be. We are always open for your suggestions and input

into the program. Together, we can make The Hornet Club even better.

We extend an invitation to use your talents with our children. Come teach

our ASP children pottery making, acting/drama, dance, yoga, sports and

maybe teach a different language or teach the children how to make a

successful musical instrument. Maybe you would like to read to our

younger children. Maybe arts and crafts are your specialty or you are

good with nails or hairstyles. We could use your talent.

In the form of a request, the program is in need of any type of jars, nuts

and bolts, tools (any size), empty shoe boxes, old but good clean paint

brushes, and old (not rusty) gardening tools, buckets, small or large plastic

containers and toilet tissue rolls for crafts. Any of these would be greatly

appreciated.

We want you to know again, that we (The Hornet Club Staff) take pride in

working with your children. Their safety and happiness, is our number one

concern.

**The above mentioned invitation to come and share time with our

children MUST accompany a background check and possibly

fingerprinting done at your expense. **

WE DO NOT/CANNOT PAY this fee for anyone.

** Eat breakfast at home and wear Hornet Club shirts on all trips (except swimming

pool). Bring extra money if you want to buy souvenirs. Bring sun-screen if needed.

Program reserves the right to reschedule any event (with notice) to other dates, or

substitute equivalent event if trip is missed due to unavoidable circumstances. **

SUMMER SCHEDULE OF EVENTS –2020

MAY

First Day of Summer Program May 27, 2020

JUNE

Kona Ice - June 3, 17, 24, July 1, 8, 15, 29

Juniper Hills Pool – June 4, 11, 18, 25, July 2, 9, 16, 23, and 28

Legends Ball Park Splash Day June10

Farmers Market –June 18 exploring

Kentucky Science Center – June 23

Farmers Market – June 25 learning about amazing seeds

JULY

Picnic/Parade - July 1 @11:00-1:00 (EVERYONE INVITED)

Farmers Market – July 2 Eating our plants ☺

Louisville Slugger Museum - July 7

Farmers Market – July 9 Quickles

Franklin Square Cinema – July 14

Farmers Market – July 16 Corn

Kentucky Kingdom – July 21 and 22 (this is back-to-back because the

22nd is FREE!! Except for food ☺ (lunch included in price for the 21st visit)

Bring/send extra money from home (at least $10 for evening meal/snack).

If swimming, money is needed for clothes locker. Bring extra money if you

want a souvenir. Please put extra money in a baggie with child’s name on

it and amount.

Farmers Market – July 23 Stone Soup

Last day of Summer Program August 2, 2020

*The Farmers Market is for the children to learn agriculture-Educational

and FUN at the same time!* Heading to the pool immediately after.

Hornet Club SUMMER HANDBOOK

Note: Every effort has been made to align program policies with FCPS

District Policies/Handbook. If any discrepancy arises, then District

Handbook/Policies apply.

Hornet Club Philosophy:

To provide a quality, affordable, and safe environment for school-age

children. To offer activities that encourages social interaction, creativity,

decision-making, and the expression of each child's unique individuality,

without regard to race, creed, or ethnic origin.

Ages:

Hornet Club is open to exiting kindergarten age children through 5th

grade.

Hours of Operation:

Hornet Club summer program is open from 7:30 A.M. to 5:30 P.M. Monday

through Friday, except on the 4th of July. On long trips, hours may be

expanded to 6 or 9 P.M. You will be notified well in advance if this would

be the case.

Registration and Fees: All Registration fees and trip fees are non-

refundable

Summer registration is open first to Hearn students, and then to other

Franklin County Public School students. Children must be pre-registered in

order to participate in the program. Summer registration information and

forms will be available on line. Registration forms along will all required

fees and documents must be turned in at registration time which will be

announced. No child is enrolled until necessary forms with original

signatures and fees are received. All balances for prior participation in

any ASP or summer program must be paid in full before your child can be

officially registered for the summer program.

Students registering from another Franklin County public school must have

a copy of current immunization, a copy of their physical, and a copy of

their state birth certificate in order to be registered.

Weekly Fee:

The weekly fee is $100. The child's legal guardian must register the child

and the person registering the child is responsible for payment of tuition. A

10% discount (on each additional child) on tuition will be given to families

with more than one child in attendance in the program (no discount on

registration or trips fees). The weekly fee is due every week, but when not

convenient, no longer than every two weeks. Failure to keep your

account balance total at an amount equal or less than your families “1

week total” (i.e. $100.00 for 1 child/$190.00 for a family with 2 children,

etc...) will result in dismissal of your child from the program. All accounts

must be paid by check or money order only. No cash please. If paying by

check, we will need a birthdate and driver's license number of person

writing check.

Late Pick-up Fees:

Late fees will be assessed to each family if tardiness occurs in picking up

students from the program. This is going to be strictly enforced and the fee

will be due at pick-up. After (5) minutes, a fee of five dollars ($5.00) will be

assessed for the first minute and $1.00 for each additional minute late for

pick-up.

Withdrawal from the Program:

A two week notice in writing must be given when withdrawing your child

from the program. You will be responsible for payment for those two

weeks.

Drop-Off/Pick-Up:

During the summer program parents/guardians are required to sign their

child or children in at drop-off and out at pick-up. Only authorized persons

listed on the parent/guardian pick-up list will be allowed to pick up your

child. Any changes in your pick-up list must be in writing. Any new

authorized person on your pick-up list must be prepared to produce a

picture I.D.

The program ends at 5:30 P.M... Beginning at 5:35, a late fee will be

charged as listed in the late fees section. Should a child remain at the

program 30 minutes past closing time, our only remaining recourse will be

to contact legal authorities. It is extremely important that all contact

numbers are up-to-date and working. Parents/guardians consistently

picking up their child or children late will be asked to find other care.

Health Rules/Emergency:

If your child has been exposed or contracted any contagious disease

such as measles, mumps, rubella, scarlet fever, strep infections, hepatitis,

chicken pox, head lice, scabies, impetigo, or flu, etc. please contact the

program immediately. We reserve the right to restrict attendance. If your

child becomes ill or is injured, we will contact you immediately. Please

make sure all contact numbers are currently up-to-date.

In the event of an emergency, parents/guardians will be contacted

immediately. If we feel that it is necessary, the Emergency Medical

Service will be asked to assist us in first aid procedures or to transport the

child to the hospital. Emergency medical information for your child must

be kept up-to-date. A staff member will accompany the child to the

hospital and stay until a parent/guardian arrives.

Any child with a temperature of 100 or above must be picked up

immediately. Your child will be separated from the other children and

monitored until pick-up. The child cannot stay in the program until you

decide to pick them up - immediately means immediately. The child

cannot return to the program until he/she has been fever free for 24 hours

without the use of medication.

Discipline:

The Hornet Club expects that all children in the program will have respect

for their instructors, other children and their property. However, if a child's

behavior endangers the safety of another child, he/she will be placed in

age-appropriate "time-out". The child will remain in the room but will be

separated from the activities for a short-time (5-10 minutes). If the

disruptive behavior continues, a conference with one of or both of the

parents will be requested. If parental intervention does not eliminate the

disruptive behavior, the child will be released from the program.

Please instruct your children that there is no hitting, biting, name-calling,

kicking, throwing of rock or gravel, or bullying, etc.

Medication:

All medications must be in original containers along with a completed

prescribed medication form stating the time and dosage to be given. The

medication needs to be given to a staff member when your child arrives

each day. A medical permission form for prescribed medication must be

completed for each day that medication is administered.

Meals/Snacks:

During the summer, breakfast, lunch, and a mid-afternoon snack will be

served. All meals meet the Kentucky Division of School Food Service

guidelines. Students cannot bring their own snack to the program unless

they have specific allergies or they are diabetic. Children allergic to milk

must produce a doctor's statement.

Personal Belongings:

All clothes, swimming items, etc. should be marked with the child's name.

No personal toys, etc. may be brought from home. No boom boxes, head

phones, Walk-mans, CD players, or DS are permitted unless announced

on special occasions.

****UNDER NO CIRCUMSTANCES will CELL PHONES, IPODS, IPHONES,

LAPTOPS, KINDLES, or ANY OTHER DEVICE WHERE ONE CAN TEXT, MAKE

CALLS, GOOGLE AND SO ON be brought to the program. (Please contact

Director if devices need to be checked into the program office for

purposes of transferring between split family homes) ALL CHILDREN WILL

NEED A BASKET FOR THEIR BELONGINGS ON FIRST DAY OF ATTENDING. You

can purchase these baskets for $1.00 at the Dollar Tree.

Swimming Pool:

Each child will need to bring a swimsuit and towel for the pool. Deck shoes

are permitted. Sunscreen will be applied to a child upon request in the

form of a note from the parent. Only PABA free sunscreen is permitted.

Children who sunburn easily should wear a white tee shirt over their

swimming suit. *** All 6 year olds will bring a white tee shirt with them to the

pool.

No rafts, rings, or other swimming accessories will be brought to the pool.

There is no room on the bus.

Dress:

Children should wear play clothes that they can get dirty and are

comfortable. Athletic shoes are required - no flip flops. They do not

provide ankle support when running and the child can run out of them,

easily resulting in falls. Sandals must have full ankle straps.

Please be aware that arts and crafts are an important learning part of our

program and they may sometimes be messy. Washable and non-

washable paints are utilized as age appropriate and project appropriate.

If you care to send a paint smock or shirt, please feel free to do so.

Hornet Club shirts must be worn on all trips except the swimming pool.

Trips/Special Activities:

Any child participating in special activities or taking a trip with the

program is required to stay with their assigned chaperone. If for any

reason a child leaves his/her chaperone and group, he/she will not be

permitted to go on the next trip. Any child that embarrasses the program

by displaying rude behavior or talk, breaking the rules of the business

being visited, etc. will not be permitted to travel with our program. The

children registered in the program represent Hearn Elementary and should

not embarrass their parents, the school or my staff.

INSURANCE/REQUIRED INFORMATION:

State regulations require our program to have insurance policy

number/information, birth certificates, physical exam forms and

immunization forms in our files. (We can sometimes assist with this via the

front office of the school, if your child attends Hearn Elementary). We,

therefore, must restrict attendance to the program until these documents

are provided.

FRANKLIN COUNTY PUBLIC SCHOOLS

AFTER SCHOOL PROGRAMS

DISTRICT HANDBOOK

(This handbook is currently under review, policies subject to change)

REGISTRATION

1. A $30 non-refundable registration fee will be assessed for each school

year program. This fee applies to any student enrolling into an After School

Program including those who are transferring from another FCPS After-

School Program.

2. All registration documents must be completed/ submitted prior to

admittance, including:

a. After School Program Registration Packet

b. Student Information Sheet

c. Medical History Form

d. Emergency Contact Information

e. Child Pick-up List

f. Medication Information

g. Current Immunization Certificate

h. If child has been previously enrolled in another Franklin County Public

Schools After-School Program, all prior balances must be paid in full prior

to acceptance into the program.

REGULAR FEE SCHEDULES

1. Fees are to be set at fifty dollars ($50) per week and forty five dollars

($45) each for siblings in the program

2. Fees are due weekly on the day set forth by individual schools

3. NO cash is to be accepted at any time as payment

4. All enrolled students in the After School Program will be responsible for

the daily base rate of ten dollars ($10.00) when the program is open

regardless of whether or not the student is in attendance (sibling rate)

would be nine dollars ($9) per day.

LATE PICK-UP FEES

1. This is going to be strictly enforced and the fee will be due at pick-up.

After (5) minutes, a fee of five dollars ($5.00) will be assessed, and $1.00 for

each additional minute late for pick-up. Should a child remain at the

program 30 minutes past closing time, our only remaining recourse will be

to contact legal authorities. It is extremely important that all contact

numbers are up-to-date and working.

RETURNED CHECK FEES

1. Returned checks will be turned over to a collection agency contracted

by the Franklin County Board of Education. Also, once a check is

returned, we will no longer accept a personal check from you, however,

we will accept money orders.

HOURS OF OPERATION

1. Hours of operation will be left to the discretion of each individual After

School Program and may vary.

2. A schedule for hours of operation will be given to each guardian upon

admittance into the Program.

INCLEMENT WEATHER /NON SCHOOL DAYS DURING REGULAR SCHOOL

YEAR

1. An additional ten dollars ($10.00) charge for a total of twenty dollars

($20) per day will be assessed if the child is present on inclement weather

days or days during the regular school year when school is not in session.

2. Hours of operation will remain that of regular day unless otherwise

announced by the Superintendent.

EARLY RELEASE DAY FEES

1. Fees will be the regular weekly fee, plus an additional five dollars ($5) for

each early release day if the child stays beyond school dismissal time.

CALENDARS

1. Calendars of days of operation will be left to the discretion of each

individual After School Program and may vary.

2. All centers will be closed on Franklin County Board of Education

recognized holidays as reflected on the district calendar.

3. A calendar reflecting days of operation will be given to each guardian

upon admittance into the program.

4. Calendars will reflect Early Release Days built into the school schedule.

SUMMER PROGRAMS

1. Fees and/or activities will be left to the discretion of each individual

After School Program and may vary. (Extra fees may be incurred for field

trips, etc.)

2. Calendars of events scheduled for each summer program will be given

to each guardian upon admittance into the summer program.

WITHDRAWAL NOTICE

1. Withdrawal from an After School Program requires notification (in

writing) to the director a minimum of two (2) weeks in advance of the

child’s last day of attendance.

2. Failure of notification may result in charges for services being incurred.

ARRIVAL PROCEDURES

1. During regular school days, children participating in the After School

Program will be escorted to the designated area upon school dismissal.

2. On full-day care, the parent/guardian will be required to escort the

child to the designated program area and sign in.

DISMISSAL PROCEDURES

1. Children will be released from the program according to the

information provided on the Childs Pick up List.

2. If someone different than those listed on the Child Pickup List will be

picking up the child, staff must be given a written note of change that is

signed and dated by the parent/guardian and must state specifically

who will be picking up the child.

3. Anyone picking up a child from the After School Program must provide

staff with photo identification in order to take the child.

HEALTH CONCERNS

1. Parents are legally responsible for notifying the After School Program of

exposure or contact of any contagious disease such as measles, mumps,

rubella, scarlet fever, strep infections, hepatitis, chicken pox, head lice,

scabies, impetigo, flu, shingles, etc., immediately. After School Programs

reserve the right to restrict attendance based on any contagious illness.

2. For any ill or injured child, the After School Program will contact the

child’s guardian immediately.

MEDICATION

1. All medications must be in the original container and not outdated. A

permission form for the prescribed medication must be completed for

each day that the medication is administered.

USE OF TOBACCO PRODUCTS

1. The use of any tobacco product is prohibited in any building owned or

operated by Franklin County Public Schools.

2. The use of any tobacco product is prohibited for all chaperones,

whether ASP employees or not, while in any supervisory role with children

on field trips, etc.

DISCIPLINE PROCEDURES

1. All discipline policies and procedures will be left to the discretion of

each individual After School Program and may vary.

ITEMS BROUGHT FROM HOME

1. All policies and procedures relating to items being brought to the After

School Program, including but not limited to toys and electronics, will be

left to the discretion of each individual After School Program and may

vary.

* Child's shirt size_____ *REQUIRED INFORMATION

HORNET CLUB SUMMER APPLICATION Student's full name: _____________________________________ Age Now_____

Address ___________________________ City _______________ Zip ____________

Mother's name _______________________________

Mother driver’s license DOB * ________________________________________

Address (if different) __________________________________________________

Day phone ___________________ Evening phone_________________________

Cell ___________________________*** Work Phone ________________________

E-mail _____________________

Father's name __________________________________

Father driver’s license DOB * _________________________________________

Address (if different)___________________________________________________

Day Phone ____________________Evening phone ________________________

Cell _________________________* Work Phone___________________________

E-mail _______________________

Child's birthday __________________________*

Child's siblings: Name __________________________

School attended ____________________________________________________

Name ___________________________ School attended__________________

Preferred Physician ___________________________

Phone number_______________________

Frankfort Regional Medical Hospital will be used unless another specified:

______________________________________________________________________

**Medical insurance carrier ______________* Policy number

____________________

Person to call in case of emergency ***Phone # _______________________

Medical Physical limitations __________________________

Food allergies _____________________________________

Other allergies ____________________________________

Does your child take medication? Yes_____ No ______

Name of medication ____________________________________

Will the child be taking medication during the program? Yes No _______

Child's hobby/hobbies _______________________________________________

If your child should become injured or ill while at The Hornet Club, please

list the phone numbers where you can most often be reached.

Mother's name __________________ Day phone ___________Cell ___________

Father's name __________________ Day phone ___________ Cell ___________

HORNET CLUB DISMISSAL FORM

*This form must be completed for each child enrol1ed in The Hornet Club.*

Child's Name ___________________________

Child's Social Security Number ________________

We will only release your child to the people below if:

1. We have their given name

2. They can show accurate identification

PERSONS WHO MAY PICK UP YOUR CHILD/and TELEPHONE NUMBER

______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

PERSONS WHO MAY NOT PICK UP YOUR CHILD

______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

Mother's name and Signature: __________________________________

Name Signature _______________________________________________

Father's name and Signature: __________________________________

Name Signature _______________________________________________

** ANY CHANGES MUST BE IN WRITING. NO TELEPHONE NOTIFICATIION.

If you cannot be reached, please give the name and number of a person

authorized to act in your place.

Name (Relationship to child) ________________________________________

Day phone ___________________

If this person cannot be reached, what steps would you like for us to take?

I, the undersigned, do hereby authorize the staff of The Hornet Club to

seek medical treatment for my child in the event of an emergency. I will

not hold the staff of The Hornet Club, school, personnel, or the school

district responsible for the emergency care and/or transportation of my

child. I understand that if any child is injured and requires doctor's care, I

will be contacted.

Parents/guardian ________________________________________

Date ______________

I have read and understand the policies of The Hornet Club handbook.

I give consent for my child __________________________ to participate in all

activities of the program.

I understand that the registration fee and all trip fees are non-refundable.

All fees are due in advance on a weekly basis regardless of absences or

number of days in the week. The program understands that hardships may

occur, but you need to contact Mrs. Marilyn, Director, if such a case

arises. However, non-payment is reason for my child's dismissal from the

program. I further understand and agree that all account balances will be

maintained to a 2 week (or less) balance and that failure to keep

account balances within this 2 week amount are grounds for suspension

and/or dismissal from the program.

Parent/guardian ______________________________

Date _____________

* If you will be writing a check for your tuition payment, we will need the

birth date and driver's license number of the person writing the check.

THE HORNET CLUB ENROLLMENT AGREEMENT

Child's name: ____________________________ Date of registration: __________

I agree to comply with the rules and regulations of The Hornet Club After-

school and summer programs regarding tuition fees, attendance, health

and other items specified in the handbook. I understand that all

registration and trip fees are non-refundable.

I agree to notify the Director at least two weeks in advance of

withdrawing my child from The Hornets Club.

I understand that tuition fees are due weekly and will be paid weekly. I

also understand that if I do not keep my account within a 2 week

balance, my child will be removed from the program.

I understand that in event of an absence during program hours, I will be

responsible for fees for time reserved, not actual time spent at The Hornet

Club.

I will notify the Director immediately if I have an address or telephone

number change.

I authorize The Hornet Club to release my child to the individuals listed on

the enrollment application form in case of my absence.

If a medical emergency arises, The Hornet Club staff will first attempt to

contact me. If I cannot be reached, the staff will contact the persons

listed as emergency contacts. If the emergency is such that immediate

hospital attention is necessary, an ambulance or emergency vehicle may

take my child to the hospital.

I hereby agree to the above terms and give my child permission to

participate in the Hornet Club After-school and/or Summer Program.

Signature Parent/Guardian: _________________________________

Date signed: _____________

Child's name: ____________________________

The Hornet Club DISCIPLINE AGREEMENT

I have read and understand to the best of my ability and agree to the

discipline procedure outlined in the Hornet Club handbook. I understand

that the following procedure will be used to correct behavior that may

endanger the safety of another child or adult or is disruptive to the

program.

1. "Time-out" for a brief period (age appropriate)

2. Parent notification

3. Parent conference (parental intervention must eliminate the behavior)

4. Release and/or suspension of the child from the program.

Child’s name: ________________________________

Parent/Guardian signature _______________________

Date: ___________

To: Parents/Guardians

From: Marilyn Nichols, Director- Hornet Club

Date: May 15, 2019

Re: Chaperone ticket fees

Child’s Name: ______________________________

Chaperone Name: __________________________________________

The following trips will be taken by The Hornet Club this summer. The

program will need as many chaperones as we can get. (You will only be

watching your child). Tickets for all trips that you wish to chaperone must

be paid at the door. Each parent/Guardian wishing to chaperone must

have a criminal record check. If you had one done last summer and I

have a copy, or one done by the school this year, your record check is

good.

DRIVING LIST FOR TRIPS - 2020

I will be driving on the following trips and my child will ride with me

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

PERMISSION SLIP for KONA ICE

I give permission for my child _____________________________________ to

participate in the following field trip at (Hearn): June _____3, _____17,

____24, July _____1, _____8, _____15, _____29

Furthermore, I waive, release, and hold harmless any staff member,

owner, director, or other employee of The Hornet Club from any and all

claims and liability arising from my child's participation in the field trip and

transportation thereto and therefrom as described above.

In the event of a medical emergency or accident, I authorize the

supervising staff person of The Hornet Club to obtain emergency medical

care for my child.

NAME OF PHYSICIAN: _____________________________

Program will use Frankfort Regional Medical Hospital unless another is

specified. Other HOSPITAL: ___________________

SIGNATURE OF PARENT/GUARDIAN: ____________________________________

PARENT'S/GUARDIAN PHONE NUMBER: ________________________

DATE: ____________

SWIMMING PERMISSION SLIP FOR JUNIPER HILL- June - July 2020

I give permission for my child ___________________________ to participate in

the following trips to Juniper Hill pool.

Please check each date your child will participate. June ____4, ____11,

____18, ____25, July____ 2, ____ 9, ____16, ____ 23, ____28



claims and liability arising from any child’s participation in the field trip and

transportation to and from as described above.



care for my child.

Name of child’s physician ______________________

Program will use the Frankfort Regional Medical Hospital unless another is


Signature of parent/guardian ___________________________

Parent/Guardian phone number ___________________

Date _________________________

Hornet Club SUMMER PROGRAM

SWIM PROFICIENCY FORM

Parent/Guardian:

Since the children are taken to Juniper Hill Pool, it is important for our staff

to know something about their swimming ability. Please write your child's

name in the appropriate description.

My child______________________________________ is an accomplished

swimmer and may go anywhere in the pool including the diving board.

My child_______________________________________ is a good swimmer and

can go anywhere in the pool except the diving area.

My child_______________________________________ can swim somewhat, but

I do not want him/her to go past the 5 foot marker.

My child________________________________________ cannot swim, but is not

afraid of the water and may stay in the 3 foot or under.

My child________________________________________ is afraid of the water

and must be watched like a hawk.

Parent/Guardian Signature: ____________________________________

Date: _______________

The Hornet Club Sunscreen Use Agreement

I, ______________________________ give permission to The Hornet Club staff to allow the

application of sunscreen to my child, ____________________________________ for outdoor

activities. I will provide my child with sunscreen and assure that the sunscreen is PABA free.

Please initial dates and sign parent signature:

______ June 4, ______ June 11, ______June 18, ______ June 25, ______,July 2,

_______July 9, ______July 16, ______July 23, ______July 28,

Parent/Guardian signature: ________________________________________

Date: _____________________

PERMISSION SLIP for Legends Ball Park Splash Day

I give permission for my child ____________________________________ to

participate in the following field trip: Legends Ball Park on June 10, 2020,

and to participate in Splash Day. (Water fun @ Legends)







care for my child.



specified. Other HOSPITAL: _______________________________________

SIGNATURE OF PARENT/GUARDIAN: __________________________________

PARENT'S/GUARDIAN PHONE NUMBER: ______________________________

DATE: __________

PERMISSION SLIP for Farmers Market Downtown Frankfort

I give permission for my child _______________________________to

participate in the following field trip: Farmers Market _____ June 18,

_____June 25, _____ July 2, _____ July 9, _____July 16 and _____July 23.







care for my child.




SIGNATURE OF PARENT/GUARDIAN: ________________

PARENT'S/GUARDIAN PHONE NUMBER: ______________

DATE: _____________

PERMISSION SLIP for Kentucky Science Center


participate in the following field trip at: Kentucky Science Center June 23







care for my child.






DATE: _____________

PERMISSION SLIP for Louisville Slugger Museum


participate in the following field trip: Louisville Slugger Museum July 7







care for my child.






DATE: _____________

PERMISSION SLIP for Franklin Square Cinema


participate in the following field trip: Franklin Square Cinema July 14







care for my child.






DATE: _____________

PERMISSION SLIP for Kentucky Kingdom/Water Park

I give permission for my child ______________________________________ to

swim, participate in water activities, and ride water rides at Kentucky

Kingdom on ______July 21 and _____July 22, 2020.







care for my child.


Program will use the nearest available Hospital in Louisville Kentucky unless

another is specified. Other HOSPITAL: __________________



DATE: _______________

Child Care Animal Consent Form

Center’s Name: The Hornet Club

Center’s Address: 300 Copperleaf BLVD, FRANKFORT, KY 40601

Child’s Name: ____________________________________

DOB: _______________

I _______________________________________ give my permission for my

child________________________ to be in the presence of the animals listed

below.

Animals

1. ______ Lizard ___________________________________

2. ______ Cat ______________________________________

3. ______Dog ______________________________________

4 _______ Fish _______________________________________

5. ______ Snails ______________________________________

6. ______ Ants _______________________________________

7. ______Worms ______________________________________

8. ______Turtle ______________________________________

Name of Parent/Guardian: ___________________Date:_________

Signature of Parent/Guardian: ______________________________

Child Care regulatory policy will allow the following enclosed or caged

classroom animals with parental consent: fish, hamsters, gerbils, guinea

pigs, hermit crabs, turtles, birds, non-poison amphibians, bearded

dragons, rabbits, chinchillas as well as caterpillars and butterflies.

PHOTOGRAPHY RELEASE FORM

This completed form is needed for student participation in activities that

involve photographs or videotaping.

___ Yes, I hereby give and grant permission to The Hornet Club After-

School and Summer Programs to use my child's photograph or voice in

any way that would reasonably and properly portray the program at

Hearn Elementary School. Such usage may include newspapers, district

wide publications and presentations at Family Resource functions.

____ No, I do not give or grant permission for use of my child’s photograph,

likeness and/or voice as described above.

Parent signature _____________________________

Child’s Name: ______________________________

Date: _______________

HORNET CLUB PARENTS/GUARDIANS

Child’s Name: _________________

(Complete only 1 section)

I, _________________________ give my permission for my child,

____________________________, to watch G rated movies only.

Signature ______________________

Date: ___________

I, _____________________________ give permission for my child,

_____________________, to watch PG movies that have been pre-viewed by

an adult/teacher

Parent/Guardian Signature: ______________________________

Date: _____________

Children's shirt sizes are small (6-8), medium (10-12), and large (14-16).

Adult sizes are Sm, Med, Lg, XL $6.00 each, and XXL $8.00, XXXL $8.50. If

in doubt about size, order the next larger size. Please make all checks

payable to The Hornet Club

My child ________________________________________ shirt size is

________ Small (6-8)

________ Medium (10-12)

________ Large (14-16)

If parents would like a shirt, please indicate name and size below:

I ________________________________ need shirt size

__________ Small

__________ Medium

__________ Large

__________ XLarge

___________ XXLarge

PERMISSION SLIP for Republic Movie Theater

I give permission for my child ____________________________________ to

participate in the following field trip: Republic Movie Theater July 14







care for my child.




SIGNATURE OF PARENT/GUARDIAN: __________________________________

PARENT'S/GUARDIAN PHONE NUMBER: ____________________

DATE: _______

I have received a copy of the CHILDREN AND PARENTS RIGHTS pursuant to

KRS 199.898.

Parents/Guardians signature:

_______________________

Child’s name: ____________________________

Date: ________________

CHILDREN AND PARENT RIGHTS

PURSUANT TO KRS 199.898

(l)All children receiving child care services in a day-care center licensed

pursuant to KRS 199.896, a family child-care home certified pursuant to

KHS 199.8982, or from a provider or program receiving public funds shall

have the following rights:

(a) The right to be free from physical or mental abuse;

(b) The right not to.be subjected to abusive language or abusive

punishment; and

(c) The right to be in the care of adults who shall meet their health, safety;

and developmental needs.

(2) Parents, custodians, or guardians of these children specified in

subsection (1) of this section shall have the following rights:

(a) The right to have access to their children at all times the child is in care

and access to the provider caring for their children during normal hours of

provider operation and whenever the children are in the care of the

provider;

(b) The right to he provided with information about child-care regulatory

standards, if applicable; where to direct questions about regulatory

standards; and how to file a complaint;

(c) The right to file a complaint against a child-care provider without any

retribution against the parent, custodian, guardian, or child; and

(d) The right to review and discuss with the provider any state reports and

deficiencies revealed by such reports.

(3)The child-care provider who is licensed pursuant to KRS 199.896 or

certified pursuant to KRS 199.8982 shall post these rights in a prominent

place and shall provide a copy of these rights at the time of the child'

enrollment in the program.

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