After-School-Registration-Packet-2016-2017

After School Program Registration Packet 2016-2017 To complete registration return the following items: • 2016 – 2017 Registration Form • Registration Fee • $25 first child, $15 sec

After School Program Registration Packet

2016-2017

To complete registration return the following items:

• 2016 – 2017 Registration Form

• Registration Fee

• ($25 first child, $15 second child, additional children free)

• Student Health Information Form

• Student Emergency Contact Form

All questions concerning the program, fees and payments are to be directed to Peter Epstein, Principal, or Joanna Gordon, Administrative Assistant, 404-565-2850

Annunciation Day School

2500 Clairmont Road, NE | Atlanta, Georgia 30329 Telephone: (404) 565-2850 | Annunciationschool@atlgoc.org

2

PROGRAM INFORMATION

The After School Program at Annunciation Day School operates on school days only It is

available on early dismissal days as well as regular dismissal days for our Pre-K (4’s) - 7th grade students

It is NOT available when school is not in session

The After School Program is located in the Karatassos Youth Center The Vocalis Education building,

library, Carlos Hall and school playground may all be utilized after school hours

Daily Program Hours: (Pre-K) 1:30 – 6:00 p.m Early Dismissal Days: (K-7 only) 12:30 – 6:00 p.m

(K-7) 2:45 – 6:00 p.m

Standard Operating Procedure: Elizabeth Zervakos or Krishna Dutta will pick up students at their

classrooms at dismissal time and they will remain under the Director’s supervision until picked up by a

parent or designated responsible adult Children in the program are given a snack each day, as well as indoor and outdoor play time, homework time, crafts and games

*If an enrolled child will not be in attendance on days for which s/he is registered please contact the school office at (404) 565-2850 Attendance will be taken daily; should a student be unaccounted for without notice, families will be called immediately,

Pick-up Procedure: The After School Program is held at various locations on campus It will conclude with

pickup at the gym at 6pm each day If you are picking up before 6pm, to ensure a timely pickup, upon arrival

contact Elizabeth Zervakos (770) 315- 3245 and Krishna Dutta (404) 434-7403 to be directed to the correct

location (call or text)

Registration Fee: The registration fee is $25 for the first child, $15 for the second child and free for any and all

additional children This must be received prior to participation in the program and can be paid for by check, money order or cash

Program Fee: The tuition rate for the After School Program is $15 per day Music and Spanish are $5 additional

per day This will be charged to your FACTS account at the end of each month

LATE PICK-UP FEE: Our After School Program concludes at 6pm If you pick your child(ren) up after 6:05

pm, a $20 LATE PICK-UP FEE will be added to your FACTS account Late fees are calculated per child

Payment: Payments will only be accepted through FACTS Payments will NOT be accepted by the After

School Faculty or the Program Director

Pre-K K-7

SNACKS

One snack and drink will be provided for each student daily If your student has a food allergy, please inform the Director

If your child has specific dietary needs, please send a snack from home

CLUBS

Students enrolled in extracurricular clubs that will also be attending the After School Program will be picked up by After School Faculty from the clubs’ designated meeting places at 3:45pm (K-7) and 2:45pm (Pre-K)

HOMEWORK

Children have the opportunity to complete all homework during afterschool time and have it checked by a staff member One-on-one peer tutoring will also be available to students

ROTATIONS

This year we are pleased to offer Spanish, Music and Crafts during our After School Program These enrichment activities give your student a chance to learn even more after the academic day ends!

Spanish ($5 per day, offered twice per week)

We are pleased to have a highly qualified Spanish language teacher offer instruction twice a week though the After School

Program Children will learn vocabulary, conversational skills and grammar in a fun, interactive environment

Music ($5 per day, offered twice per week)

With excitement, we welcome Ms Thompson to our staff! She comes to us with a wealth of musical experience and knowledge She holds a Master of Arts degree in Piano Pedagogy from Georgia State University and has served as the music director for several Atlanta area churches Students will enjoy learning new songs, games and music theory!

Crafts (no charge, offered once per week)

Ms Elizabeth and Ms Krishna will engage students in a creative project or activity Examples include making picture frames, holiday ornaments and friendship bracelets

PICK UP

upon arrival contact Elizabeth Zervakos (770) 315- 3245 and/or Krishna Dutta (404) 434-7403 to be directed to the correct location (call or text).**

Take note:

-Parents or designated adults must sign their child(ren) out daily

-Schedule may vary due to amount of homework, weather conditions, etc

classrooms

for putting toys, craft supplies, etc

classrooms

for putting toys, craft supplies, etc

away and tidying their environments

2016 – 2017 REGISTRATION FORM

Registration Fee (please attach to this packet)

First Child $25 Second Child $15 Third Child free Fourth Child free

Student:

Birthdate: Age: Gender: Grade:

Address: City: Zip:

Phone number: Email:

GUARDIAN 1 GUARDIAN 2 **If the answer is no, a copy of the official court order must be provided **

Child’s estimated After School Program schedule (For Planning Purposes Only) Day Monday Tuesday Wednesday Thursday Friday Check all days that apply Daily estimated pick up time Enrichment Activity Yes No Yes No Yes No Yes No Craft J Tuition Rate: $15 per day + $5 for each enrichment activity (Spanish and Music) If monthly plan changes, it is your responsibility to let the school know at least 14 days in advance I understand that I am responsible for paying all applicable fees I understand that I am agreeing to the terms outlined in this packet I understand that I am to notify the school office of any absences Parent’s/Guardian’s Signature Date Name:

Relationship:

Employer:

Phone (W): (C):

**Can this person pickup the child(ren)? Y N Name:

Relationship:

Employer:

Phone (W): (C):

**Can this person pickup the child(ren)? Y N

STUDENT HEALTH INFORMATION

Please print all requested information

Student’s name:

MEDICAL

Physician’s name:

Phone number: Fax number:

DENTAL

Dentist’s name:

Phone number: Fax number:

INSURANCE

Medical Insurance Company: Policy number: Dental Insurance Company: Policy number:

MEDICAL HISTORY

Have you ever been told by a physician or health care professional that your child has:

Diabetes Bone/muscle disease Skin condition Learning disability Heart condition Mental health condition (depression, anxiety, eating disorder) Other

Does your child experience any of the following?

Nose bleeds Frequent ear aches Frequent headaches

Fainting spells Frequent stomach aches Physical disabilities

Tires easily Emotional concerns Other

Do any of the above condition(s) limit/affect your child at school?

ALLERGIES

Plants Animals Food Medication 
Bees Other

Please describe the allergic reaction and the treatment for each checked allergy

MEDICATION

Does your child take any medication? Yes No If yes, name of medication: Purpose Will medication be needed at school? YES* No

AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT

I understand the information given above will be shared with appropriate school staff to provide for the health and safety of my child If either I or an authorized emergency contact person cannot be reached at the time of a medical emergency, I authorize and direct the Annunciation Day School’s After School Faculty to send my child to the most easily accessible hospital or physician I understand I will assume full responsibility for payment of any transport or emergency medical services rendered

Parent/Guardian Signature Date

*If your child needs to take medication at school, please contact the office for the necessary authorization form This form must be completed prior to any medication being brought to the After School Program

STUDENT EMERGENCY CONTACT FORM

Please print all requested information

School Annunciation Day School — After School Program Date:

Student’s name: Date of Birth:


 Address: City: Zip:

Father’s Name: 
Cell:

Father’s e-mail Address:

Mother’s Name: Cell:

Mother’s e-mail Address:

IN CASE OF EMERGENCY:LOCAL PERSONS TO BE CALLED IN THE EVENT THAT A PARENT CANNOT BE REACHED Emergency Contact Information: 1 Name: Relationship:

Phone numbers (H) (W) (C)

2 Name: Relationship:

Phone numbers (H) (W) (C)

3 Name: Relationship:

Phone numbers (H) (W) (C)

Printed Name of Parent/Guardian Signature of Parent/Guardian Date

**Designated adults must sign out the child with the Director and present

photo identification prior to leaving the facility.