Foster Dual Language PK-8

Extended Day Programs 20-21

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PREPARE Extended Day ProgramS 2020-21 Foster Dual Language PK-8 PROJECI Where: Drop-off and pick-up in the back, double doors of Foster's Cafeteria. Who: Kinder- 8th grade in-person learning students. Fees: Paid during pick-up, drop-off or our preferred method, on-line through Jeffco Connect once you have been accepted. *A limited number of partial scholarships may be awarded based on free/reduced lunch eligibility. Whole Child, Whole Community Extended Morning 7:00am-8:30am (breakfast is not provided) Full Time: More than 2 days a week. Part Time: Up to 2 days a week. Standard Fee *Scholarship Fee Standard Fee *Scholarship Fee $140 per month $50 per month $60 per month $22 per month Extended Evening 3:40pm-6:00pm (snack provided) Full Time: More than 2 days a week. Part Time: Up to 2 days a week. Standard Fee *Scholarship Fee Standard Fee *Scholarship Fee $210 per month $75 per month $88 per month $32 per month Two ways to register. 1) click here for our Google Form registration (this is our preference) 2) Fill out both sides of this form completely then return a digital copy or picture to Tracie.Mayes@Jeffco.k12.co.us Student Name Teacher Grade ('20-'21). Primary Guardian Name Email Primary Phone # Secondary Phone # Secondary Guardian Name Email Primary Phone # Secondary Phone # Other Emergency Contact Please note: We will be using Jeffco's secure Bloomz App to keep in contact and share information through text messages and emails. Go to www.Bloomz.com/parents and join with the code FXD7ME for AM Extended day and XRABHU for PM Extended Day Programs. In an emergency, we will call directly. Phone The following people have permission to pick up my child: My child will attend the following.. (Check all that apply and circle your preferred days) AM Full Time (3-5 Days per week) on the following days: Monday _AM Part Time (1-2 Days per week) on the following days: Monday Tuesday Wednesday Wednesday Thursday Thursday Friday Friday Tuesday _PM Full Time (3-5 Days per week) on the following days: Monday PM Part Time (1-2 Days per week) on the following days: Monday Tuesday Friday Friday Tuesday Wednesday Thursday Wednesday Thursday Will you need a scholarship for your child$1 (Check one below) NO, I will not need a scholarship. YES, I will need a scholarship for my child and would like to be considered for scholarship Both sides of this form MUST be complete to be considered for this activity.

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PREPARE Does your child have a health plan at school$3 (Check one below) _NO, and my child does NOT have allergies or any other medical conditions you should know about. PROJECT _YES, my child has a health plan in place during the school day. I (the parent/ guardian) understand Project Prepare staff does not have access to Health Plans on file with the school-day staff, nor any medications I may have furnished the school clinic for use during the school day. It will be my responsibility to contact Project Prepare immediately to share or establish a separate Health Plan for use during all Project Prepare activities, by calling Tracie Mayes, Project Prepare Director at (303)982-1680. As an added measure, please write out any medical conditions your child may have below. Please include any allergies. Whole Child, Whole Community To receive flyers and info first, join our Project Prepare information group: www.Bloomz.com/parents Join with code Z65KDM Project Prepare Director: Tracie.Mayes@Jeffco.k12.co.us The District is committed to ensuring that all eligible students, including those with disabilities, have an equal opportunity to participate in non-academic and extra- curricular programs and activities. If your student requires an accommodation to participate in the program(s) described above, please contact your Building 504 Coordinator at 303-982-1680. Parent/Guardian Signature Date JEFFCO Student Assumption of Risk and Waiver PUBLIC SCHOOLS Student Name Activity_ Extended Day Programs Parent/Guardian On behalf of my child, I (parent/guardian) hereby acknowledge and agree that activities such as those listed above have inherent risks such as minor physical/emotional injuries like cuts, bruises, sprains, to serious wounds, cardiovascular issues, traumatic brain injury and possibly even a risk of death. I have sufficient knowledge of the nature and extent of the risks associated with these activities and the use of facilities and equipment associated with these activities. If I had any questions or concerns regarding possible risks, I have addressed them with the activity/program or sponsor. I further acknowledge that the risks communicated by the activity/program sponsor may not be inclusive of all the possible risks associated with the Extended Day Programs_ and that the activities/program facilitator(s) may not have anticipated all of the risks associated with the above activities. I accept the fact that the program facilitator(s) cannot guarantee my child's total safety since some risks in such activities are beyond their control I fully comprehend and willingly assume the responsibilities and risks of participation in this program, as outlined in information communicated to me by the facilitator(s). (initials Parent/Guardian) I and my child agree to follow all instructions and guidelines given by _(initials Child) the facilitators, and to act in a safe and responsible manner toward all participants. (Parent/Guardian), hereby waive, release, and discharge the Jeffco Public Schools and their/its successors, heirs, assigns, directors, officers, employees, supervisors, agents, attorneys and representatives, from any and all actions, cause of action, claims, demands, losses, damages, costs, attorneys' fee, judgments, liens or liabilities whatsoever, regarding the aforementioned activity in which I and my child have elected to voluntarily participate. Parent/Guardian Signature Date *Retain Form in Corresponding Activity File at school- For at least 1 year from Date of signature Rev.4: 7/15/2015* Both sides of this form MUST be complete to be considered for this activity.

Flyer ID 2023936

Sent from Foster Dual Language PK-8

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