Childcare Enrichment Program (CEP) at the Y!

MAKING LEARNING FUN Childcare Enrichment Program YMCA OF GREATER LOUISVILLE 2011-12 SCHOOL YEAR REGISTRATION ymcalouisville.org

We serve all JCPS students in grades K-8. Transportation is available by JCPS school bus between your child’s school and CEP if needed.

The YMCA of Greater Louisville, in partnership with Jefferson County Public Schools, offers the Childcare Enrichment Program–where your child will laugh, learn and grow.

CHILDCARE ENRICHMENT PROGRAM 2011-2012 School Year

LEARN, GROW, THRIVE

ALWAYS HERE FOR YOU

The Y makes strengthening communities our cause. Through our affordable child care programs we create a nurturing environment to engage children and help them develop skills that will serve them throughout their lives. We focus on ensuring that your child’s time is spent creatively and constructively in the critical hours before and after school and during school breaks.

Our before school program is from 7 am until the start of your child’s school day. Our after school program is from the close of the school day until 6 pm. Continuous care is also available 7 am - 6 pm during school breaks, including in-service days and snow days. Spring Break, Winter Break, and Summer Camps require separate registrations.

HELPING BUILD CONFIDENCE With values of caring, honesty, respect and responsibility as our guide, we work with you every day to ensure your children have fun while helping them realize their potential. You can feel confident knowing your child is safe and well cared for by our qualified staff.

Every staff member receives extensive hours of training and professional development and is CPR and First Aid certified. We are licensed child care and meet or exceed state licensing requirements.

BUILDING THE WHOLE CHILD Your child will experience academic support, self-esteem building and character development through activities designed to enrich, strengthen and expand their learning. We offer homework assistance through our Homework Club and maintain a strong focus on literacy. We also encourage healthy eating habits, provide opportunities for physical activity, and provide nutritious morning and afternoon snacks daily.

CONNECTING WITH OUR FAMILIES Our programs have an open door policy and parents are welcome and encouraged to take part in your child’s day. Each site hosts special family events throughout the year and our Parent Advisory Committee offers parents the opportunity to give valuable feedback towards program enhancements. Parent surveys will also be distributed throughout the year, so we can receive your feedback and continuously improve your experience.

SIGN UP TODAY!

WEEKLY RATES 2011-12 Childcare Enrichment Program First Child

Each Additional

Program Members

Y Facility Member/ Partnership Employee Dependents

Program Members

Y Facility Member/ Partnership Employee Dependents

$47 $59 $73

$42 $54 $68

$37 $49 $63

$32 $44 $58

$39 $48 $60

$35 $44 $56

$31 $40 $52

$27 $36 $48

4- or 5-day Before School Only After School Only Before & After School

1-, 2- or 3-day Before School Only After School Only Before & After School

Registration Fees Per Child

$30 per child through August 4

$45 per child starting August 5

In-service and snow days are included in total number of days attended for the week. In-service and snow day only rate is $22 per day, per child.

REGISTER TODAY

PAYMENT OPTIONS

Registration for the before and after school programs will continue throughout the school year based on availability. All sites have minimum and maximum enrollment numbers and registrations are processed on a first-come, first-served basis. Completed registrations must be received at least two business days prior to your child’s start date.

The 2011-12 school year program begins on Monday, August 15th.

Payments can be made by bank or credit card draft. Automatic draft payments must be set up prior to the first day of attendance for your child to attend our program. Drafts will occur each Wednesday for the current week, unless they are otherwise scheduled through our main office.

You can register one of the following ways: • Online at ymcalouisville.org through August 4th • Bring registration form and fee to your CEP Site Director • Mail the registration form and fee to: YMCA School-Age Child Care Services 2411 Bowman Avenue Louisville, KY 40217 Mail must be post-marked one week prior to start date. Please do not fax registration forms. If you have additional questions, call 502 637 1575, or visit ymcalouisville.org.

ACCESS FOR ALL At the Y, we believe everyone should have the opportunity to grow up healthy, happy, confident and secure. That’s why we strive to make our programs and services available to everyone, even if they are unable to pay the full fee. Families can apply for financial assistance with the cost of Y programs and membership. Assistance is on an income-based sliding scale.

All sites are also eligible for 4-C and other third-party subsidy reimbursements. Valid contracts must be on file with our office prior to the program start date. Applicants who qualify for 4-C or other child care subsidies will not be eligible for additional assistance through the Y.

CEP is open to all JCPS students in grades K - 8. If your child’s school is not a CEP site listed below, transportation is available between your child’s school and their CEP site. Visit our website or call 502 637 1575 for detailed transportation information.

CEP SITES & LOCATIONS Northeast Area

Southwest Area

Bowen Elementary, 1601 Roosevelt Avenue Malcolm B. Chancey Jr. Elementary, 4301 Murphy Lane Chenoweth Elementary, 3622 Brownsboro Road Dunn Elementary, 2010 Rudy Lane *Field Elementary, 120 Sacred Heart Lane Greathouse Elementary, 2700 Browns Lane Hite Elementary, 12408 Old Shelbyville Road Lowe Elementary, 210 Oxfordshire Lane Middletown Elementary, 218 North Madison Avenue *Norton Elementary, 8101 Brownsboro Road St. Matthews Elementary, 601 Browns Lane *Joseph E. Stopher Elementary, 14417 Aiken Road *Wilder Elementary, 1913 Herr Lane Zachary Taylor Elementary, 9620 Westport Road

Cane Run Elementary, 3951 Cane Run Road Conway Middle, 6300 Terry Road Doss High School, 9601 St. Andrews Church Road Fairdale Elementary, 10104 Mitchell Hill Road Frederick Law Olmsted South Middle, 5650 Southern Parkway Johnsontown Elementary, 7201 Johnsontown Road Kerrick Elementary, 2210 Upper Hunters Trace McFerran Elementary, 1900 South Seventh Street Minors Lane Elementary, 8510 Minors Lane Rutherford Elementary, 301 Southland Boulevard Shacklette Elementary, 5310 Mercury Drive Stuart Middle, 4601 Valley Station Road

Southeast Area Audubon Traditional Elementary, 1051 Hess Lane Bates Elementary, 7601 Bardstown Road Bloom Elementary, 1627 Lucia Avenue Blue Lick Elementary, 9801 Blue Lick Road Cochrane Elementary, 2511 Tregaron Avenue *James E. Farmer Elementary, 6405 Gellhaus Lane Fern Creek Elementary, 8703 Ferndale Road Goldsmith Lane Elementary, 3520 Goldsmith Lane Hawthorne Elementary, 2301 Clarendon Avenue Highland Middle, 1700 Norris Place Jeffersontown Elementary, 3610 Cedarwood Way Klondike Elementary, 3807 Klondike Lane Laukhuf Elementary, 5100 Capewood Drive Luhr Elementary, 6900 Fegenbush Lane Rangeland Elementary, 1701 Rangeland Road Smyrna Traditional Elementary, 6401 Outer Loop Thomas Jefferson Middle, 1501 Rangeland Road *Tully Elementary, 3300 College Drive Watterson Elementary, 3900 Breckenridge Lane *Wheeler Elementary, 5700 Cynthia Drive

Downtown Area *Brandeis Elementary, 2817 W. Kentucky Street Breckinridge-Franklin Elementary, 1351 Payne Street Brown School, 546 South First Street *Carter Traditional Elementary, 3600 Bohne Avenue Coleridge-Taylor Elementary, 1115 West Chestnut Street Foster Elementary, 4020 Garland Avenue *Kennedy Montessori Elementary, 3800 Gibson Lane Noe Middle, 121 West Lee Street * Before and After School child care for 3- and 4-year olds enrolled in the host school’s tuition-based Pre-K program will be provided at these sites only. No full-day child care is available for preschoolers.

Please attach a recent wallet size photo and immunization certificate for each child.

CHILDCARE ENRICHMENT PROGRAM 2011-12 SCHOOL YEAR REGISTRATION FORM PLEASE PRINT LEGIBLY and include your registration fee. Register Online through August 4 at ymcalouisville.org. th

Program start date

Email address

(To receive important program updates and registration information)

1 CHILD st

First name Race

Middle initial

African American/Black

Alaskan

Last name

Native Asian/Pacific Islander

Date of birth Caucasian/White

Hispanic

/

Native American

/

Gender

To better serve your child, please indicate if he/she has been diagnosed with any of the following: ADD/ADHD Convulsions Bleeding/Clotting Disorders Autism Aspergers Fragile X Cerebral Palsy Bipolar Disorder Down Syndrome Chronic Health Problems Asthma/Severe Allergies Diabetes Heart defect/disease Other Yes

Participation

1-3 Days

Age

Tourettes

Rhett Syndrome

No School Attending

Childcare Enrichment Program Site Attendance

F

Medications/allergies

Physical conditions/special needs

Does this child have an IEP?

M

Other

4-5 Days

Before-School Care

Grade in School (2011-12) After-School Care

Before- & After-School Care

In-Service Day Care

Snow Day Care

2nd CHILD First name Race

Middle initial

African American/Black

Alaskan

Last name

Native Asian/Pacific Islander

Date of birth Caucasian/White

Physical conditions/special needs

Hispanic

/

Native American

/

Gender

Yes

Participation

1-3 Days

Tourettes

Rhett Syndrome

School Attending

4-5 Days

Before-School Care

Age

No

Childcare Enrichment Program Site Attendance

F

Medications/allergies

To better serve your child, please indicate if he/she has been diagnosed with any of the following: ADD/ADHD Convulsions Bleeding/Clotting Disorders Autism Aspergers Fragile X Cerebral Palsy Bipolar Disorder Down Syndrome Chronic Health Problems Asthma/Severe Allergies Diabetes Heart defect/disease Other Does this child have an IEP?

M

Other

Grade in School (2011-12) After-School Care

Before- & After-School Care

In-Service Day Care

Snow Day Care

1 PARENT/GUARDIAN st

Name

Relationship to child

Address Home phone

City

Cell phone

Date of birth

State Work phone

/

/

/

/

Zip

Employer

2nd PARENT/GUARDIAN Name

Relationship to child

Address Home phone

City

Cell phone

Date of birth

State Work phone

Zip

Employer

INSURANCE INFORMATION Health insurance company

Policy number

Name of physician

Physician phone

PLEASE LIST ANY ADULT OTHER THAN THE ABOVE THAT MAY BE PICKING UP THIS CHILD OR THAT MAY BE CONTACTED IN AN EMERGENCY.

Anyone picking up your child must be at least 18 years of age or older. A picture ID is required at pick-up. .

Name

Relationship to child

Phone 1

Phone 2

Name

Relationship to child

Phone 1

Phone 2

The YMCA has permission for my children to be photographed and/or interviewed for promotional purposes Yes No Yes No My child(ren) have permission to participate in basic health and fitness evaluations Yes, I would like to make a charitable donation to The Spirit Campaign $10 $25 $50 $100 Other/please contact me Check here if either parent is School partnership employee YMCA employee YMCA family facility member Spirit recipient YES! I would like to learn more about FREE or LOW-COST health insurance for my children and teens.

4-C recipient

You must choose one option below to process your registration. Drafts will occur each Wednesday for the current week unless otherwise scheduled through our main office.

I am currently on draft. Please use the account on file ending in ___ ___ ___ ___. Authorized account holder signature __________________________________________________________________________ I am authorizing a NEW bank draft from my checking account and I have attached a voided check.

I am authorizing a NEW credit card draft and I have provided all the information below: Credit Card Type:

Visa

MasterCard

Discover

Name on card

Authorized cc signature

Card number

Expiration date

Billing street address

Billing zip code

I have the legal authority to sign up the child/children named on this form and to the best of my knowledge the information on this application form is complete and accurate. I understand that my application will not be processed unless it includes the full fee or automatic draft authorization. I understand that the YMCA prohibits staff members from being alone with children they meet in YMCA programs outside of the YMCA. This includes but is not limited to baby-sitting, tutoring, sleep-overs, etc. In the event I cannot be reached in an emergency, I hereby give permission to the director of the program or designee to secure emergency medical services, including transportation and medical care. I also give permission for the attending physician to order injections, anesthesia or surgery for this child as named above. I understand that medical and accident insurance is the responsibility of the parent or guardian. If my child(ren) attend Jefferson County Public Schools, by signing this form I am giving the YMCA permission to communicate and exchange information with JCPS for the purpose of providing and enhancing services to my child(ren). There may also be times when JCPS or the YMCA may take photographs (or other digital images) of students participating in activities. Those images may appear in the YMCA’s or JCPS’s publications, including electronic publications. By signing this form, I am giving permission to JCPS and the YMCA to use my child(s) image for the purposes listed above. I understand that this release may be revoked by me at any time by written request.

Signature

Date Signed