IRONWOOD

SPACES ARE LIMITED TO 20 PARTICIPANTS AT THE FOLLOWING LOCATIONS:

6:30 a.m. - 6:00 p.m.

May 20 through July 31, 2020

Monday - Friday

The counselor in training program is designed for 6th, 7th and 8th grade student participants to grow in a fun and safe environment. The participants will get to experience

real world opportunities to help them be successful in the future while having pride in their daily accomplishments. They will build confidence and self-esteem as they learn important

leadership skills with hands-on classroom experience and field trips. In this program, participants will build respect for themselves and others while role modeling

for every child attending the KidSpace Summer Camp.

Eligibility: Must have completed 5th grade by Summer 2020. Must be energetic and motivated to work with young children. Must abide by CIT responsibilities and duties or withdrawal from CIT Program could occur. Must complete the application process.

Application Process: Complete the following paperwork and submit to the camp of your choice by May 1, 2020. Completed application Completed contract Completed CIT responsibilities and duties Completed emergency card with immunization record Completed summary of fees Payment for registration fee and first week.

Once completed application is submitted, parent/guardian will be notified if the student has been accepted into the program.

Lookout Mountain

Please indicate desired site:

Ironwood Lookout Mountain 14850 N. 39th Ave. 15 W. Coral Gables 602-896-5673 602-896-5991

Name:_________________________________________________ Completed: _____ School: _______________

Parent/Guardian Name:_____________________________________ E-mail: _____________________________

Is student currently enrolled in KidSpace? No Yes If yes, please list site: ___________________________

Names of siblings attending KidSpace:_____________________________________________________________

Does your child currently have an IEP, 504 plan, medical conditions that will require special accommodations? Yes No

Select Shirt Size: Youth M Youth L Adult S Adult M Adult L

COSTS & FEES:

Weekly Tuition: $150 per child DES/SRP Copay: D $______ L $_______ Start:________ End:_________ DES/SRP Clients: Coverage must be changed to the summer site no later than May 8, 2020. DES clients must prepay their co-pay to secure a reservation.

-Registration Fee: $30 per child if registration is received before May 1, 2020 -Registration Fee: $55 per child if registration is received after May 1, 2020 -All Registration Fees are NON-REFUNDABLE -All tuition fees due with contract and payable by check or money order -Parents are responsible to pay for all weeks selected on the Summer Contract -No credits for non-used weeks or days. -Weeks may not be transferred -All contract changes are due by Thursday prior to the week being changed -$25 per week late cancellation fee will be charged per child for any cancellation not received by the Thursday deadline

-$3/minute per child will be charged for late pick up after 6:00 p.m. -NOTE: This program is not eligible for any discounts

No contracts accepted without a blue emergency card, summary of fees, field trip form,

immunization record and first week’s payment.

SH ADE EACH BOX INDIC ATING THE WEEK(S) YOUR CHILD WILL BE ATTENDING:

Yes No I grant permission for staff to apply sunscreen. Yes No I grant permission for my child to be photographed for WESD use only.

Yes, I have received, read and understand all the terms and conditions of this contract. I agree to be bound by those terms and conditions. This contract is effective from May 20 through July 31, 2020. Payments due each Friday prior to each week of attendance. I agree to pay for all weeks contracted. All KidSpace balances must be paid in full in order for my child to attend the 2020 Summer Day Camp.

_____________________________________________________________ _____________ ___________________________ Parent/Guardian Signature Date Daytime Phone

2020 SUMMER KidSpace CIT CONTRACT May 20 through July 31, 2020

SUMMARY OF FEES:

Registration Fee (Before 5/1/20) $30

Registration Fee (After 5/1/20) $55

Weekly TUITION $150

Week #1 MODIFIED TUITION $90

Week #2 MODIFIED TUITION $120

Week #7 MODIFIED TUITION $120

Late Pickup - per minute $3

Cancellation Fee - weekly $25

Nonsufficient Funds $25

Contract, Emergency Card, Summary of Fees, Field Trips, Shot Records and Payment Received By:

Contract Scanned By:

- Staff Use Only -

Name Date Name Date

Grade Home Student

M T W TH F

Wk #1- May 20-22…...…

Wk #2- May 25-29……....

Wk #3- June 1-5..…...….

Wk #4- June 8-12..….….

Wk #5- June 15-19.…….

N/A N/A

N/A

Wk #6- June 22-26……..

Wk #7- June 29-July 3...

Wk #8- July 6-10………..

Wk #9- July 13-17....…...

Wk #10- July 20-24….....

Wk #11- July 27-31….....

M T W TH F

N/A