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Summer SPLASH - Vacation Bible School Information
Doc #1
04/13/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 1
Summer SPLASH Vacation Bible School 2011
Ages
• Kindergarten – 5th grade children are welcome
Dates/Times
• July 11 – 14th / Monday – Thursday
• 9 AM – 4 PM. Children are allowed to come earlier and leave later, as approved. Children enrolled in Harvest Christian Daycare may come up to 10 hours.
Theme
• Strong in the Lord and in the Power of His Might
• Put on Your “Son”-Screen (In Christ Armor)
• Beach/Vacation/Ocean/Surfing Theme
Location
Monday – Thursday Morning
• Harvest Christian Daycare and Learning Center / Spirit of Faith Family Church
• 4070 22nd
Ave SW, Cedar Rapids, IA 52404
Wednesday Night
• Wednesday night Bible Surf’n Splash Rally @ Spirit of Faith Family Church*
• *Optional. We invite parents and guardians to bring children to the mid-week Rally if you are not committed to another church.
Thursday Afternoon
• Wasserbahn Waterpark Resort and Clarion Inn of the Amana Colonies
• 2211 U Avenue, Williamsburg, IA, 52361
• Phone: (319) 668-1175
• Fax: (319) 668-2853
Program Fees
• $35 Registration Fee. This fee covers:
� Registration Processing
Summer SPLASH - Vacation Bible School Information
Doc #1
04/13/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 2
� Supplies
� Meals & Snacks
� Water park fee
� NOTE: you are required to bring a sack lunch for your children on Monday and Thursday. The costs for those lunches are not included in the registration fee.
• $80 program fee
� Daily child care services
� VBS Fee
• Children who are already enrolled in HCD’s Summer FUN program are only required to pay $10 to cover the cost of the water park.
Registration Applications / Payments
• Please visit our website at www.soffc.org for additional flyers, information sheets, applications, etc.
Registration Deadline
• To register, you must pay the $35 registration fee. Registrations will be granted on a first-come, first-serve basis.
• The remainder of the program fee, $80, is due by Wednesday, June 15th, 2011
• If the $80 program fee is not paid by June 15th, spots will not be reserved and may
be filled with others if there is a waiting list.
Refunds or Transfer Policies
• Please confirm your plan to attend ahead of time.
• All registration fees and payments are non-refundable and non-transferable
• All reservations are non-transferable unless approved by SOFFC/HCD
General Dress Code
• No secular band t-shirts
• No t-shirts with negative or questionable connotations
• No tank tops, spaghetti straps or string ties (girls)
• No cut-offs with slits up the side (girls)
• No halter or tube tops (girls)
Summer SPLASH - Vacation Bible School Information
Doc #1
04/13/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 3
• No shirts that reveal the stomach
• No bikinis or 2-piece swimsuits for girls. T-shirts must be worn over swimsuit. Boys can wear swim trunks with a t-shirt as well.
• Modest shorts, if worn, must be no shorter than mid-thigh
• All clothing must be appropriate
Medical Information
Medical Staff
• There is a nurse consultant available during VBS if needed.
Medications
• Only medication prescribed or ordered by a physician/dentist will be administered. The Medication Permission Form will need to be filled out by the parent or legal guardian and a doctor’s note must be received. All medication must be supplied in the original container, properly labeled, and will be administered only by authorized personnel.
• Over-the-counter medication may only be given upon a written physician order with instructions for administration including dosage and frequency.
• All medication will be kept in an area inaccessible to the children or refrigerated as required.
General Information
Schedule
• Please see attached daily schedule
• There will be a Bible Surf’n Splash Rally on Wednesday PM at Spirit of Faith Family Church.
• Thursday is Big Splash day! We will be spending the afternoon at the waterpark. We will return by 4 PM. The waterpark we are going to is Wasserbahn Waterpark Resort and Clarion Inn of the Amana Colonies.
Vacation Bible School Registration Form
Doc #2
04/15/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 1
Please include all the forms in this packet when turning in your application including:
• Registration Form – Doc #2
• Parent Contract Agreement – Doc #3
• Parental Emergency Medical Consent Form – Doc #4
• Health Assessment Form – Doc #5
• Medication Permission (if needed) – Doc #6
• Copy of Immunization Record
Child Information Child’s Name (last, first, middle)
Social Security # Age Birth date
Address
City State Zip
Gender: � Male
� Female
If languages other than English are spoken in the home, please list below:
Parent Information (Father) Father’s Name (last, first, middle)
Social Security # E-mail Address
Address (if different from child’s)
City State Zip
Phone
( )
Work Phone Ext.
( )
Cell Phone
( )
Employer
Job Title
Address
City State Zip
Marital Status of father: � Never Married � Married � Divorced
� Separated � Widowed � Remarried
Vacation Bible School Registration Form
Doc #2
04/15/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 2
Parent Information (Mother) Mother’s Name (last, first, middle)
Social Security # E-mail Address
Address (if different from child’s)
City State Zip
Phone
( )
Work Phone Ext.
( )
Cell Phone
( )
Employer
Job Title
Address
City State Zip
Marital Status of mother: � Never Married � Married � Divorced
� Separated � Widowed � Remarried
Emergency Contact
Emergency contact information will be used when the parents cannot be reached.
Name
Relationship Home Telephone
( )
Home Address
City State Zip
Work Address
City State Zip
Work Phone
( )
Cell Phone
( )
Pager Number
( )
Name
Relationship Home Telephone
( )
Home Address
City State Zip
Work Address
City State Zip
Work Phone
( )
Cell Phone
( )
Pager Number
( )
Vacation Bible School Registration Form
Doc #2
04/15/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 3
Name
Relationship Home Telephone
( )
Home Address
City State Zip
Work Address
City State Zip
Work Phone
( )
Cell Phone
( )
Pager Number
( )
Allergy/Food Exemption Information
Nature of Allergy/Food Exemption:
FOODS CHILD SHOULD AVOID REACTION
ALLERGIES OTHER THAN FOOD REACTION
Date Signature of Parent(s) or Legal Guardian
Vacation Bible School Registration Form
Doc #2
04/15/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 4
Release Authorizations
Facility Name/Address:
TRAVEL RELEASE
I/We do _____, do not_____, give consent for (name of child)________________________________ to
participate in field trips with the above named program. I/We do reserve the right to be notified before
each field trip that involves travel out of town. I release the program of any liability unless negligence is
proven.
Restrictions:
Date Signature of Parent(s) or Legal Guardian
PHOTOGRAPHY/VIDEOTAPING RELEASE
I/We do _____, do not_____, give consent that the above named program may take
photographs/videotapings of our child (name of child)_____________________________________,
and I/we consent that the program may use the photographs/videotapes of our child in promoting the
purpose of the Center. We understand that no financial benefits from the use of the
photographs/videotapes are obligated to be paid to us.
Restrictions:
Date Signature of Parent(s) or Legal Guardian
Vacation Bible School Registration Form
Doc #2
04/15/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 5
Topical Agent Permissions
I hereby give you, Harvest Christian Daycare & Learning Center permission to use the
following on my child, when appropriate. Check all
(Name of Child) that are approved.
Sunscreen
Insect Repellent
First Aid Cream / Spray
Lotion – Jergens Ultra Healing Lotion
Sunburn relief spray/lotion/gel
Vaseline
Other:
Other:
Parent(s) or Guardian(s) Signature Date
Vacation Bible School Registration Form
Doc #2
04/15/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 6
Pick-up Authorizations
Child’s Full Name:
Child’s Age:
I hereby give permission for my child to leave the center with the following persons identified below. It is my responsibility to notify the center in writing of any changes to this authorization.
Name
Relationship Telephone
( )
Address
City State Zip
Name
Relationship Telephone
( )
Address
City State Zip
Is there a court order prohibiting contact with my child by any person? � YES � NO
If yes, please provide a photocopy of the order.
Name of prohibited person
Relationship
Is there any child custody order of which we need to be aware? � YES � NO
If so, please advise:
Name(s) of person(s) who may not pick up my child:
Signature(s) of Parent(s) or Guardian Date
Vacation Bible School Registration Form
Doc #2
04/15/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 7
Program Schedule
My Child, ____________________________ is registering in Harvest Christian Daycare/Spirit of Faith Family Church’s Vacation Bible School from July 11
th – 14th.
Schedule: M T W TH F (circle days)
Care will be provided from AM / PM to AM / PM
AM / PM to AM / PM
Note: This application form alone does not ensure final registration. The non-refundable registration fee of $35 and all the paperwork completely filled out is required to guarantee a child’s enrollment and must be included with the application. If VBS is full, we will refund the registration fee, unless you desire to remain on a waiting list. The remainder of the program fee, $80, is due by Wednesday, June 15
th, 2011.
If the $80 program fee is not paid by June 15th, spots will not be reserved and may be filled with others if
there is a waiting list.
Harvest Christian Daycare/Spirit of Faith Family Church enrolls children of any race, color, ethnicity, nationality, religion or gender. All children are offered all rights, privileges, and program generally afforded or made available to children at the daycare/church. It does not discriminate on the basis of race, color, ethnicity, nationality, religion or gender in the administration of its educational policies, admissions policies and other daycare programs.
Declaration:
I have read and understand this application. I affirm that all the information in this application is true and accurate to the best of my knowledge. I understand that providing false information could be reason for rejection of this application or dismissal of my child from VBS. I also understand I may be asked to provide additional information, if necessary.
Father or guardian’s signature Date
Mother or guardian’s signature Date
Please send in all required paperwork and payments to:
SOFFC / HCD Attn: Vacation Bible School PO Box 8355 Cedar Rapids, IA 52408 Email: info@harvestchristiandaycare.com Telephone: 319-390-4077
Vacation Bible School Parent Contract Agreement
Doc #3
04/15/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 1
This contract is an agreement between:
Parent Names
and Harvest Christian Daycare & Learning Center to provide care for:
Child(s) Name(s)
on
Date
1) I agree that Harvest Christian Daycare and Learning Center is not responsible for clothes that become soiled or torn during recess or activities.
2) Harvest Christian Daycare & Learning Center will make every attempt to prevent your child from being exposed to sickness or an infectious disease, however I understand that Harvest Christian Daycare is not responsible for any illness that may child may contract while at the center. In addition, Harvest Christian Daycare & Learning Center is not liable for accidents or financial obligations pertaining to health care.
3) It is agreed that any changes to your child’s schedule for the week will be communicated prior to the change. A week’s notice is requested.
4) I agree to pay a Registration fee, as stated below, at the time of registration.
5) None of the fees identified are refundable.
6) HCD’s Vacation Bible School program will be Monday through Thursday, from 9:00 a.m. until 4:00 p.m.
7) Harvest Christian Daycare & Learning Center’s hours of operation are Monday through Friday, 6:30 a.m. until 6:00 p.m.
8) I agree to pay a per family Late Pickup fee of $10.00 for every 15 minutes any child is left at the center after the center’s closing.
9) I agree to pay a NSF fee of $20.00 if I have a declined payment. Harvest Christian Daycare will then have the option to refuse service until payment is made in its entirety.
10) Photographs taken of children involved in Harvest Christian Daycare’s program may be used for promotional purposes unless denial has been made in writing by a parent or guardian.
11) Legal authorities may be contacted for children left at the daycare more than one hour after closing time of the daycare.
12) This Agreement may be terminated by Harvest Christian Daycare at any time and for any reason. A child may be disenrolled by the daycare without prior notice if, in the sole opinion of the daycare, it is in the best interest of the child or the daycare to disenroll the child.
13) Both parents/legal guardians of the child must sign below as an agreement to meet the terms stated above.
Vacation Bible School Parent Contract Agreement
Doc #3
04/15/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 2
14) Failure to comply with the terms set form in this Agreement other supplied paper work, at Harvest Christian Daycare’s discretion, result in immediate termination of child’s enrollment.
1) Registration $35.00 Child’s hours are from AM to PM
2) Program Fee $ 80.00 Late Pick-Up fee is $10 every 15 minutes over.
NSF fee – maximum allowed by state law.
Father or guardian’s signature Date
Mother or guardian’s signature Date
Harvest Christian Daycare Date
1 copy – Office
1 copy – Parent / Guardian
Vacation Bible School Parental Emergency Medical Consent Form
Doc #4
04/13/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 1
This form must be COMPLETEY filled out and presented upon registration. Registrations will not be returned if this form is not completely filled out.
Child’s Full Name Date of Birth
This form allows parents and guardians to authorize the provision of emergency treatment for above
named child who becomes ill or injured while under program authority when parents or guardians
cannot be reached.
In the event reasonable attempt to contact me at ________________________(phone number) or
______________________(phone number) have been unsuccessful, I hereby give consent for the
administration of any treatment deemed necessary by Doctor _________________(physician) at
______________________(phone number) or Doctor ______________________(dentist) at
______________________ or in the event the designated practitioners are not available, then by
another licensed physician or dentist; and the transfer of the child to_________________________
(preferred hospital).
1) Parent(s)/Guardian(s)/Custodian(s) with whom the child resides:
Name: Relationship to child
Address Home phone
Cell phone
Employer Email address
Work phone Work hours
Name Relationship to child
Address Home phone
Cell phone
Employer Email Address
Work Phone Work hours
Vacation Bible School Parental Emergency Medical Consent Form
Doc #4
04/13/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 2
2) Medical Contact Information:
• NOTE: We are required by DHS to have the full contact information for the physician AND the dentist for EVERY child registered.
Physician Name Dentist Name
Street Address Street Address
City, State City, State
Phone Number Phone Number
Date of last Tetanus Known Allergies
Present Medication
Insurance Company Policy Holder’s I.D
This consent will be in effect for one year beginning (date) :
Signature Parent/Guardian date Signature Parent/Guardian date
Summer SPLASH Vacation Bible School Health Assessment Form
Doc #5
04/13/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 1
HEALTH STATEMENT
___________________________________________________________________________
Child’s Full Name Birth Date
1. Significant illnesses and surgeries child has had (give age at time):
________________________________________________________________________________
________________________________________________________________________________
2. Any special health-related needs of child (allergies, medications, injuries, etc.):
________________________________________________________________________________
________________________________________________________________________________
PHYSICAL ASSESSMENT
1. Is there any defect of vision, hearing or speech of which the VBS program should be aware, or could compensate by appropriate action?
________________________________________________________________________________
________________________________________________________________________________
2. Is this child subject to any conditions which limit classroom activities or physical education?
___________________________________________________________________________
___________________________________________________________________________
3. Is this child subject to any condition which may result in an emergency situation?
___________________________________________________________________________
___________________________________________________________________________
Summer SPLASH Vacation Bible School Health Assessment Form
Doc #5
04/13/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 2
4. Is this child subject to any mental or physical condition for which he/she should remain under periodic medical observation?
___________________________________________________________________________
___________________________________________________________________________
5. Other information you would like to share:
Parent’s Signature________________________________ Date _____________________
Vacation Bible School Medication Permission Form
Doc #6
04/15/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 1
NOTE: This form only needs to be filled out and returned if child is on medication.
I, (Name of Parent) give permission to
(Name of caregiver) to give my child (Name of child ) the following medicine (Name of medicine ) for (Problem or illness ) on at (Date or dates) (Time or Times) in the amount of (Amount or amounts) by (Body location and method of use) Side effects of the medicine to watch for (Possible side effects) This medicine has been prescribed by (Name of Doctor) The telephone number of the doctor is By (Signature of parent or legal guardian) (Date)
Medication prescribed or ordered by a physician/dentist will be administered by Harvest Christian Daycare when this form is filled out by the parent or AND a doctor’s note is received. All medication shall be supplied in the original container, properly labeled, and will be administered only by authorized personnel. Over-the-counter medication may only be given upon a written physician order with instructions for administration including dosage and durations. Medication will be kept in an area inaccessible to the children or refrigerated as required.
Summer SPLASH - Vacation Bible School Supply List
Doc #7
04/15/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 1
What to bring:
• Surf/Hawaiian attire (optional)
• Bible (optional)
• Notebook
• Pens / pencils
• Swimsuit. We are asking girls to bring a one-piece swimsuit and also bring a t-shirt that can be worn over the swimsuit, and boys can wear swim trunks with a t-shirt on as well.
• Swim towel (for Wednesday and Thursday afternoons)
• Change of clothes. Please make sure that your participant has a change of clothes each day of VBS. If they wear their change of clothes that is kept at HCD, they need to bring another set the following day. We have many fun (and sometimes messy!) activities planned that involve whipped cream, water, and many other fun things that children are going to need a change of clothes!
• Sunscreen – we have some sunscreen on hand, but we are asking parents to provide a bottle of sunscreen as well.
• Sack Lunch on Monday and Thursday
What NOT to bring:
• Cell phones
• Radios
• MP3 players
• Game systems, video games (PSP’s, gameboys, etc)
• CD players
• Comics, magazines, secular books
• Matches or lighters
• Prank materials
• Skateboards, roller blades
• Electronics
Please note, all unapproved items will be confiscated and returned at the end of VBS.
Summer SPLASH - Vacation Bible School Rules and Regulations
Doc #8
04/13/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 1
Please read carefully all rules and regulations. This form must be signed and returned with your registration. No one will be permitted without this agreement.
General Rules
1) No cell phones (cell phones will be collected and returned at the end of the day).
2) Children are required to be involved in all the activities.
3) Children are required to obey all Summer SPLASH Staff and Volunteers.
4) Children are not allowed to be unattended at any time.
5) Children who are ill must not attend while they are ill.
6) No violent activity including extreme hitting, biting, or other physical violence.
7) No swearing or use of curse words or calling inappropriate names.
8) No destroying of property (you will be held responsible for all damages and cost incurred).
Discipline Policy
• 1st time – verbal warning given
• 2nd
time – timeout
• After 3 timeout’s, meet with Daycare Director
• Continued disobedience may result in dismissal from VBS. The child’s parent or guardian will be contacted to pick-up the child.
Date Signature of Parent(s) or Legal Guardian
Summer SPLASH - Vacation Bible School Schedule
Doc #9
04/13/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 1
Daily Schedule Monday & Tuesday
9:00 – 9:20 Ride the Waves Workout
9:20 – 9:40 Praise and Worship
9:40 – 9:50 Educational Lesson (Summer Theme)
9:50 – 10:00 Dune Buggy Draw
10:00 – 10:15 Bathroom Break
10:15 – 10:50 Bible Surf Morning Rally (Praise song, Lesson, Scripture Bee)
10:50 – 11:10 Games
11:10 – 11:45 Outdoor Time
11:45 – 12:00 Bathroom
12:00 – 12:30 Lunch
12:30 – 1:30 Free / quiet time
1:30 – 2:10 Life Skills Class
2:10 – 2:25 Snack
2:25 – 2:40 Bathroom
2:40 – 3:00 Bible Splash (Scripture Memory Verse)
3:00 – 3:15 Art
3:15 – 3:45 Wet & Wild Activity / Beach Carnival
3:45 – 4:00 Praise & Power Recap / Creative Time
Summer SPLASH - Vacation Bible School Schedule
Doc #9
04/13/11
© 2011 Harvest Christian Daycare & Learning Center. All rights reserved.
Page 2
Wednesday
9:00 – 9:20 Ride the Waves Workout
9:20 – 9:40 Praise and Worship
9:40 – 9:50 Educational Lesson (Summer Theme)
9:50 – 10:00 Dune Buggy Draw
10:00 – 10:15 Bathroom Break
10:15 – 10:50 Bible Surf Morning Rally (Praise song, Lesson, Scripture Bee)
10:50 – 11:10 Games
11:10 – 11:45 Outdoor Time
11:45 – 12:00 Bathroom
12:00 – 12:30 Lunch
12:30 – 1:30 Free / quiet time
1:30 – 2:10 Life Skills Class
2:10 – 2:25 Snack
2:25 – 2:40 Bathroom
2:40 – 3:00 Bible Splash (Scripture Memory Verse)
3:00 – 3:15 Art
3:15 – 3:45 Water sports Activity
3:45 – 4:00 Praise & Power Recap / Creative Time
7:00 – 8:30 Bible Surf’n Splash Rally @ SOFFC (optional)
Thursday
9:00 – 9:20 Ride the Waves Workout
9:20 – 9:40 Praise and Worship
9:40 – 9:50 Educational Lesson (Summer Theme)
9:50 – 10:00 Dune Buggy Draw
10:00 – 10:15 Bathroom Break
10:15 – 10:50 Bible Surf Morning Rally (Praise song, Lesson, Scripture Bee)
11:10 – 11:45 Outdoor Time
11:45 – 12:00 Bathroom
12:00 – 12:30 Lunch
12:30 – 1:00 Travel to Water Park
1:00 – 3:30 Water Park
3:30 – 4:00 Return from Water Park
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