MVP After-School Application
PLEASE READ ALL BEFORE SIGNING
In order for your application to be counted for our after-school enrollment all information must be completed, signed and dated along with payment of fees; there will be NO EXCEPTIONS! All Phone NUMBERS and EMERGENCY CONTACT INFORMATION must
be accurate and up to date at the start and during the program. Any PHONE NUMBER(s) or RESIDENTAL ADDRESS change must be printed on paper and given to the front office staff at the time of the change; failure to do so will result in the dismissal or suspension of your child/children.
*ALL individuals that enter the building must have temperature checked.
FAMILY’S PRIMARY LAST NAME:
Registration: Child/Children must be under the legal guardian ship of the person who signs
the application.
Emergency Contact:
Where do you attend church?
Give name of 2 alternate (Relatives or Friends) who may be contacted in case parent/guardian
cannot be reached.
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MEDICAL RESPONSIBILTY RELEASE FORM
(Please read carefully before signing)
I, the signed parent/ guardian hereby agrees that neither M.V.P. After School Program, its Director and Staff, board members, volunteers nor the Church of the Firstborn and its Pastor/Elders are responsible for any pre-existing injury or illnesses or reoccurrence of any
undisclosed pre-existing injury or illnesses of any camper or campers (listed within this application) prior to the first day of registration. I also agree that I will not hold the M.V.P. After-School Program, its Director and Staff, board members, volunteers nor the Church of
the Firstborn and its Pastor/Elders responsible for any injuries or illnesses incurred by my child while participating in the M.V.P. Summer Program on or off the premises. The law requires that parental permission be obtained for surgical procedures on minors; I understand
that this consent form should be signed by the parent/guardian so that such surgical procedures may be promptly carried out and that no unnecessary delays will occur with any emergency or surgical procedures. However, I also understand that no surgery will be performed except
emergency without parent/guardian being contacted and fully informed. Under these stipulations, I therefore give my permission for such diagnostic, therapeutic and operative procedures as may be deemed necessary for my son/daughter’s medical care. I also understand
that the parent/guardian will be responsible for any medical or legal costs that may occur while or after the program has ended. *Due to the recent outbreak of Covid-19, I am assuring that I will NOT send my child/children to camp with a fever of 100.4 or above or other signs of
illness.
HEALTH INFORMATION FORM
Name of Family Doctor:
If you do not have a family doctor, which hospital do you prefer?
Do you have medical insurance?
If yes give the name of the Insurance Company and the identification number:
Name of Policy Holder:
ALLERGIES:
SIGN OUT INFORMATION
Safety to us is top priority in the M.V.P. After School Program, therefore, no child in the program will be released from the program without a parent/guardian signature or that of the (3) individuals listed below. (PLEASE NOTE: the names that appear below must be someone 16 years of age or older along with proper picture ID).
Name: Relationship:
Name: Relationship:
Name: Relationship:
FIELD TRIPS RELEASE FORM
I the undersigned do acknowledge that I have the legal right to hereby grant permission for my
child/children:
1.
To participate in the summer field trips. I do hereby agree to release from any and all liability and other wise hold harmless the M.V.P. After School Program, Director and its staff, board members, the Church of the Firstborn and
its Pastor/Elders and all personnel acting in their supervisory capacity for personal injury/death, loss of property or any type of loss which may occur as a result of a field trip activity. I further authorize staff members to seek and arrange for emergency medical care, hospitalization and/or surgery that may become necessary in my absence and will assume all
financial responsibilities for that arrangement(s)
PHOTO RELEASE FORM
I hereby give permission for my child/children to be shown and/or identified in a film, video tape or photograph made for the M.V.P. After School Program.
TRANSPORTATION
M.V.P. will provide transportation at your child/children’s place of residence. M.V.P. will NOT be responsible and/or liable during pick up and drop off. The assigned bus driver will only wait for 5 minutes during pick up and will leave drop off location once the child/children reach his or her front door. If the child/children miss the bus, the bus will not return for that day. If the
child/children miss or does not respond to at least three attempts of transporting, the bus will not return until confirmed by Program Director. Pick up/drop off location must be at the same address and cannot be changed
TRANSPORTATION RELEASE FORM
Please read carefully before signing; must be legal parent/guardian.
In the event that the M.V.P. After School Program’s director deems it necessary to use other forms of transportation for outings/field trips: I do hereby agree to release the M.V.P. After-School Program, Director and its staff, board members, Church of the Firstborn and its Pastor/Elders, Donors, Bus Drivers(s) or any authorize person using personal vehicle and all personnel acting in their supervisory and or teaching capacity from all liability for personal injury/death, loss of limb or property or any
type of loss which may occur as a result of my child/children participating in the transportation.
program.
Name Date
Please check form of transportation
DISCIPLINE POLICY
Please read the following information carefully. Parent/Guardian must sign at the bottom indicating that you understand and agree to all of the following:
During the After-School Program a discipline policy that is firm, consistent, fair and tempered with love will be maintained. If parents/guardians have any questions or disagreements regarding disciplinary actions, it shall be their responsibility to immediately discuss these questions or concerns with the Program Director. If the matter is not resolved, the final steps is
to bring the matter to the attention of the Program Administrator.
The following major violations will result in suspension or expulsion from the program:
1. Fighting
2. Foul Language
3. Incompatible attitudes (unable to get along with others)
4. Threats to do bodily harm to staff or other children
5. Continuous disobedience to those that are in authority.
THE DISCIPLINE PLAN
Children will be responsible with working with the teacher if a discipline plan is deemed
necessary. The plan simply consists of answering three (3) questions.
1. What is the problem?
2. Why is there a problem?
3. What can I do to avoid this problem in the future?
BASIC RULES FOR CAMPERS
ï‚· All students must dress appropriately in order to attend (This rule includes no short shorts, halter tops, midriff tops, sagging pants, or anything that is revealing. Failure to abide by this rule will have your child sent home immediately)
ï‚· Students cannot bring or invite visitors (Including smaller brother/sister)
ï‚· All students must follow bus rules in order to continue to ride the bus.
ï‚· All playground rules established by the teachers must be followed or camper will lose his/her rights for playtime.
ï‚· Inappropriate language, behavior or bodily contact (touching) will not be accepted on or off camp premises.
ï‚· Attendance is mandatory (required) In order to attend any field trips or activities.
ï‚· Any student suspended within a two (2) period (back-to-back) will constitute a dismissal from the summer program.
ï‚· If the bus transportation stops by the school three consecutive times and the child/children does not report to the bus, the bus driver is not allowed to return for those child/children until further instructed. The parent/guardian is then responsible for taking and picking the child up for the program until further notice.
ï‚· All decisions made by the Program Director are FINAL.
ï‚· Hands will be washed and sanitized consistently.
Name Date
