summer playground registration
Oceanside Public Schools DEPARTMENT OF COMMUNITY ACTIVITIES SUMMER 594-2336 2015 Early Childhood SUMMER PLAYGROUND REGISTRATION 3, 4, & 5 YEAR OLD PROGRAMS ROLLING REGISTRATION Register for PLAYGROUND at the D.O.C.A. office between March 9th and April 18th and be GUARANTEED A SPOT in the program *See inside for Registration Hours* Parents will receive all information and a Playground T-shirt when registering For further information concerning programs, please call The Department of Community Activities 594-2336 BOARD OF EDUCATION Robert M. Transom - President Donald Maresca - Vice President Trustees Seth J. Blau Michael D’Ambrosio Kimberly Grim Garrity Mary Jane McGrath-Mulhern Sandie Schoell Dr. Phyllis S. Harrington Superintendent of Schools Dr. Jill DeRosa Christopher Van Cott Robert Fenter Asst. Superintendent for Human Resources, Student Services & Community Activities Asst. Superintendent for Business Asst. Superintendent for Curriculum, Instruction and Research DEPARTMENT OF COMMUNITY ACTIVITIES Supervisor - Maria Bavaro Recreation Assistant - Nancy Baxter Oceanside Public Schools Department of Community Activities Dr. Jill DeRosa Assistant Superintendent for Human Resources, Student Services and Community Activities Maria Bavaro Nancy Baxter School #6, 125 Merle Avenue Oceanside, NY 11572-2218 Supervisor Recreation Assistant (516) 594-2336 Fax (516) 594-2341 February 2015 Dear Parents: Our 2015 Early Childhood Summer Playground program for children ages 3-5 will begin on Monday, July 6th and end Friday, August 14th. The EARLY CHILDHOOD Program will operate at School #6 during the hours indicated Pre-K 3 Year Olds Pre-K 4 Year Olds Tuesday, Wednesday & Thursday 9:30am–12:00pm. Child must be 3 years old by June 30, 2015 and must be toilet trained. Monday thru Friday 9:15am–12:15pm Child must be 4 years old by December 31, 2015 Kindergarten - 5 Year Olds Grades K-6 Extended Playground Choice of 3 or 5 days a week (8:00am to 4:00pm OR 8:00am to 6:00pm) Monday thru Friday 9:15am – 1:45pm. Child must be 5 years old by December 31, 2015 School #6 No transportation will be provided. PROGRAM INFORMATION All Early Childhood playgrounds will have daily organized activities for the children. As part of the Early Childhood and Extended Playground Kindergarten programs, we include several special events for your child. These events take place on-site at the School #6 building during regular playground hours. Youngsters must bring their lunch if attending the Kindergarten program, or if they are attending the Extended Playground program. *See enclosed forms for all fees and registration information* Additional forms are available at the Department of Community Activities office REGISTRATION INFORMATION ROLLING REGISTRATION for all Playground programs will begin on MONDAY, MARCH 9th. You may come into the D.O.C.A. office during registration hours between March 9th and April 18th and be guaranteed a spot in the Early Childhood program. After April 18th, registration will be subject to availability. REGISTER EARLY SPACE IS LIMITED! • Please refer to the REGISTRATION HOURS sheet, included in this packet, for days and times during which registration can be accepted. • PLEASE NOTE: Beginning May 4 th late fees will apply! The deadline for registration is JUNE 5, 2015. Registration will not be accepted after this date. • A separate registration form is needed for each child. Forms may be photocopied, or are available at the Dept. of Community Activities Office. You may also download forms from our website at www.oceansideschools.org: Click on the About Oceanside sidebar and choose Community Activities. There you will find the link to download the 2015 Early Childhood Summer Playground Registration packet. • PLEASE CHECK THAT YOU HAVE THE CORRECT REGISTRATION FORM. We look forward to having you join us for another fun-filled summer! Dr. Jill DeRosa Assistant Superintendent Maria Bavaro Supervisor Nancy Baxter Recreation Assistant SUMMER PLAYGROUND REGISTRATION HOURS You may register at the D.O.C.A. Office March 9th through June 5th during the following hours ONLY! Monday-Friday 9:00am-12:00pm and 1:30pm-3:30pm Monday-Thursday Evenings 7:30pm-8:30pm Saturdays until May 16th 10:00am-12:00pm REGISTRATION CANNOT BE ACCEPTED DURING ANY OTHER OFFICE HOURS. Please Note Late Registration Fees will apply beginning Monday, May 4th. 3 Yr Olds DEPARTMENT OF COMMUNITY ACTIVITIES 2015 SUMMER PLAYGROUND REGISTRATION NO REGISTRATION AFTER JUNE 5, 2015 SEPARATE APPLICATION FOR EACH CHILD PLEASE PRINT CLEARLY REGISTRATION ACCEPTED ONLY AT: DEPT. OF COMMUNITY ACTIVITIES NO MAIL-INS _____________________________________ CHILD’S LAST NAME _____________________________ ________________________ FIRST _______________________ HOME PHONE _______________ ________ ______ TOWN ZIP AGE ADDRESS BOY GIRL __________________ DATE OF BIRTH SCHOOL #6 PRE-K SUMMER PROGRAM (3 YR OLD) 3-DAY PROGRAM TUESDAY THRU THURSDAY 9:30 AM – 12 NOON Child must be 3 years old by June 30, 2015 Child must be toilet trained Father’s Name _____________________________ Work # ____________ Cell # ________________ Mother’s Name _____________________________ Work # ____________ Cell # _______________ EMERGENCY CONTACT & RELEASE INFORMATION - Must be provided for profile sheet to be considered complete! Additional persons, besides parents, to call in an emergency for pick up from the playground: Name 1. _______________________________ 2. _______________________________ 3. _______________________________ Relationship to Child _________________________ _________________________ _________________________ Phone ____________________ ____________________ ____________________ If someone other than the above will pick up your child at any time, the staff must be notified in writing. Name of friend(s) you wish your child to be grouped with (Please limit to two): _________________________________________________________________________________________ Are there any medical, emotional or other problems the playground staff should be aware of? Specify: __________________________________________________________________________________ _________________________________________________________________________________________ Does your child have allergies? __________ Specify: _________________________________________ Does your child take medication on a daily basis? __________ Specify: __________________________ If divorced/separated, name of person with legal custody: ________________________________________ If there is any other information that you feel the staff should be aware of, please indicate below: _________________________________________________________________________________________ _________________________________________________________________________________________ Doctor’s Name: ________________________ Phone: _________________ Dentist’s Name: ________________________ Phone: _________________ Please Sign & Date Reverse side of Form PRE-K 3 YEAR OLD PROGRAM 3 DAYS (Tues, Wed, Thurs) Tuesday, July 7th– Thursday, August 13th 9:30am - 12 noon REGISTRATION FEE SCHEDULE March 9th through May 2nd A Late Registration Fee of $30 per child will be charged beginning May 4th. 1st Child Each Additional Child $420 $390 PLEASE NOTE THE FOLLOWING: There will be NO REGISTRATION after June 5, 2015. Vacations or absence due to illness will NOT affect the payment schedule. Space is limited at each site. Placement is based upon availability. REFUND POLICY: Withdrawal by Friday, June 5th............. FULL REFUND Withdrawal by Wednesday, July 8th ........ 50% REFUND Withdrawal after Wednesday, July 8th ...... NO REFUND ******************************************************************* PAYMENT MUST ACCOMPANY ALL REGISTRATIONS MAKE CHECK PAYABLE TO: Oceanside UFSD Visa, MasterCard, American Express & Discover are accepted IN-OFFICE REGISTRATION ONLY NO MAIL-INS Department of Community Activities School #6, 125 Merle Ave. PLEASE READ AND SIGN BELOW Each registrant is required to comply with all rules and regulations established by the Oceanside Dept. of Community Activities. Right of participation is limited to registered Oceanside School District residents in good standing. Participation may be suspended or revoked for violation of any established rules, or for unacceptable behavior. In case of emergency, I authorize the Dept. of Community Activities staff to act as my legal representative and to see that proper medical, surgical or hospital treatment is provided in the event that no one can be reached at the emergency phone numbers. PERMISSION TO ATTEND SPECIAL EVENTS: My signature below gives permission for my child to take part in all planned and supervised events. In the event that no one may be reached at the phone numbers I have provided, I authorize the Department of Community Activities staff to act as my legal representative with full authority to consent to any medical, surgical or hospital treatment that may be required for any illness or injury arising from my child’s participation in said events. SIGNATURE OF PARENT/GUARDIAN: _________________________________ DATE ____________ FOR OFFICE USE ONLY: TOTAL PD: $ ______________ FEE FOR: 1 ADDIT’L ST CASH TYPE: CHECK # ___________________ CREDIT CARD LATE SCHL RECEIPT # ___________________________ 4 Yr Olds DEPARTMENT OF COMMUNITY ACTIVITIES SUMMER PLAYGROUND REGISTRATION 2015 NO REGISTRATION AFTER JUNE 5, 2015 SEPARATE APPLICATION FOR EACH CHILD PLEASE PRINT CLEARLY REGISTRATION ACCEPTED ONLY AT: DEPT. OF COMMUNITY ACTIVITIES NO MAIL-INS _____________________________________ CHILD’S LAST NAME _____________________________ ________________________ FIRST _______________________ HOME PHONE _______________ _________ TOWN ZIP ADDRESS BOY GIRL ______ ___________________ AGE DATE OF BIRTH SCHOOL #6 PRE-K SUMMER PROGRAM (4 YR OLD) 9:15 AM – 12:15 PM Child must be 4 years old by December 31, 2015 Father’s Name _____________________________ Work # ____________ Cell # _________________ Mother’s Name _____________________________ Work # ____________ Cell # ________________ EMERGENCY CONTACT & RELEASE INFORMATION - Must be provided for profile sheet to be considered complete! Additional persons, besides parents, to call in an emergency for pick up from the playground: Name 1. _______________________________ 2. _______________________________ 3. _______________________________ Relationship to Child _________________________ _________________________ _________________________ Phone ____________________ ____________________ ____________________ If someone other than the above will pick up your child at any time, the staff must be notified in writing. Name of friend(s) you wish your child to be grouped with (Please limit to two): _________________________________________________________________________________________ Are there any medical, emotional or other problems the playground staff should be aware of? Specify: __________________________________________________________________________________ _________________________________________________________________________________________ Does your child have allergies? __________ Specify: _________________________________________ Does your child take medication on a daily basis? __________ Specify: __________________________ If divorced/separated, name of person with legal custody: ________________________________________ If there is any other information that you feel the staff should be aware of, please indicate below: _________________________________________________________________________________________ _________________________________________________________________________________________ Doctor’s Name: ________________________ Phone: _________________ Dentist’s Name: ________________________ Phone: _________________ Please Sign & Date Reverse side of Form PRE-K 4 YEAR OLD SUMMER PROGRAM Monday, July 6th– Friday, August 14th 9:15am - 12:15pm REGISTRATION FEE SCHEDULE March 9th through May 2nd A Late Registration Fee of $30 per child will be charged beginning May 4th. 1st Child Each Additional Child $420 $390 PLEASE NOTE THE FOLLOWING: There will be NO REGISTRATION after June 5, 2015. Vacations or absence due to illness will NOT affect the payment schedule. Space is limited at each site. Placement is based upon availability. REFUND POLICY: Withdrawal by Friday, June 5th............. FULL REFUND Withdrawal by Wednesday, July 8th ........ 50% REFUND Withdrawal after Wednesday, July 8th ...... NO REFUND ******************************************************************* PAYMENT MUST ACCOMPANY ALL REGISTRATIONS MAKE CHECK PAYABLE TO: Oceanside UFSD Visa, MasterCard, American Express & Discover are accepted IN-OFFICE REGISTRATION ONLY NO MAIL-INS Department of Community Activities School #6, 125 Merle Ave. PLEASE READ AND SIGN BELOW Each registrant is required to comply with all rules and regulations established by the Oceanside Dept. of Community Activities. Right of participation is limited to registered Oceanside School District residents in good standing. Participation may be suspended or revoked for violation of any established rules, or for unacceptable behavior. In case of emergency, I authorize the Dept. of Community Activities staff to act as my legal representative and to see that proper medical, surgical or hospital treatment is provided in the event that no one can be reached at the emergency phone numbers. PERMISSION TO ATTEND SPECIAL EVENTS: My signature below gives permission for my child to take part in all planned and supervised events. In the event that no one may be reached at the phone numbers I have provided, I authorize the Department of Community Activities staff to act as my legal representative with full authority to consent to any medical, surgical or hospital treatment that may be required for any illness or injury arising from my child’s participation in said events. SIGNATURE OF PARENT/GUARDIAN: _________________________________ DATE ____________ FOR OFFICE USE ONLY: TOTAL PD: $ ______________ FEE FOR: 1 ADDIT’L ST CASH TYPE: CHECK # ___________________ CREDIT CARD LATE SCHL RECEIPT # ___________________________ 5 Yr Olds DEPARTMENT OF COMMUNITY ACTIVITIES SUMMER PLAYGROUND REGISTRATION 2015 NO REGISTRATION AFTER JUNE 5, 2015 SEPARATE APPLICATION FOR EACH CHILD PLEASE PRINT CLEARLY REGISTRATION ACCEPTED ONLY AT: DEPT. OF COMMUNITY ACTIVITIES NO MAIL-INS _____________________________________ CHILD’S LAST NAME _____________________________ ________________________ FIRST _______________________ HOME PHONE _______________ _________ TOWN ZIP ADDRESS BOY GIRL ______ ___________________ AGE DATE OF BIRTH SCHOOL #6 KINDERGARTEN SUMMER PROGRAM (5 YR OLD) 9:15 AM – 1:45 PM Child must be 5 years old by December 31, 2015 Father’s Name _____________________________ Work # ____________ Cell # _________________ Mother’s Name _____________________________ Work # ____________ Cell # ________________ EMERGENCY CONTACT & RELEASE INFORMATION - Must be provided for profile sheet to be considered complete! Additional persons, besides parents, to call in an emergency for pick up from the playground: Name 1. _______________________________ 2. _______________________________ 3. _______________________________ Relationship to Child _________________________ _________________________ _________________________ Phone ____________________ ____________________ ____________________ If someone other than the above will pick up your child at any time, the staff must be notified in writing. Name of friend(s) you wish your child to be grouped with (Please limit to two): _________________________________________________________________________________________ Are there any medical, emotional or other problems the playground staff should be aware of? Specify: __________________________________________________________________________________ _________________________________________________________________________________________ Does your child have allergies? __________ Specify: _________________________________________ Does your child take medication on a daily basis? __________ Specify: __________________________ If divorced/separated, name of person with legal custody: ________________________________________ If there is any other information that you feel the staff should be aware of, please indicate below: _________________________________________________________________________________________ _________________________________________________________________________________________ Doctor’s Name: ________________________ Phone: _________________ Dentist’s Name: ________________________ Phone: _________________ Please Sign & Date Reverse side of Form KINDERGARTEN 5 YEAR OLD SUMMER PROGRAM Monday, July 6th– Friday, August 14th 9:15am - 1:45pm REGISTRATION FEE SCHEDULE March 9th through May 2nd A Late Registration Fee of $30 per child will be charged beginning May 4th. 1st Child Each Additional Child $475 $445 PLEASE NOTE THE FOLLOWING: There will be NO REGISTRATION after June 5, 2015. Vacations or absence due to illness will NOT affect the payment schedule. Space is limited at each site. Placement is based upon availability. REFUND POLICY: Withdrawal by Friday, June 5th............. FULL REFUND Withdrawal by Wednesday, July 8th ........ 50% REFUND Withdrawal after Wednesday, July 8th ...... NO REFUND ******************************************************************* PAYMENT MUST ACCOMPANY ALL REGISTRATIONS MAKE CHECK PAYABLE TO: Oceanside UFSD Visa, MasterCard, American Express & Discover are accepted IN-OFFICE REGISTRATION ONLY NO MAIL-INS Department of Community Activities School #6, 125 Merle Ave. PLEASE READ AND SIGN BELOW Each registrant is required to comply with all rules and regulations established by the Oceanside Dept. of Community Activities. Right of participation is limited to registered Oceanside School District residents in good standing. Participation may be suspended or revoked for violation of any established rules, or for unacceptable behavior. In case of emergency, I authorize the Dept. of Community Activities staff to act as my legal representative and to see that proper medical, surgical or hospital treatment is provided in the event that no one can be reached at the emergency phone numbers. PERMISSION TO ATTEND SPECIAL EVENTS: My signature below gives permission for my child to take part in all planned and supervised events. In the event that no one may be reached at the phone numbers I have provided, I authorize the Department of Community Activities staff to act as my legal representative with full authority to consent to any medical, surgical or hospital treatment that may be required for any illness or injury arising from my child’s participation in said events. SIGNATURE OF PARENT/GUARDIAN: _________________________________ DATE ____________ FOR OFFICE USE ONLY: TOTAL PD: $ ______________ FEE FOR: 1 ADDIT’L ST CASH TYPE: CHECK # ___________________ CREDIT CARD LATE SCHL RECEIPT # ___________________________ GRADES K-6 DEPARTMENT OF COMMUNITY ACTIVITIES SUMMER 2015 EXTENDED PLAYGROUND PROGRAM FOR OFFICE USE ONLY NO REGISTRATION AFTER JUNE 5, 2015 SEPARATE APPLICATION FOR EACH CHILD PLEASE PRINT CLEARLY REGISTRATION ACCEPTED ONLY AT: DEPT. OF COMMUNITY ACTIVITIES NO MAIL-INS _______________________________ CHILD’S LAST NAME _____________________________ ADDRESS ____________________ FIRST _______________ TOWN ___________________ HOME PHONE BOY GIRL ________ ZIP ______ ________ ________ AGE D.O.B. Grade in Sept 2015 SCHOOL #6 EXTENDED PLAYGROUND SUMMER PROGRAM (Grades K-6) If registering for Kindergarten, child must be 5 years old by December 31, 2015 You will have a choice between 3 Days a Week or 5 Days a Week. Please circle choice of Days and Times: -OR- 8:00am to 4:00pm Mon Father’s Name Tues Wed Thurs Fri 8:00am to 6:00pm Mon Tues Wed Thurs Fri _____________________________ Work # _____________ Cell # ______________ Mother’s Name _____________________________ Work # _____________ Cell # ______________ EMERGENCY CONTACT & RELEASE INFORMATION - Must be provided for profile sheet to be considered complete! Additional persons, besides parents, to call in an emergency for pick up from the playground: Name 1. _______________________________ 2. _______________________________ 3. _______________________________ Relationship to Child _________________________ _________________________ _________________________ Phone ___________________ ___________________ ___________________ than the above will pick up your child at any time, the staff must be notified in writing. If someone other Initial here to grant permission for your child to WALK or BICYCLE home at dismissal. Are there any medical, emotional or other problems the playground staff should be aware of? Specify: __________________________________________________________________________________ _________________________________________________________________________________________ Does your child have allergies? __________ Specify: _________________________________________ Does your child take medication on a daily basis? __________ Specify: __________________________ If divorced/separated, name of person with legal custody: ________________________________________ If there is any other information that you feel the staff should be aware of, please indicate below: _________________________________________________________________________________________ _________________________________________________________________________________________ Doctor’s Name: ________________________ Phone: _________________ Please Sign & Date Reverse side of Dentist’s Name: ________________________ Phone: _________________ EXTENDED PLAYGROUND SUMMER PROGRAM Monday July 6th through Friday August 14th REGISTRATION FEE SCHEDULE March 9th through May 2nd A Late Registration Fee of $30 per child will be charged beginning May 4th. 8:00am to 4:00pm 1st Child 5 days: 3 days: 8:00am to 6:00pm 1st Child Each Additional Child $1,040 ....................... $1,010 $825 ......................... $795 5 days: 3 days: Each Additional Child $1,400 ....................... $1,370 $1,040 ....................... $1,010 3 Day Program: In addition to the 3 days you select, your child may attend the Extended Playground program from 9:00am to 2:00pm on non-extended days for no additional charge. PLEASE NOTE THE FOLLOWING: • Remember Your Pick-Up Schedule! There will be a late charge of $25 for each day or incident. • Vacations or absence due to illness will NOT affect the payment schedule. REFUND POLICY: Withdrawal by Friday, June 5th ............ FULL REFUND Withdrawal by Wednesday, July 8th ........ 50% REFUND Withdrawal after Wednesday, July 8th ...... NO REFUND ******************************************************************* PAYMENT MUST ACCOMPANY ALL REGISTRATIONS MAKE CHECK PAYABLE TO: Oceanside UFSD Visa, MasterCard, American Express & Discover are accepted IN-OFFICE REGISTRATION ONLY NO MAIL-INS Department of Community Activities School #6, 125 Merle Ave. PLEASE READ AND SIGN BELOW Each registrant is required to comply with all rules and regulations established by the Oceanside Dept. of Community Activities. Right of participation is limited to registered Oceanside School District residents in good standing. Participation may be suspended or revoked for violation of any established rules, or for unacceptable behavior. In case of emergency, I authorize the Dept. of Community Activities staff to act as my legal representative and to see that proper medical, surgical or hospital treatment is provided in the event that no one can be reached at the emergency phone numbers. PERMISSION TO ATTEND TRIPS: My signature below gives permission for my child to take part in all planned and supervised trips. In the event that no one may be reached at the phone numbers I have provided, I authorize the Department of Community Activities staff to act as my legal representative with full authority to consent to any medical, surgical or hospital treatment that may be required for any illness or injury arising from my child’s participation in said trips. SIGNATURE OF PARENT/GUARDIAN: _________________________________ DATE ____________ FOR OFFICE USE ONLY: TOTAL PD: $ ______________ FEE FOR: 1 ADDIT’L ST CASH CHECK # ________________ CREDIT CARD LATE SCHL RECEIPT # _______________________ ESL/ RD&MATH
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