1. education
2. school

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
