section for child care regulation

MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES SECTION FOR CHILD CARE REGULATION BUREAU OF COMMUNITY FOOD & NUTRITION ASSISTANCE CHILD CARE ENROLLMENT FORM

FACILITY/PROVIDER NAME ADMISSION DATE DISCHARGE DATE

CHILD’S NAME GENDER BIRTHDATE

ADDRESS (STREET, CITY, STATE, ZIP CODE)

IDENTIFYING INFORMATION MOTHER’S/GUARDIAN’S NAME HOME TELEPHONE NUMBER

ADDRESS (STREET, CITY, STATE, ZIP CODE) OR CHECK IF SAME AS ABOVE CELL PHONE NUMBER

E-MAIL ADDRESS

EMPLOYER OR SCHOOL ATTEND WORK/SCHOOL SCHEDULE

EMPLOYER/SCHOOL ADDRESS (STREET, CITY, STATE, ZIP CODE) WORK TELEPHONE NUMBER

FATHER’S/GUARDIAN’S NAME HOME TELEPHONE NUMBER

ADDRESS (STREET, CITY, STATE, ZIP CODE) OR CHECK IF SAME AS ABOVE CELL PHONE NUMBER

E-MAIL ADDRESS

EMPLOYER OR SCHOOL ATTEND WORK/SCHOOL SCHEDULE

EMPLOYER/SCHOOL ADDRESS (STREET, CITY, STATE, ZIP CODE) WORK TELEPHONE NUMBER

EMERGENCY CONTACT AND PERSONS AUTHORIZED TO TAKE CHILD FROM FACILITY (OTHER THAN PARENT) AT LEAST ONE EMERGENCY CONTACT IS REQUIRED.

NAME RELATIONSHIP TO CHILD TELEPHONE NUMBERS (CELL, WORK, HOME)


NAME RELATIONSHIP TO CHILD TELEPHONE NUMBERS (CELL, WORK, HOME)


COMMENTS ON CHILD’S DEVELOPMENT (PERSONAL DEVELOPMENT, BEHAVIOR, PATTERNS, HABITS, & INDIVIDUAL NEEDS)

CA

CFP

REQ

UIR

EMEN

T

RELATED CHILD

YES NO HOW IS CHILD RELATED TO CHILD CARE PROVIDER?

CHILD’S PROJECTED ATTENDANCE SCHEDULE AND ANY VARIATIONS EXPECTED

CHECK HERE WHAT DAYS THE CHILD WILL ATTEND. WILL CHILD ATTEND:

FULL TIME OR PART TIME

WHAT TIME DOES YOUR CHILD USUALLY ARRIVE EACH DAY? CIRCLE AM OR PM

WHAT TIME DOES YOUR CHILD USUALLY LEAVE EACH DAY? CIRCLE AM OR PM

WRITE ANY COMMENTS, CHANGES OR VARIATIONS IN USUAL ATTENDANCE IN THIS SECTION INCLUDING SHIFT CHANGES.

MONDAY AM PM AM PM

TUESDAY AM PM AM PM

WEDNESDAY AM PM AM PM

THURSDAY AM PM AM PM

FRIDAY AM PM AM PM

SATURDAY AM PM AM PM

SUNDAY AM PM AM PM

MO 580-2994 (10-18) Page 1 of 3 SCCR/CACFP

CA

CFP

REQ

UIR

EMEN

T CHECK THE MEALS YOUR CHILD IS USUALLY GIVEN AT THIS FACILITY

BREAKFAST MORNING SNACK LUNCH AFTERNOON SNACK SUPPER EVENING SNACK NONE

CHECK THE HOLIDAYS YOUR CHILD IS IN CARE AT THIS FACILITY

NEW YEARS’S DAY (JANUARY) MARTIN LUTHER KING JR.’S BIRTHDAY (JANUARY)

PRESIDENT’S DAY (FEBRUARY) EASTER (MARCH/APRIL)

MEMORIAL DAY (MAY) INDEPENDENCE DAY (JULY) LABOR DAY (SEPTEMBER) COLUMBUS DAY (OCTOBER)

VETERANS DAY (NOVEMBER) ELECTION DAY (NOVEMBER) THANKSGIVING (NOVEMBER) CHRISTMAS DAY (DECEMBER)

AUTHORIZATION FOR EMERGENCY MEDICAL CARE

I UNDERSTAND THAT I WILL BE NOTIFIED AT ONCE IN CASE OF AN EMERGENCY WITH MY CHILD, AND I WILL MAKE ARRANGEMENTS FOR MEDICAL CARE OF MY CHILD WITH THE PHYSICIAN OR HOSPITAL OF MY CHOICE.

IF I CANNOT BE REACHED TO MAKE NECESSARY ARRANGEMENTS, OR IN A CRITICAL EMERGENCY REQUIRING MEDICAL CARE, I AUTHORIZE

DAY CARE PROVIDER OR HOME PROVIDER TO CONTACT THE FOLLOWING:

PHYSICIAN OR CLINIC NAME TELEPHONE NUMBER

PREFERRED HOSPITAL NAME TELEPHONE NUMBER

ACKNOWLEDGEMENTS

A I HAVE RECEIVED A COPY OF THIS FACILITY’S POLICIES PERTAINING TO THE ADMISSION, CARE AND DISCHARGE OF CHILDREN.

PARENT/GUARDIAN INITIALS

B I HAVE BEEN INFORMED THAT A COPY OF THE LICENSING RULES FOR CHILD CARE HOMES OR THE LICENSING RULES FOR GROUP CHILD CARE HOMES AND CENTERS IS AVAILABLE AT THIS FACILITY FOR REVIEW.


C THE PROVIDER AND I HAVE AGREED ON A PLAN FOR CONTINUING COMMUNICATION REGARDING MY CHILD’S DEVELOPMENT, BEHAVIOR, AND INDIVIDUAL NEEDS.


D WHEN MY CHILD IS ILL, I UNDERSTAND AND AGREE THAT S/HE MAY NOT BE ACCEPTED FOR CARE OR REMAIN IN CARE.


E I UNDERSTAND THAT, BEFORE THE FIRST DAY OF ATTENDANCE BY MY CHILD, I WILL PROVIDE PROOF OF COMPLETED AGE-APPROPRIATE IMMUNIZATIONS OR EXEMPTION FROM IMMUNIZATIONS.


F I DO DO NOT GIVE PERMISSION FOR FIELD TRIPS/EXCURSIONS.

I UNDERSTAND I WILL BE NOTIFIED IN ADVANCE WHEN THEY ARE PLANNED.


G I DO

DO NOT GIVE PERMISSION FOR THE FACILITY TO TRANSPORT MY CHILD.


H I HAVE BEEN INFORMED AND HAVE RECEIVED A COPY OF THE FACILITY’S SAFE SLEEP POLICY WHEN ENROLLING A CHILD LESS THAN ONE (1) YEAR OF AGE.


I I HAVE BEEN NOTIFIED THAT I MAY REQUEST NOTICE AT INITIAL ENROLLMENT OR ANY TIME THERE AFTER WHETHER THERE ARE CHILDREN CURRENTLY ENROLLED IN OR ATTENDING THE FACILITY FOR WHOM AN IMMUNIZATION EXEMPTION HAS BEEN FILED.


PARENT’S/GUARDIAN’S SIGNATURE DATE

CA

CFP

R

EQU

IREM

ENT

FIRST ANNUAL UPDATE PARENT/GUARDIAN SIGNATURE DATE

SECOND ANNUAL UPDATE PARENT/GUARDIAN SIGNATURE DATE

THIRD ANNUAL UPDATE PARENT/GUARDIAN SIGNATURE DATE

MO 580-2994 (10-18) Page 2 of 3 SCCR/CACFP

MO 580-2851 (6-14) TO BE FILED IN CHILD’S RECORD AT CHILD CARE FACILITY. BCC-6B

MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICESSECTION FOR CHILD CARE REGULATIONPARENT’S HEALTH STATEMENT FOR SCHOOL-AGE CHILD

IDENTIFYING INFORMATIONCHILD’S NAME BIRTHDATE

HEALTH STATEMENT (CHECK ONE)

My child is in good health, is able to participate in group care, has no special health or medical requirements.

My child is able to participate in group care but has special health or medical requirements as listed below.

SCHOOL-AGE CHILD’S SPECIAL HEALTH OR MEDICAL REQUIREMENTSPLEASE LIST ANY ALLERGIES, SPECIAL MEDICAL CONDITIONS, INCLUDING CHRONIC HEALTH PROBLEMS (SUCH AS ASTHMA, SEIZURES), BEHAVIORAL DISORDERS,SPECIAL NEEDS, ETC.

PARENT OR LEGAL GUARDIAN SIGNATURE DATE

MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICESSECTION FOR CHILD CARE REGULATION

MEDICATION AUTHORIZATION

MO 580-1875 (6-14) FORM TO BE RETAINED IN CHILD’S RECORD BCC-11

MEDICATION REQUIREMENT

RECORD OF ADMINISTRATION

PRESCRIPTION MEDICATION SHALL BE IN THE ORIGINAL CONTAINER AND LABELED WITH THE CHILD’S NAME, INSTRUCTIONS,INCLUDING TIMES AND AMOUNTS FOR DOSAGES, AND THE PHYSICIAN’S NAME. ALL NON-PRESCRIPTION MEDICATION SHALLBE IN THE ORIGINAL CONTAINER AND LABELED BY THE PARENT(S) WITH THE CHILD’S NAME AND INSTRUCTIONS FORADMINISTRATION, INCLUDING TIMES AND AMOUNTS FOR DOSAGES. A SEPARATE FORM IS NEEDED FOR EACH MEDICATION.THIS FORM IS VALID ONLY FOR THE DATES INDICATED BELOW.

I AUTHORIZE CHILD CARE PERSONNEL TO ADMINISTER THE FOLLOWING MEDICATION TO MY CHILD:

(PROPER NAME OF MEDICATION)

CHILD’S FULL NAME DATE MEDICATION TAKEN FROM UNTIL

DOSAGE TIME(S) OF DAY

POSSIBLE SIDE EFFECTS

SIGNATURE OF PARENT(S) OR GUARDIAN DATE

STAFF NAME DATE MEDICATION NAME DOSAGE TIME

COVID-19 Screening Questions

Date: _________________________

Child’s Name (first and last name):______________________________________________________________________________

Date of Birth (mmddyy): __________________________________

COVID-19 Screening

Questions

YES NO

Does child or anyone in your

household have any of the

following?

□ Fever or feeling feverish

(chills, sweating) □ Shortness

of breath (not severe) □ Cough

In the past 14 days, has your

child or any household member

traveled outside the four

state? If so, where:

______________________________________

In the past 14 days, has your

child or any household member

had any contact with a person

who has tested positive for

COVID-19?

Has your child or any

household member have a

history of exposure to

COVID19 biologic material?

__________________________________ _______________________________________

PRINT NAME PARENT/GUARDIAN SIGNATURE

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization.

COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. The Joplin

Family YMCA (JFY) has put in place preventative measures to reduce the spread of COVID-19; however, the JFY

cannot guarantee that you will not become infected with COVID-19. Further, participation could increase your risk

of contracting COVID-19.

READ CAREFULLY BEFORE SIGNING – INITIAL EACH PARAGRAPH

____ INITIALS By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by participation; and that such exposure or infection may result in personal injury, illness, permanent

disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the JFY may result from the actions,

omissions, or negligence of myself and others, including, but not limited to, the JFY’s employees, volunteers, and program participants

and their families.

____ INITIALS I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur

in connection with my participation at the JFY. On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless the JFY,

its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses

of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions,

omissions, or negligence of the JFY, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during,

or after participation at the JFY.

____ INITIALS I represent that I have adequate insurance to cover any injury or illness I may suffer or cause while participating in this

activity, or else I agree to bear the costs of such injury or illness myself. I further represent that I have no medical or physical condition

which could interfere with my safety in this activity, or else I am willing to assume – and bear the costs of – all risks that may be

created, directly or indirectly, by any such condition.

____ INITIALS In the event that I file a lawsuit, I agree to do so in the state where the JFY is located, and I further agree that the

substantive law of that state shall apply. I agree that if any portion of this agreement is found to be void or unenforceable, the

remaining portions shall remain in full force and effect.

____ INITIALS By signing this document, I agree that if I am exposed or infected by COVID-19 during my participation in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence.

____ INITIALS I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing.

Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly

greater if I were to choose not to sign this release, and agree that the opportunity to participate at the stated cost in return for the

execution of this release is a reasonable bargain. I have read and understood this document and I agree to be bound by its terms.

____ INITIALS If I have signed a separate general waiver of liability connected to my participation at the JFY, I agree that the terms of

that waiver are wholly incorporated into this document and that the terms of this document are incorporated into the separate general

waiver.

____ INITIALS I agree that I will practice safe social distancing and clean hygiene during my participation at the JFY.

Signature Print Name

Address City State Zip

Telephone ( ) Date

Emergency Contact__________________________________ Emergency Contact Number______________________________________

PARENT OR GUARDIAN ADDITIONAL AGREEMENT (Must be completed for participants under the age of 18)

In consideration of _________________________________ (PRINT minor’s names) being permitted to participate in this activity, I further agree to

indemnify and hold harmless Releasees from any claims alleging negligence which are brought by or on behalf of minor or are in any

way connected with such participation by minor.

Parent or Guardian Print Name Date

JOPLIN FAMILY YMCA

3404 W. McIntosh Circle Dr., Joplin, MO 64804 P 417 781 9622 F 417 625 2503

School Age Services Enrollment and Handbook Acknowledgements

Child Name: ______________________________________ Date of Birth:____________________________

Program Participating In (Circle One): After School Summer Day Camp Winter/Spring Activity Days

School your child is attending:_________________________________________________________

I, _______________________________________________________ acknowledge that I have been provided with a copy of the parent

handbook outlining the following policies, releases, and program information:

Media Release- I am giving my child permission to be a part of YMCA’s advertising, photo promotions highlighting

our child care programs: YES of NO (please circle one)

Please Initial ____________________

Authorization for Release of Information- I am giving my child’s attending school authorization to release

information that will assist with completing enrollment and assist with any program concerns: YES or NO

(please circle one) Please initial ______________________

Behavior Management Procedures and Discharge Policy- Children who attend our program are expected to interact

appropriately and follow behavior guidelines outlined in parent handbook.

Foster/Adoptive Parent Child Care Subsidy- Children must use our program every day and not miss more than 5

days in a month. Children are checked in upon arrival that day and must stay a minimum of 30 minutes that day, if

not the state will not authorize payment. See more information in the parent handbook.

Late Fee and Pick-up Policy- Normal business hours for are 2:30 p.m. 6:00 p.m. Monday thru Friday. A fee of

$10.00 will be assessed after a 10 minute grace period and assessed $10.00 every 10 minutes thereafter. Please

note we do not provide services at school locations when school is not in section and earlier outs.

Release and Waiver of Liability and Indemnity Agreement- In consideration for being permitted to utilize the

facilities, services and programs of the YMCA an expressed agreement that foregoing information has been

outlined in the parent handbook regarding this matter.

_________________________________________________________ ________________________

Print Name Date

_________________________________________________________

Parent/Guardian Signature

FOR YOUTH DEVELOPMENT®

FOR HEALTHY LIVING

FOR SOCIAL RESPONSIBILITY

JOPLIN FAMILY YMCA

FINANCIAL AGREEMENT &

AUTHORIZATION FOR

AUTOPAYMENT

Child's Name Date of Birth ------------------------------- --------

Responsible Party's Information

Name ----------�F-irs_t ___________ M_I ___________ La_s_t -------------

Address -----�S-tr -ee-1-----------�Ap_t_#------�C�it_y ______ �S-tate

Home Phone # Cell Phone # Work# Zip

----------- ----------- ------------

Socia I Security# __________ Relationship to child _________ Email ____________ _

• Automatic bank and credit card drafts for the enrolled child's tuition are processed at 9am on Monday mornings,regardless of bank holidays, unless the Joplin Family YMCA billing office is closed.

• Weekly tuition is billed at a flat weekly rate. No other discounts will be provided based on closures or absences forholidays, illness, weather or any other unforeseeable events. I understand I will be charged the same rate every weekwhether the enrolled child attends the program or not.

• I understand I am only allowed ONE excused week of absences per calendar year.• A wrjtten notjce must be submjtted to Childcare Billing Office a week prior or no later than the Friday prior to

any additions/changes to the enrolled child's record/account. Add/Change Forms are available at the site oronline for me to use as written notice for cancellation out of the program and for additions/changes. If I do notprovide advance written notice, I will be charged the regular weekly rate.

• If the child is enrolled into the activity days or drop program, my payments are due in advance and must be receivedbefore the child attends the program. Proof of payment will be required at drop off. If payment is not made .b.e.fo.re. theenrolled child attends, I will incur a $10 late fee. If I do not make my payment in full by close of business Friday, mybalance will be automatically deducted from my bank account or charged to my credit card the following Monday.

• A ONE JIME and PERMANENT switch from the weekly program to the daily drop program (and vice versa) is allowed.Written notice of the switch must be submitted by a week or Friday prior to the planned week of change.

• I am fully responsible for updatjnq changes to my credjt/debjt card number expjratjon and securjty code or my bank

checkjnq/sayjnqs jnformatjon a week or the frjday prjor to my next bank draft date• If my payment for my tuition or balance is returned or declined, I will be notified immediately and will be assessed a $25

return-payment fee, and my payment will be due immediately.• If I do not make my payment in full by close of business Friday, the enrolled child will not be allowed to attend the

program until payment is made.• If I receive assistance through a third party agency, I am fully responsible for the remaining balance the third party

does not pay.• If the enrolled child is not allowed to attend the program due to non-payment and I do not make payment, I will be

referred to a third-party collection aqency.

BANK DRAFT (Attach a voided check to this form) CREDIT CARD DRAFT

Name on Bank Account Name on Card

Name of Bank Card Tv□e

Boutin□# #

Account# Exoiration Pate

D Checking D Savings Securitv Code

I have given authority to the above bank or credit card company to honor all preauthorized ACH drafts on my account for childcare payment and/or outstanding balance due for the current program my child is enrolled.

I understand that by signing this form I assume all financial responsibility for this child and agree to abide by all policies in the parent handbook (included with the enrollment packet).

Parent/Guardian Signature: _____________________________ Date: ____ _For confidentiality purposes, this document is only accepted by fax (417-625-2503), in person, or through the upload link on our After School Program webpage.

Revised 4/13/2021

School Age Services (Ages 5 to 12)

JOPLIN FAMILY YMCA School Plus After School Services

Out of School Activity Days

Summer School After School Extension

Summer Day Camp

School Plus Available at these area schools:

Carl Junction Elementary

Joplin School District

Cecil Floyd

Eastmorland

Irving

Kelsey Norman

McKinley

Royal Heights

Soaring Heights

Stapleton

West Central (Jefferson/Columbia)

Webb City School District

Madge T. James (Webster)

Mark Twain (Eugene Fields/Middle)

Carterville

Harry S. Truman

The Y’s mission: To promote a positive, nurturing

environment while protecting youth from any form of

abuse. Our staff have been trained in child abuse prevention.

Revised 4/13/2021

SCHOOL PLUS AFTERSCHOOL CARE

The Joplin Family YMCA’s School Plus Program is an

afterschool care and activity program designed to provide a

safe, nurturing environment for children in elementary school.

It is held on-site at participating schools and is supervised by

Joplin Family YMCA staff. For safety and peace of mind, each

member of our staff is CPR-certified and has undergone a

comprehensive background check, which includes

fingerprinting. Each site director has college credits in

education, and all School Plus staff undergo 12 hours of

continuing education in child care annually.

DAILY SCHEDULE Every School Plus site offers a unique and special

experience for all children. All School Plus programs offers

2:45 pm Arrival Time/Roll Call

3:00 pm Restroom Break

3:15 pm Snack Time

3:45 pm Homework/Arts & Humanities/

Health, Wellness & Fitness

4:30 pm Outdoor Play/Indoor Activities

5:15 pm Homework Assistance (time may

vary)

6:00 pm School Plus Closing Time

JOPLIN AND WEBB CITY SCHEDULE

*Jefferson students are transported to West Central; Eugene Field, Mark Twain, and Webb City students are transported to Madge T James.

TIMES AND HOURS OF OPERATION The Joplin Family YMCA School Plus Program will be offered

DVN NUMBERS For families who will be utilizing the State Assistance

Childcare Program, the following DVN numbers are listed

for your caseworkers. The numbers are also the license

SCHOOL DVN NUMBER

Carl Junction 001994865

Carterville 002325817

Cecil Floyd 000284099

Eastmorland 000359106

Harry S. Truman 002319128

Irving 002303439

Kelsey Norman 000284124

Madge T. James/Bess T. 002319226

Mark Twain 002319217

McKinley 002155706

Royal Heights 000310318

Soaring Heights 002444840

Stapleton 000284115

Webb City Middle School 002699834

West Central 002155699

Joplin Family Y Location 002825447

JOPLIN SCHOOLS WEBB CITY SCHOOLS

Eastmorland Madge T. James/Webster

Irving Mark Twain/Eugene Fields/Middle

Kelsey Norman Carterville

McKinley Harry S Truman

Cecil Floyd Note: Eugene Field bused to Mark Twain

Royal Heights Note: Webster and Middle transport by Y

Van Driver

Soaring Heights

Stapleton CARL JUNCTION

West Central Elementary School (ages 5-12)

Note: Columbia and

Jefferson bused to

West Central

SUMMER DAY CAMP/OUT OF SCHOOL AC-

TIVITY DAYS at the Joplin Family Y loca-

tion

PROCEDURE: If an emergency situation should arise be-

tween the hours of 2:45 pm and 6:00 pm, please contact

the Joplin Family YMCA at 417 781 9622 to get a mes-

sage to the site.

Revised 4/13/2021

WINTER/SPRING BREAK CAMPS

The Joplin Family YMCA’s Winter and Spring Break camps are

care and activity programs designed to provide a safe and

nurturing environment for children in elementary school on

winter and spring break respectively. Camps are held at the

Joplin Family Y and are supervised by Joplin Family Y staff. For

safety and peace of mind, all members of our staff are CPR

certified and have undergone background checks.

PROCEDURES Children must be dropped off at the Joplin Family Y between

7 am – 8 am and picked up between 3 pm – 6 pm. (Not this is

subject to change. Updates will be available on the

Joplinfamilyy.org website.

TIMES AND HOURS OF OPERATION The Winter and Spring Break camps are held Monday –

Friday; their start and end dates are based on the Joplin

School District’s calendar. Care is provided 7 am – 6 pm for

both camps.

DAILY SCHEDULE Each day’s activities, lunch, and snacks are determined prior

to each camp’s start.

DVN NUMBERS Winter/Spring Break camps do not qualify for the State

Assistance Childcare Program.

SUMMER DAY CAMP

The Joplin Family Y’s Summer Day Camp is a care and

activity program designed to provide a safe and nurturing

environment for children in elementary school on summer

break. Camp is held at the Joplin Family Y and includes daily

off-site activities. Camp is supervised by Joplin Family Y

staff. For safety and peace of mind, all members of our staff

are CPR certified and have undergone background checks.

Note: programming activities are subject to change.

PROCEDURES Children must be dropped off at the east door of Joplin

Family Y between 7 am – 7:30 am and picked up between 3

pm – 6 pm. Note: visit joplinfamiilyy.org website for any

changes/updates.

TIMES AND HOURS OF OPERATION Summer Break Camp is held Monday – Friday; its start and

end dates are based on the Joplin School District’s calendar.

DAILY SCHEDULE Each day’s activities and meals are determined prior to the

camp’s start.

Breakfast, lunch, and a “Fuel Up, Stay Fit” afternoon snack

are provided to all campers.

Kids will participate in daily enrichment and structured

physical activities.

3:20 pm Arrival Time

3:30 pm Combine Groups/Roll Call

4:00 pm Snack Time

4:30 pm Homework/Arts & Humanities/

Health, Wellness & Fitness

5:00 pm Outdoor Play/Indoor Activities

5:30 pm Homework assistance (time may

vary)

6:00 pm School Plus Closing Time

CARL JUNCTION SCHEDULE*

*Start time on Fridays accommodates the early dismissal time.

SUMMER SCHOOL PLUS EXTENSION

For children enrolled in summer school in Joplin, Carl Junction,

and Webb City, we provide an extension on our School Plus

program. Joplin students are bused to the Joplin Family Y for

care, Carl Junction students are cared for on-site, and Webb

City students are transported to Carterville Elementary School

for care. NOTE: This is subject to change, if transportation is

not offered by the school.

DVN NUMBERS

SCHOOL DVN NUMBER

Carl Junction 001994865

Carterville 002325817

Joplin Family Y 002825447

Revised 4/13/2021

SCHOOL AGE SERVICES POLICIES

All policies are final and without exception.

PAYMENT INFORMATION Each child is considered to have his/her own account, and

tuition is due IN ADVANCE for each child. If a parent has not

paid the fee, the child’s account will be considered unpaid,

resulting in the child not being able to attend. Services will be

suspended for accounts that become seven days past due.

We will not become involved in disputes with divorced or

separated parents as to who will pay the fee.

FEES

•No discounts will be given for partial weeks attended unless

we do not offer a full week of service.

•Every participant must also pay a non-refundable enrollment

fee due at the time of enrollment.

DRAFTED PAYMENTS Program payments for School Plus and Summer Day Camp are

made through weekly auto bank draft with credit or debit

card or through a checking or savings account. Auto-bank

drafts are processed at 9:00 am on Monday mornings,

regardless of bank holidays, unless the Joplin Family YMCA is

closed.

RETURNED-PAYMENT FEE If a bank or credit/debit card draft is returned or declined,

you will be notified immediately and will be assessed a $25

returned-payment fee, and your payment will be due

immediately. If you do not make your payment in full by close

of business on Friday, your child will be suspended from the

program until payment is made. If your child is suspended

from the program due to non-payment and you do not make

payment, you will be referred to a third-party collection

agency.

FINANCIAL ASSISTANCE

Financial Aid assistance is available. Please visit our

joplinfamilyy.org website for additional information. Families

who have received assistance previously must re-apply each

year. Parents are responsible for the balance owed after third

-party payments.

TAX STATEMENTS

End-of-year tax statements may be requested from the

Child Care Billing Office the last week of January. We

distribute tax information for the School Plus and Day

Camp Programs only. Your request can be made by

emailing [email protected].

ORIENTATION You will be oriented with the specific School Age Services

program when you register at the Joplin Family YMCA. You

will be asked to read through and sign the policies and fill out

an enrollment form. In addition to completing the

enrollment information, you will also need to supply us

with a copy of your child’s current immunization record.

LATE PICKUP FEE If a child is not picked up by 6:10 pm, a late fee will be

incurred. Additional late fees will be assessed every 10

minute increment thereafter. You will be emailed a late

pickup form along with the late fee amount via email.

ABANDONMENT After all attempts to contact parents and emergency contacts

have failed, a child who is not picked up by 7:00 pm will be

considered abandoned. The police department and the

Division of Family Services will be called.

SIGNING IN/OUT PROCEDURE It is mandatory that you or someone approved on your child’s

enrollment form sign your child out of the program each day.

A child may only be released to persons listed on the

enrollment form. Persons who do not regularly pick up your

child will be asked to show a picture ID. You also may be

asked for ID on occasion. Only individuals 16 years of age or

older may pick up a child from the program.

MEALS AND SNACKS Depending on the program, children may be provided a daily

breakfast, lunch, and/or a snack. Notify staff of any food

allergies. If your child does have food allergies, we will need a

doctor’s letter on file.

PARENT/GUARDIAN VISITATION Parents/guardians are welcome to visit School Age Services

programs at any time. We would love to have you share your

job skills or hobbies with us. Please contact the Joplin Family

Y if you wish to share your skills/hobbies during the program.

If at any time your visitation disrupts the program, you will

be asked to leave. Note: this is subject to change. Visit our

website at joplinfamilyy.org for any updates/changes.

Revised 4/13/2021

ILL CHILDREN

A child may NOT attend a School Age Services program if he/

she is experiencing any of the symptoms below:

•Fever of 100.4 degrees Fahrenheit or higher

•A rash that may be considered contagious

•Vomiting or diarrhea twice or more on the same day of the program

HEAD LICE (INCLUDING NITS OR EGGS) Children with head lice may not return until treated and upon our staff finding no evidence of eggs or lice. •Any other illness that is deemed contagious

Children who are suspected of having a contagious illness

SHALL NOT BE ACCEPTED INTO CARE. If a child becomes ill

while attending a School Age Services program, parents/

guardians are requested to come for their child at once.

Should the ill child have a fever of 100.4 degrees Fahrenheit

or above, or visible symptoms of an illness, the child will be

isolated from the other children and will be monitored by a

staff person until the parent/guardian arrives. Any neglect of

this policy may result in your child being permanently

released from the program.

MEDICATION POLICY Please list on your child’s enrollment form all medications

taken regularly. If an accident occurs, we will refer to their

enrollment form for taken medications and doses. As a

general rule, the School Age Services staff will not administer

medications unless absolutely necessary and required by the

doctor to be given during programming.

The medication must be in its original container, with the

pharmacist’s label marked with the prescription name, date,

child’s name, and physician’s name. (Your pharmacist will

provide an additional container for this purpose.)

At the end of the medication period, parents should take

home any unused medication. The School Plus Program is

separate from the school. We cannot accept or assume

instructions from the school concerning medication, ONLY

FROM YOU. The School Age Services department reserves

the right to refuse to administer medication to children in

our program; it is ultimately the parents’ responsibility to

ensure children receive their medication.

MEDIIA RELEASE

Child in our program may have opportunities to be

involved in media cover and/or photos demonstrating their

social skills and team building in the community.

RELEASE AND WAIVER OF LIBILITY HEREBY RELEASES WAIVES, DISCHARGES AND COVENANTS

NOT TO SUE the YMCA, its directors, officers, employees, and

agents; releases from all liability to the undersigned, his

personal representative, assigns, heirs, and next of kin for

any loss or damage, and any claim or demands thereof on

account of illness/injury to the person or property or

resulting in death of the undersigned, whether caused by the

negligence of the releases or otherwise.

ACCIDENTS The Joplin Family YMCA is not responsible for any injury

incurred while children are at any School Age Services

program. Parents/guardians will assume responsibility for all

medical costs while their children are attending Joplin Family

YMCA programs.

SPECIAL CARE PLANS If your child has special needs as defined by the Missouri

Department of Health and Senior Services, you will be required

to complete a Specialized Care Plan. All YMCA child care

programs try to accommodate children’s needs as much as

possible; unfortunately, there are times our programs cannot

meet the needs of all children. In such cases we will be glad to

offer suggestions for appropriate care through other

providers.

CHILD CUSTODY CASES, FOSTER CARE In a situation where one or both parents are prohibited by law

from having contact with their child, the custodial parent/court

-appointed guardian must present legal documents (e.g.

custodial order, ex parte order, etc.) informing us of the

situation. The Joplin Family Y cannot refuse a parent the right

to pick his/her child up if that parent is listed on the

enrollment form unless we have received legal documents

prohibiting that parent from having contact with the child.

BEHAVIOR MANAGEMENT AND DISCHARGE POLICY A write-up will be used any time a situation has occurred with

a child in which behavior has disrupted the program, harmed or

potentially harmed any child involved, or has caused concern

from staff that the behavior could serve to diminish the

program. The first write-up will serve as a warning to the

student and will be discussed with the parent/guardian. A

second write-up may result in a 1- to 5-day suspension from

the program. A third write-up may result in discharge from the

program until the following school year. Parents are not

allowed to employee Y staff for babysitting while their child is

in the program. IF A SEVERE BEHAVIOR INCIDENT OCCURS,

YOUR CHILD MAY BE SUSPENDED OR DISCHARGED

IMMEDIATELY.

ANTI-VIOLENCE The Joplin Family YMCA makes every effort to ensure the

safety of all children. That is why we will not tolerate any

violent or aggressive behavior. Bringing any potentially

dangerous objects to the program (knives, smoke bombs,

firecrackers, guns, etc.) is strictly prohibited.

You may schedule an appointment with the Director of School

Age Services at any time to discuss any issue relevant to your

child’s progress in the program.

PERSONAL PROPERTY The Joplin Family YMCA is not responsible for any personal

property brought to our programs. Please label your child’s

belongings. If any property is brought to a program site that

may cause a disruption, you will be asked to remove the

property.

section for child care regulation

Documents