Membership Enrollment Contract

Overview:

The SOUTHSIDE YOUTH SENTER offers after-school, holiday and summer programs for youth ages 5-15. We incorporate education with athletic activities and provide a safe, supervised setting at a reasonable fee. During our after-school program youth may participate in various athletic activities, homework help center, reading activities, arts and crafts, fitness challenge, family rated movies and more.

Mission:

The Mission of the Southside Youth Senter is to provide a safe, supervised setting where youth and children can develop character and social skills in an educational yet fun environment, to aid students of all backgrounds, culture, and gender, to develop self-esteem, discipline, and respect for their community. Our motto is “where children live what they learn” with an emphasis on developing an understanding and respect for diversity while building lifelong friendships along the way.

Daily Activities:

We schedule our daily activities so each child has an opportunity to play, learn and experience lots of positive interaction with both staff and other children. Our small group activities include homework help, arts & crafts, drama, group games, cooking, music, science, animal care, puppetry and more. Our large group time will be spent either playing games, singing songs, going to area parks, sports and local field trips. Please be sure your child has a water bottle or jug for when we go to area parks to play so they may stay hydrated better. Our goal is for your child to have a great time here, make and strengthen friendships, learn leadership, responsibility and skills they can take with them the rest of their lives. If there are any activities you’d like to see us do or you’d like to help us with, just stop in and talk with our either our Program Director or Executive Director.

Kids Cafe:

As a partner with the Wichita Falls Food Bank we will be serving dinner at our facility Monday through Friday of each week to anyone who comes through our door and is between the ages of 0 and 18 yrs. The meal will be provided by the Food Bank and our serving hour will be 4:15pm – 5:00pm each day. If you are interested in learning more about this program feel free to stop in and ask.

Program Fees:

Childcare fees need to be paid as agreed in order that Southside Youth Senter (SYS) maintains an operating budget for its programs. Also, your timely payments of fees are documented and can be used as a tax credit. You are required to pay fees as specified in your service agreement.

Child Care Fees
Fiscal Year 2019

After-School Van Pickup- $50.00 Weekly

After-School Southern Hills Elementary- $35.00 Weekly

After-School (parent drop off)- $35.00 Weekly

Drop-In Care Service (Holidays/Breaks)- $25.00 per Day*

Summer Program- $75.00 Weekly per child

Note: There is a $5.00 discount per sibling. Due to availability of slots for members requiring pickup from local schools and Southern Hills Elementary pickup, fees are not subject to the number of days a member attends. (Example: Registered member fees are due weekly even if the member does not attend)

* Days of care for drop-in care are subject to the availability of the center as a result of the total enrollment in the child’s particular group.

Closed Days

Independence Day
Labor Day
Thanksgiving Day
Day after Thanksgiving
Christmas Eve
Christmas Day
New Year’s Eve
New Year’s Day
Memorial Day

*See the front office for particular dates and or for an updated Calendar.

Holidays that fall on Saturday, the center will close on Friday, and any holiday that fall on Sunday, the center will close on Monday.

Registration Fee
There is a $10.00 fee for registration or re-registration. There may be additional activity and or registration fees for the Summer Camp. THESE FEES ARE NON-REFUNDABLE.

Late Pickup Fee
You are responsible for insuring that your child is picked up by the time indicated on your service agreement.
After 6:00 pm, you will be charged $1 per minute until your child is picked up.

Late Fees
If your fees are not paid by the end of the service period, you will be charged a late fee of $10. Once you have accumulated 3 late payments your child care service will be suspended until your balance is paid in full.

Returned Checks
You will be charged $25.00 if your check is returned by the bank for any reason. If there are two non-sufficient checks, you will be required to pay future payments using money orders.

Incentives
A parent who volunteers 5 hours in a classroom will be entered into the i-parent involvement quarterly drawing. A parent who pays childcare fees on time for four consecutive months will be entered into a quarterly drawing.

Scholarship Assistance
Need based scholarship assistance may be available depending upon funding. Please contact the Executive Director for more information.

Fee Payments
Your fee payment is due on or before the first service day in each week, and will be considered late if it is not paid. If you owe more than one-week back fees, service for your child will no longer be provided until you pay all past and current fees. If you incur financial difficulties, speak to the Executive Director.

Payment
Payment of fees may be made by automatic weekly payments via the Automated Clearing House (ACH), personal check, money order, cash or credit/debit card. Checks and money orders should be made payable to “SYS” or “Southside Youth Senter”. All checks must have your children(s) full name (s) bottom left corner of check. If you have any questions, please seek the assistance from the front office.

Record of Payment
A statement of your account is available upon request. Receipts are issued upon request.

Tax Documentation
At the end of each January, parents will receive an accounting of their childcare fees along with our EIN (Employer’s Identification Number).

Re-enrollment
All re-enrollments cannot be processed if there are unpaid fees from a previous enrollment. Unpaid fees must be satisfied prior to enrollment.

Absence or Withdrawal Notification
If your child is absent for any reason, notify SYS immediately. Two weeks’ advance notice is required if you intend to withdraw your child from care.

Workforce Solutions Childcare Services

Workforce Solutions Childcare Services Parent Fees
Fees for parents receiving subsidized care are set by the Workforce Solutions Childcare Services. We do not set these fees nor do we have the ability to change them.

Parents Receiving Workforce Solutions Childcare Services Subsidy
Your fee is due on the first service day of each week and will be considered late if it is not paid. We are required to notify Workforce Solutions Childcare Services whenever your fee is delinquent. Workforce Solutions Childcare Services will mail you a written notice terminating service in ten (10) calendar days unless the delinquent fee is paid. You have the right to appeal this adverse action terminating service with the enrolling Workforce Solutions Childcare.

If, during one year’s eligibility, you have been sent three (3) written notices of termination due to delinquent fees, and have paid the delinquent fees prior to service termination, at the time of the third delinquent payment, the Workforce Solutions Childcare Services may initiate action to terminate your service on the basis of habitual delinquency in fee payment.

Workforce Solutions Childcare Services Parent Attendance Policies
Your child is expected to attend the SYS program on all days for which you agreed that the child needed care. Those days are specified in writing on the Workforce Solutions Childcare Services authorization form. CCIS will not pay for a child whose absence exceeds five (5) consecutive service days. If this happens, we are required to notify CCIS. CCIS will then mail you a notice terminating service if your child does not return to care within the next five (5) service days. If you disagree with this adverse action terminating your child care service, then you must address it with CCIS. We have the right to request transfer of service for the disregard of our policies as stated in the parent handbook.

Non-Reimbursable Fees
Childcare cost not reimbursed by Workforce Solutions Childcare Services, is to be paid by the enrolling parent/guardian which will be reflected in the written fee agreement. Fees are due each Monday.

Membership Enrollment Contract

Must be printed by director and signed by parent after completion to be valid.

Enrollment Information
Program*
Please select all that apply.
- After- School Pick Up $50.00 per week
- After-School Drop-Off $35.00 per week
- Southern Hills Elementary $35.00 per week
- Summer Program $75.00 per week
Member Information*
Please list all children being registered under this agreement.
Child's Name Age Date of Birth Gender Tshirt size
School Name and Phone Number
Grade
Primary Contact*
This must be a contact other than primary guardian/s listed above.
First Last Relationship to Child
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Cell Phone
Employer*

If unemployed list N/A
Business Phone
Primary Contact Email*
Secondary Contact
First Last Relationship to Child
Home Phone
Cell Phone
Employer

If unemployed list N/A
Business Phone
Secondary Contact Email
Emergency Contacts*
Name Relationship to Child Phone

Please list at least 2 emergency contacts.
Pick Up List
First Name Last Name Relationship to Child

Other than Primary and Secondary Contacts, only those listed below will be allowed to pick up the above child/children.
Medical Information
Primary Care Provider Name*
Primary Care Provider Phone Number*
Primary Care Provider Address*
Does your family have health and/or accident insurance?*
- Yes
- No
Does child have any serious health problems?*
Please include allergies.
- Yes
- No
If yes, please explain
Does child currently take any medications of which we should be aware of?*
- Yes
- No
If yes, please explain
Lunch/ Snack Policy*
During our after school program, youth will receive a meal from Kid’s Café. Anytime your child will be at our facility through the lunch hour, please be sure to pack a nonperishable lunch with a drink for your child. Please do not pack anything that requires being heated up if at all possible. You are responsible for providing your child with a lunch. During any of our all day programs, parents must provide child’s morning/afternoon snacks.
I understand the meal policy.
Club Rules*
1. Respect your building and don’t run inside!
2. Respect others by refraining from personal contact between members (hitting, kicking, pulling hair, biting, kissing, hugging, etc.)
3. Respect your staff by speaking appropriately, no talking back and not striking any staff member in an aggressive manner.
4. No throwing items.
5. Respect everyone by not calling them names or using profane or inappropriate language of any sort.
6. Alcohol, drugs and/or tobacco use is prohibited. Weapons of any kind (including toys) are not allowed on the premises.
7. Ask and receive permission before entering the cubby area.***
8. Please. Dispose of all trash appropriately and responsibly.
9. Respect others and ask before you borrow something that is not yours.
10. Absolutely no fighting of any sort!!

***The SOUTHSIDE YOUTH SENTER provides cubbies for storage of members’ personal items to prevent lost or stolen articles. Members are not allowed in the cubby area without staff approval.
I have reviewed and discussed the club rules with my child/children.
Discipline Policy*
Discipline is essential to provide a safe, yet fun environment for everyone to enjoy. Without discipline, chaos will ensue and be counter-productive to our goal, which is to aid members in the development of social interaction and life skills.
1. 1st Offense: Verbal warning
2. 2nd Offense: Written warning and incident report. Staff will separate member from group or activity and administer an alternate activity such as trash duty, cleaning, writing sentences, etc.
3. 3rd Offense: Member will be sent to Director's (Program or Executive) Office at which time members will be counseled and parents will be contacted to discuss the situation. The severity of the offense could lead to a 3-day suspension.
4. 4th Offense: If the parent is receiving multiple phone calls regarding his/her child, a meeting will be set to discuss other courses of action for the member. Child could be suspended for a minimum of one week, or terminated from program.
5. STRIKING STAFF OR FIGHTING IS NOT ALLOWED AT ANY TIME! If a member is caught fighting, parent/guardian will be called and asked to pick up his/her child. A minimum of a 3 days suspension and or program termination may be necessary depending on the severity of the infraction. This will be discussed with the parent on an individual basis when the parent arrives at the facility to pick up the child.
While program staff have authority to discipline a member, Suspensions and Membership Terminations are at the discretion of the Executive Director.
I have reviewed and discussed the disciple policy with my child/children
Program Fees*
I have read the entire program fees listed at the top of this contract and understand that weekly fees are to be paid whether or not my child attends, except for when SYS is closed. No fee deduction is provided for emergency closings, legal holidays or vacations. I understand that I am not permitted to temporarily drop my child from service for a period of one or more weeks and then re-enter my child, without prior approval from a Director.

I/we have read this contract between myself and Southside Youth Senter. I/we agree to pay the required weekly fee by Monday of each week.

If my child attends the SYS Summer Program. I understand any field trip or special event fees are additional and payment in full is required for my child to participate.

In the event I fall behind on my child’s fees for the Afterschool and/or Summer Programs, I understand that my child’s spot could be filled and he/she may not have an available spot when he/she wants to return. I further understand that if I have an outstanding balance of more than two weeks my child will not be allowed to participate in any SYS programs until all accounts are current or payment arrangements have been made.

I have read and agree to adhere to the programs fees.
Insurance Disclaimer and Permission Statement*
In consideration of my child’s membership and participation in the Southside Youth Senter (a.k.a. the “Senter”), I, as parent/guardian of named minor, do hereby release the Senter from all liability to me, my child and my child’s personal representatives, assigns and heirs for all claims and damages which my child or I may have against the Senter and/or its Board resulting from participation in or connection to a Senter-related activity.
I hereby authorize the Senter, as my agent. To secure medical treatment as is deemed necessary and will, on behalf of said minor, assume and pay all expenses associated with such treatments in the event of accident, illness or other incapacity.
I will ensure that my child will comply with the behavioral rules listed in this packet. I acknowledge that failure by my child to follow Senter rules could result in his/her suspension from ALL Senter program and events.
I permit the Senter to utilize photographs of my child taken of his/her involvement in Senter programs for public relations purposes and hereby waive all rights of compensation for said use.
I /we have received and read the information pertaining to my child’s participation in the Southside Senter Program. I understand that use of technology (computers) is a part of the Southside Youth Senter Programming, and I hereby give my permission to Southside Youth Senter and its employees to create profiles/ login credentials on all web based and installed software programs Southside Youth Senter uses to enhance my children's learning and life. I also understand that water play activities may be scheduled at Southside Youth Senter during the Summer Programs, and permit my child to participate in these activities. I authorize my child to be transported on Southside Youth Senter owned vehicles for the purposes of after school pick up and field trips. I agree to hold my child and myself responsible for upholding the policies, rules and regulations set forth by the Southside Youth Senter as an active member and participant.
I understand that the Senter is a licensed day care provider and that day care licensing does regulate and pertains to the Senter‘s operation. I realize it is my responsibility to be familiar with Senter program hours and make arrangements for my child to be picked up by closing time. If my child is not picked up on time, I understand a late fee will be charged to me.

I agree to Insurance Disclaimer and Permission Statement
Parent/Legal Guardian*
I attest that I am the parent/ legal guardian of all children listed on this contract.
Today's Date*
MM slash DD slash YYYY