TOGETHER WE CARE

ASES Parent Handbook 2012-2013 Lompoc Family YMCA A branch of the Channel Islands YMCA 805.736.3483

Ciymca.org

IT’S NOT JUST KID’S STUFF The Y is a diverse organization of men, women, and children joined together by a shared commitment to nurturing the potential of kids; promoting healthy living and fostering a sense of social responsibility. TABLE OF CONTENTS

Channel Islands Mission Statement Character Counts!

40 Developmental Assets Welcome to ASES Program Goal and Description page 3 page 4 ASES Staff Baby Sitting Ratio Days and Hours of Operation Enrollmentand Registration page 5 Parent Involvement Attendance, Absence, and Early Release Student Pick Up Student Behavior and Expectations page 6 Emergency Card Illness Injury page 7 Medication Child abuse or Neglect or Special Needs Nutrition Causes of Termination Lost and Found Photo Release Program Concerns page 8 Site Locations Contact Information Thank You

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CHANNEL ISLANDS YMCA MISSION STATEMENT

The Channel Islands YMCA is a charitable organization providing programs based upon Christian principles to men, women, and children of all ages, races, religious beliefs, and economic status, to develop and enrich the spirit, mind, and body.

CHARACTER COUNTS!

The Channel Islands YMCA promotes the Character Development Program designed by The Josephsen Institute. By implementing "Character Counts", we focus on Caring, Fairness, Respect, Responsibility, Trustworthiness, and Citizenship. The Afterschool Care Staff will use these values in planning their curriculum. For more information visit charactercounts.org.

Trustworthiness:

Being honest, dependable & loyal.

Respect:

Living the Golden Rule, accepting others, showing courtesy and manners.

Responsibility:

Being accountable, doing one’s best.

Fairness:

Playing by the rules, treating everyone fair & equal.

Caring:

Being kind, compassionate & understanding, showing love and charity to others.

Citizenship:

Respecting authority, obeying the rules, protecting the environment.

40 DEVELOPMENTAL ASSETS

The YMCA uses the Search Institute's 40 Developmental Asset Model to measure the success of our youth and teen programs. Through extensive research the Search Institute of Minneapolis has identified 40 positive experiences and qualities - "developmental assets" - that all youth and teens need to become healthy, contributing adults - assets like adult role models, high expectations, and safety. Ideally all youth and teens should experience at least 31 of the 40 developmental assets; however, current national studies show that most youth experience less than 20.

YMCA programs are designed to help fill the gap and give youth and teens the assets they need to succeed. Search-institute.org. WELCOME TO ASES

Dear Families, Welcome to the Lompoc Unified School District/Family YMCA Education and Safety Program (ASES). ASES is committed to providing a safe place for students to experience academic support, enrichment in arts, physical education, and other enrichment activities. The program is supported by a state grant and community partners. This handbook is a comprehensive guide to understanding the ASES program. Please read this handbook in its entirety and become familiar with its contents. As a participant in this program, you will be responsible to follow program policies. Failure to comply with the policies stated in this handbook may result in the termination of current or future enrollment in the ASES program. After you read this handbook, please feel free to contact our staff to discuss the contents or answer questions. We believe that the family is a vital part of our community and that parent involvement is essential to student success. This handbook is the first step in your participation in the ASES program and we encourage you to become involved in the after school community. We hope your child’s participation in our program will be beneficial to his/her overall development and school performance. Our goal is to give students and their families the support they need to succeed in school and in life.

Sincerely, After School Education and Safety Program Team 3

CHANNEL ISLANDS YMCA MISSION STATEMENT

The Channel Islands YMCA is a charitable organization providing programs based upon Christian principles to men, women, and children of all ages, races, religious beliefs, and economic status, to develop and enrich the spirit, mind, and body.

CHARACTER COUNTS!

The Channel Islands YMCA promotes the Character Development Program designed by The Josephsen Institute. By implementing "Character Counts", we focus on Caring, Fairness, Respect, Responsibility, Trustworthiness, and Citizenship. The Afterschool Care Staff will use these values in planning their curriculum. For more information visit charactercounts.org.

Trustworthiness:

Being honest, dependable & loyal.

Respect:

Living the Golden Rule, accepting others, showing courtesy and manners.

Responsibility:

Being accountable, doing one’s best.

Fairness:

Playing by the rules, treating everyone fair & equal.

Caring:

Being kind, compassionate & understanding, showing love and charity to others.

Citizenship:

Respecting authority, obeying the rules, protecting the environment.

40 DEVELOPMENTAL ASSETS

The YMCA uses the Search Institute's 40 Developmental Asset Model to measure the success of our youth and teen programs. Through extensive research the Search Institute of Minneapolis has identified 40 positive experiences and qualities - "developmental assets" - that all youth and teens need to become healthy, contributing adults - assets like adult role models, high expectations, and safety. Ideally all youth and teens should experience at least 31 of the 40 developmental assets; however, current national studies show that most youth experience less than 20.

YMCA programs are designed to help fill the gap and give youth and teens the assets they need to succeed. Search-institute.org. WELCOME TO ASES

Dear Families, Welcome to the Lompoc Unified School District/Family YMCA Education and Safety Program (ASES). ASES is committed to providing a safe place for students to experience academic support, enrichment in arts, physical education, and other enrichment activities. The program is supported by a state grant and community partners. This handbook is a comprehensive guide to understanding the ASES program. Please read this handbook in its entirety and become familiar with its contents. As a participant in this program, you will be responsible to follow program policies. Failure to comply with the policies stated in this handbook may result in the termination of current or future enrollment in the ASES program. After you read this handbook, please feel free to contact our staff to discuss the contents or answer questions. We believe that the family is a vital part of our community and that parent involvement is essential to student success. This handbook is the first step in your participation in the ASES program and we encourage you to become involved in the after school community. We hope your child’s participation in our program will be beneficial to his/her overall development and school performance. Our goal is to give students and their families the support they need to succeed in school and in life.

Sincerely, After School Education and Safety Program Team 4

PROGRAM GOAL AND DESCRIPTION

It is the after school program’s goal that students improve academically, emotionally, and socially through community, academic, recreation, and enrichment activities.

The ASES Program is a state funded education and enrichment program designed to provide school age children with a safe environment after the regular school day ends. Students will participate in academic tutoring, homework assistance, leadership training, and enrichments in the arts, academics, and recreation. Enrollment and tuition are free of cost. This program is available to all students and targets those that are at risk of academic failure and/or have financial needs.

The program consists of two elements, a literacy component and an educational enrichment component. We coordinate with regular day teachers and administration to integrate these components with the school’s curriculum, instruction, learning support activities and behavior policies.

The educational and literacy component provide tutoring, monitoring and/or homework assistance in language arts, mathematics, history, and social science, and/or science [California Education Code (EC) Section 842.3© (1)].Students are organized into grade level groups of approximately 20 children supervised by 2 staff members whenever possible.

The educational enrichment component may include but not limited to, recreation and prevention activities, [EC Section 842.3©(2)]. Such activities might involve the visual and performing art, music, physical activity, health promotion, general recreation, career awareness, and work preparation activities, community service-learning, and other youth development activities, based on students’ needs and interests.

This program is NOT a “baby-sitting” or “child care” service, and is viewed as an extension of the school day. Activities are held in the classrooms, the computer lab, library, multi-purpose room and on the playing field. Occasionally activities will take

ASES STAFF

The ASES staff at each site consists of the program coordinator and the proper amount of activity leaders to ensure the maintaining of a student to staff ratio of no more than 20 to 1ratio. All staff meets the instructional aide qualifications established by the district (EC Section 8483.4) All have cleared fingerprint clearance and are certified in CPR, AED, First-Aid, and Child Abuse Prevention. They have had a successful experience working with children and have been trained by YMCA Directors and are looking forward to getting to know your family.

BABYSITTING

YMCA staff shall not socialize with children enrolled in YMCA programs outside of approved YMCA activities,

including babysitting or transporting children

. Immediate disciplinary action will be taken by the YMCA toward YMCA staff if a violation is discovered.

PLEASE DO NOT ASK STAFF TO BABYSIT!

RATIO

Due to regulation of the ASES. program, we are required to maintain at least a 1:20 ratio at all times. The Channel Islands YMCA does not provide one-on-one aides for children with special needs. If an aide is necessary the parent may provide one.

HOURS AND DAYS OF OPERATION

Program operates from school dismissal until 6:00 pm., including scheduled half days. We are closed on teacher workdays and legal holidays. Annual calendars are available from your site coordinator.

During holidays The Lompoc Family YMCA offers camps on the following dates for an extra fee:

Winter Camp I:

December 10 th -14th

Winter Camp II: Winter Camp III:

December 17 th -21 st December 22 nd - 28

Winter Camp IV:

December 31 st -January 4 th

Spring Camp:

March 29 th - April 5 th th * * 5

ENROLLMENT AND REGISTRATION

Elementary enrollment to the ASES Program is assessed after the completion of the application and teacher referral. Students are enrolled on the basis of academic need. Those with the greatest need will be enrolled first. Enrollment is limited to space available. Placement priority will be given to students who attend the program daily (EC Section 8483). Enrollment may be terminated at any time due to lack of funds or non-compliance to rules and policies. You may discontinue your child’s enrollment at any time; however, one week’s notice is requested.

Registration forms are required, pick them up at your schools front office.

Updated Information:

Providing updated information to the YMCA and or School is the responsibility of the parent and must be made immediately at the time of change.

PARENT INVOLVEMENT

The YMCA recognizes that parents are the most important people in a child’s life. Because parents are #1 in importance, they are also #1 in the ability to influence and motivate their children. We welcome your advice, participation and support. The YMCA allows for parent visitation at any time. In addition, parents are also encouraged to participate in our many volunteer opportunities. From advisory boards to campaigners, the YMCA recognizes the importance of volunteers. Contact the Program Director for more information on ways in which you can volunteer.

ATTENDANCE, ABSENCES, EARLY RELEASE

Daily attendance is mandatory for elementary students. The ASES Program is a state funded, tuition free program. Students are required to attend a minimum of 3 hours each day, Monday through Friday.

Why Attendance Policy?

The grant that funds the ASES program sets this strict attendance policy. We receive funds based on the number of students who attend the required three hours each day. To maintain our funding and the quality of the program, participants must follow the attendance policy. In addition, there is usually a waiting list of families who want to participate in the program and are willing to follow all policies. A student with irregular attendance occupies a space that another student could fill.

Absence or Early Release:

If your student is absent, please contact the site coordinator or leave a message with your child’s school. Students may be released for participation in activities with grant collaborative partners such as: sports, arts, music, enrichment activities, field trips, or tutoring. Students may be released for medical or religious purposes. Students may not be releases or leave program without a permission slip indicating student name, activity or specific reason they are leaving the program earlier then required. (Ed Code 8483, Board Policy AR 5148.2).

Extended Absences:

It is understandable that unpredicted, unavoidable, extended absences occur. In this case, arrangements can be made with site coordinator on a student-by-student basis.

STUDENT PICK UP

Students may be picked up after 5:15 p.m. no less than 3 hours of attendance, but no later than 6:00 pm at all elementary school sites. Students must be signed out before going home by parent or person approved by the parent. Elementary Students can only be signed out by a parent, legal guardian, or by a person listed on the child’s “Authorized Release” list located on their emergency form. Parent’s initials and time of pick up are required on sign-out sheet. No one under 18 years of age may sign a child out, unless pre approval of site coordinator. Please be sure to include all adults you trust to pick up your child and that their phone numbers are accurate, up to date, and in service when filling out the Authorized Release list to avoid any problems. Staff will strictly enforce these rules for the safety of your child. Any pick-up person may be asked to show identification to a staff member. Students who leave by themselves or go home without permission will receive an unexcused absence, a note home and 6 may result in termination from the ASES Program.

STUDENT BEHAVIOR AND EXPECTATION

It is the goal of our YMCA to provide a healthy, safe and secure environment for all participants. Children attending ASES are expected to exhibit Character Counts values, follow basic behavior guidelines and to interact appropriately in a group setting.

Discipline is viewed by our staff as a teaching opportunity. Our goal is to teach children the kind of self –control that results in appropriate, and cooperative behavior. Redirection is the first logical step to behavior management. Should a problem persist, natural consequences and removal from the activity will be used as a form of discipline. In the event that chronic behavior problems develop, incidents will be documented and communicated to the parent. The following behaviors are unacceptable and may result in the immediate suspension of a child for the remainder of the current day and/or further time period: • • • • • • • Endangering or threatening to endanger the health and safety of others, self, children, staff or volunteers.

Stealing or damaging YMCA, host site, or personal property.

Leaving the program or boundaries as set by staff without permission.

Continuous disruption of the program.

Refusal to follow the behavior guidelines of the program.

Using profanity, vulgarity or obscenities.

Acting in a lewd manner.

While the before mentioned is the general outline of behavior procedures, the YMCA reserves the right to ask parents to find alternative arrangements for their child without prior notification, as deemed necessary for the safety of staff and/or program participants, not limited to the before mentioned behaviors.

Immediate expulsion may occur if a child is in possession of and/or using tobacco, alcohol, illegal drugs, firearms, knives, explosives or any other weapon.

Be Safe

Use safe, non-violent, actions at all times.

Be Respectful

Be respectful of others and obey all school personnel Use appropriate and polite language at all times Be respectful of school and personal property

Students who violate ASES Program Behavioral Expectations will receive the following consequences: 1 st Incident

: Behavior Report sent home, copy of report filed in student’s records, school teacher notified, and parents notified.

2 nd Incident

: Behavior report sent home, copy of report filed in student’s records, school teacher notified, parents notified, and 1 week suspension from ASES Program.

3 rd Incident

: Behavior report sent home, copy of report filed in student’s records, school teacher notified, parents notified, and child expelled from the ASES Program.

•

EMERGENCY CARE CARD

The ASES program Emergency Card is the most important piece of information you provide to the staff. Your child safety and well-being depend on it. It must be accurate and up-to-date at all times. If your child becomes suddenly ill or has an accident at school, the staff will use the information on the Emergency card to call you or your designated contact person. Remember: • Names on the Emergency card must be persons you trust to pick up your child in an emergency.

• Designated persons must be adults over 18 years of age.

• Phone numbers must be accurate, up-to-date and in service.

• Please submit all pager numbers and cell phone numbers as well.

• If changes in your Emergency information occur during the year, please take the time to update your card and inform the staff. Names may be added or removed at any time.

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ILLNESS

and hearing of staff, until the parent arrives. If the parent cannot be reached, the staff will phone the emergency contact person(s) listed on the child’s enrollment form. The YMCA is not licensed to provide care for sick children. Parents or emergency contacts are required to pick up the ill child within one hour of being contacted.

The Site Coordinator or designated staff have the authority to ask a parent to remove their child from the program, if that child appears ill or their health is judged to be detrimental to the other children and staff.

Children exhibiting the following symptoms may not attend the program: • Severe pain • • • • • Temperature over 100 Diarrhea Blood in urine Swollen joints Jaundiced skin, yellow eyes or red eyes with • • • • discharge Visibly enlarged lymph nodes 2 or more episodes of vomiting in a 24 hours Infected/untreated skin patches or rash lasting more than one day Evidence of head lice or nits

INJURIES

All injuries will be treated as needed, including washing, applying Band-Aids or ice packs. Parents/ Guardians will be notified upon pick up, and given an “ouch report” explaining the details and aid given. Please note, in accordance with sanitation and state regulations, YMCA staff cannot administer any cream ointment or anti-bacterial solutions. Parents/ Guardians will be contacted immediately in the case of more serious injuries, in which medical attention is needed.

MEDICATION

You must provide staff with a completed signed medication form when your child is taking any medication. This form is available in the school office.

CHILD ABUSE, NEGLECT, AND SPECIAL NEEDS

The State of California considers all ASES Program Staff “Mandated Reporters.” This requires the staff to report any and all cases of suspected child abuse. All staff are trained in child abuse awareness. Program staffs have been screened through the department of Justice and Child Abuse Index.

Channel Islands YMCA will accept children with special needs into our programs and makes a reasonable effort to accommodate the child without fundamentally altering the child care program. The Channel Islands YMCA provides group child care and is not able to provide personal assistants for children with special needs. If a child needs an aide please contact the program director for directions in placing an assistant in our program to aide your child.

NUTRITION

As part of the National Lunch Program, all ASES participants will receive a free afternoon snack. This snack includes two of the four basic food groups. Cooking projects may accompany the daily snack, as well as provide opportunities for nutritional education. If you provide your child with a snack from home, we ask that it be a nutritious snack such as apples, peanut butter, juice, oranges, cheese and crackers, ½ sandwiches. Unhealthy snacks are not allowed.

If your child has any dietary restriction or allergies, please contact the program coordinator so an alternative snack may be provided. Be sure to include it on the student’s emergency card.

Please do not send fast food, soda or candy!

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PHOTO RELEASE

The Channel Islands YMCA may take photos, videos or sound recordings of your children in our childcare programs. We often use them for crafts or projects. The YMCA is not required to contact you regarding using photos.

Emergency/Natural Disaster Plan

In the event a natural disaster occurs, our goal is to keep children safe and calm. The staff will determine the safest plan of action. The Site Coordinator will always keep the children’s emergency information with them at all times. Our designated area of safety in the event we need to evacuate the facility is the grass field located on each school’s campus. You may want to consider making arrangements for a friend or relative who works or lives close to the YMCA to pick up your child in case of a disaster. Their names must be included on the emergency contact list on your Emergency/Health Information Form. Remember, they must have a Photo ID and they must be at least 18 years old. It is also a good idea to have an out of state contact to call in case of a natural disaster.

CAUSE FOR TERMINATION

The following is a review of reasons for which a student’s enrollment may be terminated.: 1. Lack of program funds.

2. Determinations the student’s needs are not being met by program after appropriate accommodations are made.

3. More than 3 unexcused absences.

4. More than 3 late pick-ups.

5. Three “incidents” on the Behavior Incident Expectations Report.

6. Student behavior that threatens the health and safety of students or staff. 7. Non-compliance to rules & policies parents or students 8. Abusive language or treatment of staff by parents or students.

Often out of state phone lines are still active in the event of a local disaster. Remember, making plans prior to emergencies can expedite the safe release of your child.

Site closure due to a natural disaster is at the discretion of the Program Directors, or the Executive Director. If questionable situations arise, please call the Lompoc Family YMCA at 805.736.3483.

SITE LOCATIONS

The Lompoc Family YMCA and Boy’s and Girl’s Club operate ASES programs at the following local schools: La Honda Elementary 1213 North ‘A’ Street, LO 93436 805.742.2300

Lompoc Family YMCA PROGRAM CONCERNS OR QUESTIONS

The YMCA encourages constant communication between parents, staff, and children to assure everyone’s needs are being met. If you should ever have a problem, concern or question, we encourage you to ask you’re ASES staff. Should they not be able to meet your needs, please contact the Program Director at the main YMCA facility. It is through your input that we are better able to meet the needs of the community and enhance the quality of our programs.

THANK YOU!

We are happy that you have selected the ASES Program for your child. We offer days filled with happiness, wonderful activities and educational fun. We thank you for sharing your child with us.

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EMERGENCY/HEALTH INFORMATION HISTORY FORM

General Information

(Please print) Child’s Name: ______________________________________________Age __________ M______F_____ Grade in Sept ’12_____________ Address: ___________________________________________________City ____________________________________Zip _______________________ Home Phone: _________________________________ School: ______________________________ Birthday: _____/______/_____ Father’s Name ___________________________________________________________ Father’s Birthday: ________/_________/__________ Father’s Work Phone_____________________________________ Father’s Cell Phone _________________________________ _________ Father’s E-Mail Address_________________________________ Mother’s E-Mail Address____________________________________ Mother’s Name_________________________________________________________ Mother’s Birthday: _________/_________/___________ Female head of household Mother’s Work Phone_____________________________________ Mother’s Cell Phone _________________________________________ Child lives with __________________________________________________ _____________________________________ Relationship

Please attach copies of any legal documentation regarding non-custodial parents Health Information

Has your child had any serious or severe illnesses or accidents in the last 3 years? Yes No If yes, explain ____________________________________________________________________________________ ____________________________ Does the child take any medication during the day? Yes No If yes,

Medication Release Form is required

. Please list medications: ___________________________________________ Allergies? Yes No If yes, list: ____________________________________________________________________________________ _ Please check all immunizations which are current: POLIO DTP MMR HIB HEB A HEB B Special needs or fears? Yes No If yes, explain:___________________________________________________________ CHICKEN POX Physician: ___________________________________________ Phone: _____________________________ Dentist : ___________________________________________ Phone: _____________________________ Insurance Co: ___________________________________________________________ Group #: __________________________________________

Emergency Contacts/ Authorized Pick-Up

(In addition to Parents) Name: _____________________________ Phone: ____________________ Relationship: _______________ Name: _____________________________ Phone: ____________________ Relationship: _______________ Name: _____________________________ Phone: ____________________ Relationship: _______________ Name: _____________________________ Phone: ____________________ Relationship: _______________ 10

Walking Fieldtrip permission, Consent to Treatment and Release, Child’s Health Statement, Photographic Release, and Insurance Disclaimer

Child’s Name (Please Print) ______________________________________________

PERMISSION FOR FIELDTRIPS, WALKING FIELDTRIPS, WALKING EXCURSIONS, AND USE OF PUBLIC PARK FACILITIES

I hereby give consent to the Channel Islands YMCA and its designated leaders to take the above named child on walking trips in the neighborhood, public park facilities, special excursions to places of interest in YMCA vans, buses, commercial vehicles, public transportation, or rented vans or buses, with the understanding that such trips are under supervision of authorized personnel of the YMCA and that all possible precautions are taken to insure the health and safety of my child.

Initial ___________

CONSENT FOR EMERGENCY MEDICAL TREATMENT

As the parent [ ], domestic partner [ ], or authorized representative [ ], I hereby give consent to Channel Islands YMCA to obtain all emergency medical or dental care prescribed by a duly licensed physician (M.D) Osteopath (D.O.) or Dentist (D.D.S.) for the child named above. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of a child named above.

Initial ___________

CHILD’S HEALTH STATEMENT

I, the undersigned parent/legal guardian, understand that at a YMCA Camp Program and Childcare Program, physical activity is a regular part of the program. To the best of my knowledge, my child is in excellent physical health and needs no restrictions (except what is listed on the Emergency/Health Information Form) from strenuous physical activity.

questions regarding my If I have any child’s health, I understand that it is my obligation to seek professional medical advice and to inform the Channel Islands YMCA of any restrictions on my child’s activities.

Initial ___________

PHOTOGRAPHIC RELEASE

In exchange for good and valuable consideration, the adequacy of which is hereby acknowledged, I hereby give Channel Islands YMCA, its volunteers, employees and any other person and entity acting with its permission the right to take, copyright, use, and publish any photographs or video of the above named child for the purpose of any YMCA advertising, promotion, or other purpose consistent with the YMCA mission.

I agree that any such photograph or video is the property of the Channel Islands YMCA, and I hereby waive all rights thereto. I further waive any right to inspect or approve any printed or electronic material that may be used in conjunction with the photographs or video, or to approve the use to which the photographs or video may be applied.

Initial ___________

INSURANCE DISCLAIMER

Channel Islands YMCA does not carry health or accident insurance on its members or participants. All expenses incurred in the treatment of illness, injuries or accidents will be the 11 responsibility of the participant’s parents or guardians.

Initial ___________

PARTICIPANT SWIM ABILITY ASSESSMENT FOR MINOR :

The YMCA program may include aquatic activities at a pool, beach or other location with water. Your initial below authorizes your child to participate in swimming activities. Please check the box below with the description that most closely fits the participant.

Type I: Does not know how to swim or is uncomfortable or nervous around water. Cannot put their face in the water, hold their breath, right themselves or float.

Type 2: Can hold their breath, fully submerge their head under water, right themselves, float unsupported for five (5) seconds, flutter kick and can turn over from front and back. Is uncomfortable in water over their head and is unable to propel themselves beyond ten (10) yards.

Type 3: Comfortable in deep water, can demonstrate basic swimming stroke techniques with controlled breathing, can propel themselves twenty five (25) meters and tread water for two minutes.

Type 4: Comfortable in deep water, can demonstrate advanced swimming stroke techniques with controlled breathing, can continuously propel themselves for a minimum of 100 meters, tread water for four (4) minutes and swim fifteen (15) meters under water.

Initial: __________

PERMISSION FOR AUTHORIZING USE OF SUNSCREEN:

I understand that providers now must have written permission from parents authorizing use of sunscreen and identifying the Sunscreen Brand and Sun Protection Factor (SPF) to be used on children. The Channel Islands YMCA is trying to avoid the possibility of an allergic reaction. I hereby give consent to the Channel Islands YMCA and its designated leaders to apply sunscreen, which I have provided for my child during the YMCA program. The staff may use the brand provided by the Channel Islands YMCA in the event my child does not have their own sunscreen. Sunscreen provided by parent: (brand)___________________________ SPF: ___________________ I understand that a large portion of our day will be spent outdoors.

Initial:__________ I understand that I am required to provide my sunscreen for my child and I authorize the YMCA Staff to directly apply the sunscreen to my child.

Initial: __________

CODE OF CONDUCT FOR ALL PARTICIPANTS:

By Submitting this application, you, for yourself or on behalf of your minor child, agree to abide by the policies and conditions of the Channel Islands YMCA Association "Code of Conduct.” The “Code of Conduct” can be found at the front service center of your local YMCA.

Initial: __________

MANDATED REPORTING:

I understand that the YMCA staff is mandated by state law to report any suspected cases of child abuse or neglect to the appropriate authorities for investigation. Initial: __________ I HAVE READ AND AGREE TO THE ABOVE INFORMATION: _________________________________________ Parent or Legal Guardian’s Signature _________________________________________ Printed Name _________________ Date April 2012 12

CHANNEL ISLANDS YMCA MEMBER/CHILDREN RELEASE and WAIVER of LIABILITY and INDEMNITY AGREEMENT

IN CONSIDERATION of being permitted to utilize the premises, facilities, services and programs of the Channel Islands YMCA, YMCA, (or for my children to so participate) for any purpose, including, but not limited to observation or use of facilities or equipment, or participation in any off-site program affiliated with the YMCA, the undersigned, for himself or herself and such participating children and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will, inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry onto the YMCA’s facilities for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated program have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation by the undersigned and such children.

IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION 1N ANY OFF-SITE PROGRAM AFFILIATED WITH YMCA, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING: THE UNDERSIGNED ON HIS OR HER BEHALF AND BEHALF OF SUCH CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES AND CONVENANTS NOT TO SUE the YMCA and all branches thereof; its directors, officers, employees, and agents (hereinafter referred to as "releasees") from all liability to the undersigned or such children and all his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned or such children whether caused by the negligence of the releasees or otherwise while the undersigned or such children is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with the YMCA.

THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any, loss, liability, damage or cost they may, incur due to the presence of the undersigned or such children in, upon or about YMCA’s premises or in any way observing or using any facilities or equipment of the YMCA or participating in any program affiliated with the YMCA whether caused by the negligence of the releasees or otherwise.

THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such children due to negligence of releasees or otherwise while in, about or upon the premises of the YMCA and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with YMCA. THE UNDERSIGNED further expressly agrees that the foregoing RELEASE WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

THE UNDERSIGNED' HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducment apart from the foregoing written agreement have been made.

I HAVE READ AND UNDERSTAND THIS DOCUMENT AND RELEASE Date: ______________________________ Print Name: _____________________________________________ Signature of Applicant/Parent: ______________________________ Signature of other Adult:___________________________________ Name of Child in Program: _________________________________ Name of Child in Program:_________________________________ Name of Child in Program: _________________________________ 13

Exhibit E 5148.2

A.S.E.S Lompoc Unified School District After School Education and Safety (ASES) Program EARLY RELEASE POLICY – MIDDLE & ELEMENTARY SCHOOL Legislation – Ed. Code 8483 (a) (1):

Every after school component of a program established pursuant to this article shall commence immediately upon the conclusion of the regular school day, and operate a minimum of 15 hours per week for elementary and 9 hours per week for middle school, and at least until 6p.m. on every regular school day. Every after school component of the program shall establish a policy regarding reasonable early daily release of pupils from the program. For those programs or school sites operating in a community where the early release policy does not meet the unique needs of the community or school, or both, documented evidence may be submitted to the department for an exception and a request for approval of an alternative plan

Early Release and Late Arrival Policy

The ASES grant requires after school programs begin at dismissal time for the regular instructional day and remain open until 6:00 p.m. each day school is in session.

Elementary school students are required to attend every day for a minimum of 15 hours a week and junior high (middle school) students must attend a minimum of 9 hours a week.

Students may; however, leave the program early or enter the program late as listed below. Students who are absent from ASES

and do not appear on the school’s absence list

must bring a note to the ASES Site Coordinator the next day to explain the reason for the absence. Any student failing below the minimum number of hours and attending 5 days per week may be dropped from ASES. If a student is dropped, a parent must re-apply and the student may be placed on the waiting list. A student who leaves early or arrives late may be signed in or signed out by a parent, a designee listed by the parent/guardian on the emergency card or an ASES Program staff member and the time of departure or arrival must be recorded.

A student may be released early from ASES prior to the end of the program time at 6 p.m. based on the following conditions

:  Family emergencies (such as death in the family or other catastrophic incidents)  Medical appointments     Weather conditions particularly is a child walks home during Daylight Savings Months Child accidents that occur during the ASES Program Religious-related activities  Sports, Community Events & other activities

A student may arrive late to program for following reasons:

Academic tutorial  Leadership classes  Sports

Each parent shall sign an early release form if their child is leaving prior to 5:15pm for middle school and 5:15pm for elementary school students.

The students may be signed out after that time period as needed without signing an early release form. Students are STILL required to meet their hourly requirements (attending 5 days per week) for their enrollment into the ASES program. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ I agree to follow the revised Early Release and Late Arrival Policy as outlined above. I understand that I am responsible for my child’s attendance requirements and that my child may be dropped from ASES, if he/she does not meet the hourly requirements for the ASES grant. 14 Parent/Guardian Signature: __________________________________________ Date: __________________________

Exhibit E 5148.2

A.S.E.S Distrito Escolar Unificado de Lompoc Programa Educativo y Seguridad Después de Clases (ASES) NORMAS DE SALIDA TEMPRANO –ESCUELA INTERMEDIA Y PRIMARIA Legislación – Código Educativo 8483 (a) (1):

Cada componente de un programa después de clases establecido conforme a este articulo deberá comenzar inmediatamente después de la conclusión del día escolar regular, y deberá llevarse a cabo por un mínimo de 15 horas por semana para los estudiantes de escuela primaria y 9 horas por semana para los estudiantes de escuela intermedia y por lo menos hasta las 6p.m. durante cada día escolar regular. Cada componente de un programa después de clases debe establecer una norma en referencia a una salida temprano razonable para los estudiantes del programa. Para aquellos programas ó escuelas trabajando en una comunidad donde las normas de salida temprano no cumplen con las necesidades específicas de la comunidad ó de la escuela ó de ambas, podrá someterse evidencia documentada al departamento para una excepción y una solicitud para la aprobación de un plan alternativo.

Normas de Entrada Tarde y Salida Temprano

Los fondos del programa ASES requieren que los programas después de clases comiencen a la hora de la salida de un día regular de instrucción y se mantenga abierto hasta las 6:00 p.m. cada día que la escuela este en sesión.

intermedia asistan un mínimo de 9 horas por semana. Se requiere que los estudiantes de escuela primaria asistan cada día por un mínimo de 15 horas por semana y los estudiantes de escuela

Sin embargo, los estudiantes podrán salir temprano del programa ó entrar tarde como se indica a continuación. Los estudiantes que estén ausentes del programa ASES

y no aparezcan ausentes en la lista escolar de ausencias

deberán traer una nota al Coordinador Escolar del programa ASES al día siguiente para explicar la razón de la ausencia. Cualquier estudiante que no cumpla con la cantidad de horas mínimas y con asistir 5 dias por semana podrá ser dado de baja del programa ASES. Si el estudiante es dado de baja, el padre tendrá que volver a aplicar y puede que el estudiante sea asignado a una lista de espera. Un estudiante que salga temprano ó llegue tarde puede ser registrado por un padre, un adulto asignado por el padre/apoderado legal que este indicado en la tarjeta de emergencia ó por un miembro del personal del Programa ASES y deberán asegurarse de incluir la hora de la salida ó entrada en el registro.

Un estudiante puede salir temprano de ASES antes del final del programa a las 6 p.m. de acuerdo a las siguientes condiciones:

 Emergencias Familiares (tal como fallecimiento de algún familiar cercano ó incidentes de gravedad)   Citas medicas   Condiciones del clima, particularmente si el estudiante camina a casa durante los meses que se obscurece más temprano Accidentes de los estudiantes que ocurran durante el programa ASES Actividades religiosas 

Un estudiante puede llegar tarde al programa por las siguientes razones solamente:

 Deportes, Eventos de la Comunidad y otras actividades Tutoría Académica   Clases de liderazgo Deportes

Cada padre tendrá que firmar un formulario de salida temprano si su estudiante saldrá antes de las 5:15 pm para los estudiantes de escuela intermedia y 5:15 pm para los estudiantes de escuela primaria.

Los estudiantes podrán salir después de ese periodo de tiempo cuando sea necesario sin tener que firmar un formulario de salida temprano. Los estudiantes AUN tienen el requisito de cumplir las horas necesarias (asistir 5 dias por semana) para permanecer inscritos en el programa ASES. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Estoy de acuerdo en seguir las Normas de Entrada Tarde y Salida Temprano como son indicadas anteriormente. Entiendo que soy responsable por los requisitos de asistencia de mi estudiante y que mi estudiante puede ser dado de baja del programa ASES si no cumple con el requisito mínimo de las horas necesarias del programa ASES. 15 Firma del Padre/Apoderado Legal: __________________________________________ Fecha: _____________________

CHANNEL ISLANDS YMCA Branches: Camarillo – Lompoc – Montecito -Santa Barbara Stuart C. Gildred – Ventura - Youth & Family Services

PARENT STATEMENT OF UNDERSTANDING

The following information is important for the safety and protection of your child. Please read the information, sign this form and return it to the YMCA.

I understand that YMCA staff are not allowed to babysit or transport children at any time outside of the YMCA program. Immediate disciplinary action will be taken by the YMCA toward staff and volunteers if a violation is discovered.

I understand that I am not to leave my child at the YMCA or program site unless a YMCA staff or volunteer is there to receive and supervise my child.

I understand that my child will not be allowed to leave the program with an unauthorized person.

Any person authorized to pick up my child must either be listed with the YMCA or other arrangements must be made by calling the YMCA office to inform them of a change.

I understand that should a person arrive to pick up my child who appears to be under the influence of drugs or alcohol, for the child's safety, staff may have no recourse but to contact the police. Please do not put staff in a position where they have to make this judgment call.

I understand that the YMCA is mandated, by state law, to report any suspected cases of child abuse or neglect to the appropriate authorities for investigation.

I have received a copy of the YMCA Handbook. I have read and understand the statements above and in the YMCA Handbook: (Please check one)

Preschool Handbook Afterschool Handbook Camp Handbook ______________________________________________________ ___________________ Parent or Legal Guardian’s Signature Date

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