Operation Name	Director’s Name
The HIVE After School Program	Fred Pirotina
Child’s Full Name	Child’s Date of Birth	Child’s Home Telephone No.
Child’s Home Address
Date of Admission	Date of Withdrawal	EMAIL:
Parent’s or Guardian’s Name	Address (if different from child’s address)
List telephone numbers below where parents/guardian may be reached while child will be in care:
Mother’s Telephone No.	Father’s Telephone No.	Guardian’s Telephone No.	Cell Phone No
Give the name, address and phone number of person to call in case of an emergency if parents / guardian cannot be reached:	Relationship
I hereby authorize the childcare operation to allow my child to leave the childcare operation ONLY with the following persons. Please list name & telephone number for each. Children will only be released to a parent or a person designated by the parent/guardian after verification of ID.

RECEIPT OF WRITTEN OPERATIONAL POLICIES: I acknowledge receipt of the facility’s operational policies including those for discipline and guidance.
I UNDERSTAND THAT THE FOLLOWING MEALS WILL BE SERVED TO MY CHILD WHILE IN CARE: PM Snack
MY CHILD WILL ATTEND ON THE FOLLOWING DAYS AND TIMES: Mondays 7:00AM: 3:00PM Tuesdays 7:00AM: 3:00PM Wednesdays 7:00AM: 3:00PM Thursdays 7:00AM: 3:00PM Fridays 7:00AM: 3:00PM

AUTHORIZATION FOR EMERGENCY MEDICAL ATTENTION: In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to:
Name of Physician:	Address:	Ph.#:
Name of Emergency Medical Care Facility:	Address:	Ph.#:
I give consent for the facility to secure any and all necessary emergency medical care for my child.
Signature - Parent or Legal Guardian

List any special problems that your child may have, such as allergies, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months, any medication prescribed for long-term continuous use, and any other information which caregiver’s should be aware of:

Child daycare operations are public accommodations under the Americans with Disabilities Act (ADA), Title III. If you believe that such an operation may be practicing discrimination in violation of Title III, you may call the ADA Information Line at (800) 514-0301 (voice) or (800)-514-0383 (TTY).

Signature – Parent or Legal Guardian	Date

SCHOOL AGE CHILDREN:
My child attends the following school:
Name of School and Address	School Ph.#
CHECK ALL THAT APPLY:
His / her immunization record is on file at the school and all required immunizations and/or tuberculosis test are current. Vision and Hearing screening records are also on file.	My child has permission to:	walk to or from school or home,
ride a bus, and/or	be released to the care of his/her sibling(s) under 18 years old.
Name of sibling(s):

Signature – Parent or Legal Guardian	Date

The HIVE After School Program

TUITION CONTRACT & POLICY STATEMENT

REGISTRATION
A non-refundable registration fee is required yearly at time of registration. ($125 Individual/$175 Family)

TUITION
Tuition for the 2023–2024 school year is divided equally into 10 monthly payments running from August through May and remains the same regardless of absence or holidays (school closures have already been deducted from the total number of days and half days have been added to the total.) Registrations after August will be subject to different monthly rates.
Tuition is to be paid on the 1st class day of the month. Any payment made after the 10th of the month will be charged a $25.00 late fee payable immediately. Early drop in care is available at $10 per day. Part time drop in care is available at a daily rate of $35.00 per day. Drop in care for two or more days a week is available at a rate of $30.00 per day. Drop in half day care will be charged at a rate of $50.00 dollars per day. There is a $ 25.00 NSF fee. If enrollment is terminated, a withdrawal form is required 30 days prior and final months tuition is due.

WITHDRAWALS AND REFUNDS
One month notice from the first of the month is required to discontinue any enrollment. Withdrawal must be done in writing and will not be accepted over the phone. Withdrawal must be received by the Director. Withdrawal must occur within the first 7 days of the month. To withdraw from after care a parent must:

Inform the Director in person.

Complete and sign a withdrawal from provided in the office.

Pay the final months fees.

The HIVE After School Program reserves the right to withdraw any student without notice. In such a case a pro-rated refund for classes will be given within 30 days of the withdrawal.

I understand and accept these policies and procedures for payment to The HIVE.

__________________________________	______________

(Signature of Responsible Party)	(Date)

Office Use:

Reg fee paid _________ CK#________ Received by _______ Paid online _______ Date ________

Tuition monthly ________________

The HIVE After School Program

Handbook, Photo Release, and Information Statement

Policies and Procedures Handbook

Acknowledgment Form

I have received a copy of The HIVE Parent Handbook. I understand that I will be held responsible for reading and understanding the information provided and will adhere to the rules and regulations set forth.

_______________________________ ____________________

Signature Date

Photograph/Video/Film/Website/Internet

Release Form

I, ____________________________ hereby authorize __________________________

(Name of Parent or Guardian) (Name of Student)

to participate in the making of a project consisting of photographs and/or

video/film production and /or internet website titled www.thehiveafterschool.com. I

specifically understand that The HIVE After School Program shall hereby retain any and all

rights in the photograph(s) and /or video/film production and/or internet/website,

including by not limited to, the right to reproduce, copy, edit, exhibit, publish, or

distribute such photograph(s) and/or video/film and/or internet. Including our Facebook pages.

______________________________________ ____________________

Signature Date

Contact Information and Email Directory

Family e-mail address: ________________________________________

Home or other contact phone number: ____________________________

Our email and phone number info: MAY or MAY NOT (circle one)

be given out to other BEE After Care families

The HIVE After School Program

Discipline and Guidance Policy

Discipline must be:

(1) Individualized and consistent for each child;

(2) Appropriate to the child’s level of understanding; and

(3) Directed toward teaching the child acceptable behavior and self-control.

A caregiver may only use positive methods of discipline and guidance that encourage

self-esteem, self-control, and self-direction, which include at least the following:

(1) Using praise and encouragement of good behavior instead of focusing only upon unacceptable behavior.

(2) Reminding a child of behavior expectations daily by using clear, positive statements;

(3) Redirecting behavior using positive statements.

(4) Using brief supervised separation or time out from the group, when appropriate for the child’s age and development, which is limited to no more than one minute per year of the child’s age.

There must be no harsh, cruel, or unusual treatment of any child. The following types

of discipline and guidance are prohibited:

(1) Corporal punishment or threats of corporal punishment.

(2) Punishment associated with food, naps, or toilet training.

(3) Pinching, shaking, or biting a child.

(4) Hitting a child with a hand or instrument.

(5) Putting anything in or on a child’s mouth.

(6) Humiliating, ridiculing, rejecting, or yelling at a child.

(7) Subjecting a child to harsh, abusive, or profane language.

(8) Placing a child in a locked or dark room, bathroom, or closet with the door closed.

(9) Requiring a child to remain silent or inactive for inappropriately long periods of time.

Texas Administrative Code, Title 40, Chapters 746 and 747, Subchapters L, Discipline and Guidance

My signature verifies I have read and received a copy of this discipline and guidance policy.

________________________________________________________ _________________

Signature	Date

Check one please:

Parent Employee/Caregiver Household member of child-care home