LITTLE ROCK ATHLETIC CLUB

Billing Options:

LRAC MEMBERS:

LRAC members have a choice of automatic bank draft or pay by check.

*If paying by house charge your club account cannot be in arrears.

NON-MEMBERS:

*Automatic bank draft or credit card draft will be required upon registration.

*Bank or credit card draft will be processed on the 10^th of each month.

LRAC

AFTER SCHOOL CARE

APPLICATION

CHILD’S NAME: _____________________AGE:__________GRADE________

BIRTHDAY: ____________ SCHOOL: ______________________________

TEACHER’S NAME: ______________________ ROOM #: ______________

IS AFTER SCHOOL PICK-UP BY LRAC NEEDED: YES______ NO ______

TENNIS CHOICE_____ SWIMMING CHOICE_____

PARENT’S NAME: ________________________________________________

ADDRESS: ______________________________________________________

CITY: ______________________________ STATE: _______ ZIP: __________

FATHER’S NAME: __________________ MOTHER’S NAME: _______________

(HOME#)____________________ (HOME#) _____________________

(WORK#) ____________________ (WORK#) ______________________

GENERAL INFORMATION

*This application will be considered for the Little Rock Athletic Club After School Care Program.

*The LRAC is excited about offering a great fitness aspect to the well being of your child. We will make every consideration in your child’s acceptance into the program.

*A minimum number of students from each school are required to provide transportation from each school site. If space is available, we may accept students that provide their own transportation.

*You will be contacted by phone or mail upon acceptance.

*Once accepted, you will need to fill out an after school care registration form, and return it to the Little Rock Athletic Club.

*Space is limited. Applications will be processed in the order that they are received.

*The program starts the first day of your child’s school.

LITTLE ROCK ATHLETIC CLUB

AFTER SCHOOL CARE PROGRAM

REGISTRATION FORM

YOUTH INFORMATION

CHILD’S NAME___________________________________ DOB_______________

FATHER’S NAME____________________ MOTHERS NAME_____________________

HOME ADDRESS _________________________________________________________

CITY_______________ STATE_______ ZIP____________PHONE# (___) _____________

FATHER’S EMPLOYER____________ WORK # (___) __________ WORK HOURS ________

MOTHER’S EMPLOYER ___________ WORK # (___) _________ WORK HOURS ________

EMERGENCY CONTACT INFORMATION

NAME OF PERSON TO CALL IF PARENTS CANNOT BE REACHED _______________

RELATIONSHIP TO CHILD _____________________ PHONE (___) ____________

ADDRESS__________________ CITY ____________ STATE_____ ZIP ___________

IS THIS PERSON AUTHORIZED TO TAKE THE CHILD FROM THE LRAC ____________

LIST ALL OTHER ADULTS AUTHORIZED TO PICK UP THE CHILD FROM THE LRAC:

1.______________________ 2._______________________ 3._________________________

NAME & RELATIONSHIP NAME & RELATIONSHIP NAME AND RELATIONSHIP

_______________________ _______________________ ________________________

ADDRESS ADDRESS ADDRESS

_______________________ ________________________ ________________________

CITY STATE ZIP CITY STATE ZIP CITY STATE ZIP

_______________________ ________________________ ________________________

TELEPHONE TELEPHONE TELEPHONE

MEDICAL INFORMATION

CHILD’S PHYSICIAN OR EMERGENCY TREATMENT FACILITY _________________________

ADDRESS________________ CITY____________ STATE______ PHONE#(___) ______________

Father

I, ______________________ Mother (circle the appropriate description)

Guardian

of ______________________ do hereby give my consent to the Director of the After School Care

(CHILD’S NAME)

Program or her duly appointed representative, for said child to receive medical or surgical aid as may be deemed

necessary and expedient by a duly licensed or recognized physician or surgeon in the case of an

emergency when the parents cannot be reached. Consent is also given for the Director or her duly

appointed representative to transport said child for emergency medical treatment, if the parents cannot

be reached.

SIGNED ____________________DATE_________WITNESS_________________DATE_________

CHILD’S DEVELOPMENTAL NEEDS

CHILD’S SPECIAL FOOD NEEDS: DIABETIC DIET_____________________________________

ALLERGIES_____________________________________ASTHMA__________________________

SPECIAL PROBLEMS: MEDICATIONS_______________________ ALLERGIES______________

DIABETES________________ SUN SENSITIVITY_____________SEIZURES_________________

FAINTING SPELLS_______________ OTHER___________________________________________

PLEASE STATE WHETHER OR NOT THE LRAC WILL NEED TO DISPENSE MEDICINE

YES_______ NO_______

I the parent/guardian of this child, understand that I may ask for a conference with the caregiver(s) as needed. I the parent/guardian of this child also understand that the Department of Human Services (DHS) can ask me or my child for an interview at any time concerning the facility and if there are any problems that DHS should know about.

___________________________________ ___________________

SIGNATURE DATE

WAIVER RELEASE STATEMENT

PLEASE READ THE FOLLOWING INFORMATION CAREFULLY. No child will be admitted into this LRAC camp/program if this form is not signed by a parent or legal guardian. By signing this form, you are releasing all claims for injury you or the participant might sustain through this program.

I agree to assume full risk and to waive, relinquish, and release all claims I and or the participant may have against, indemnify, hold harmless, and defend the Little Rock Athletic Club. This release includes as well LRAC officers, agents, servants, and employees from any such claims resulting from injury, damages, or loss sustained on account of participation in this camp program. I understand that I am responsible for all personal medical insurance and the participants in this camp program. I understand that I am responsible for all personal insurance and the participant’s family must cover any medical costs incurred. I also understand that every precaution is taken to protect the safety of each participant. I agree to emergency treatment by a physician or hospital in the event that I or the emergency contact listed cannot be reached.

The Hospital emergency room of my choice is: ____________________________________

Child’s Name: _________________________________

Parent/Guardian Signature: ______________________________ Date: _______________

LITTLE ROCK ATHLETIC CLUB

AFTER SCHOOL CARE PROGRAM

DISCIPLINE POLICIES

The discipline policy of the Little Rock Athletic Club (LRAC) After School Care Program will be that anytime a child’s behavior jeopardizes the safety of him/herself, others, or is acting in a disruptive manner the child will be removed from the class or program.

The LRAC After School Care Program uses a timeout situation to encourage good behavior. A child who has to take a timeout will be taken out of class participation and must sit alone quietly for 1 minute for each year of age (example:(age) 6x1 (minute)= 6 minutes). After the second offense another timeout will be given. Following a third offense the child is sent to the Director’s Office for the remainder of the day. Also, the parents and the child will have to schedule a conference with the Director to discuss the problem. Continuous or more serious behavioral problems may result in termination form the LRAC After School Care Program.

I, ________________________ Parent/ Guardian of

________________________ (Child’s name) have read, understand, and agree with the Little Rock Athletic Club After School Care Program Discipline Policies.

_______________________________ __________________

SIGNATURE DATE

LITTLE ROCK ATHLETIC CLUB

AFTER SCHOOL CARE PROGRAM

POLICIES AND PROCEDURES

WELCOME:

On behalf of the Little Rock Athletic Club and Kids’ Down Under Center we would like to welcome you to our After School Care Program. The following information will address our policies and procedures, and is designed to help your family become more familiar with our program. Our goal is to provide a first class After School Care Program for children in grades Pre-K - 6^th. The following policies and procedures will serve as guidelines for the successful accomplishment of our goal.

HOURS OF OPERATION:

The LRAC After School Care Program operates Monday through Friday from 2:30 p.m. to 6:00 p.m. when school is in session. When school is out of session the LRAC will offer a full day session if we have at least two children participating.

INCLEMENT POLICY:

The Little Rock Athletic Club After School Care Program will follow the Little Rock School District’s school closing policy for inclement weather. Therefore, if the LRSD makes an early morning or mid-day closing, the After School Care Program will be closed as well. In addition, if the LRAC deems the weather or road conditions too dangerous for travel, we will not provide transportation to the club, to ensure the safety of all children & staff. Staff will call parents immediately to inform them of the situation.

ENROLLMENT/TUITION:

A non-refundable registration fee of $25.00 is due every semester to reserve your child’s place in our program. Tuition will not be prorated or credited for missed days. Please refer to the billing and fee sheet for tuition rates.

CHECK IN / OUT:

All children will be checked in when they arrive at the Little Rock Athletic Club by an After School Care staff member, and every child must be signed out by a designated parent or guardian at the end of each day. Please notify the program director if someone other than a parent or guardian will be picking up your child. We also ask that every adult authorized to pick up a child bring a picture I.D.

ATTENDANCE:

The After School Care Program follows a strict student / teacher ratio. As a result we ask that a parent or guardian please notify us in advance to let us know if a child will be absent from school. Also calling us will save time by knowing that your child will not be riding the van. Your cooperation is greatly appreciated.

If your child will not be attending the After School Care Program, we MUST be notified. Please leave me a voice mail message at 225-3601 ext.283, before 1:00 p.m.

After 1 p.m. Please do the following:

· CALL THE LRAC (225-3600)

· ASK FOR THE TENNIS DESK, GIVE YOUR NAME

· TELL THE ATTENDANT YOUR CHILD’S NAME and

· WHAT SCHOOL HE OR SHE ATTENDS

· THE TENNIS DESK WILL NOTIFY THE VAN DRIVER

LATE PICK UP:

If your child remains in the care of LRAC After School Care Program past 6:05 p.m. there will be a $5.00 charge for every additional 5 minutes. If a child remains in the Down Under Center for over one hour after the close of the After School Care Program, we are required to call Social Services. Therefore, please let us know if you are going to be late. Also, remember that your child as well as our staff worries about you when you are late.

SNACK AND LUNCH:

Snacks will be provided by the LRAC After School Program. If your child has allergies to specific foods we will work with you to provide what your child needs. Lunches will only be provided on days when schools are out all day. We do understand that some children may be hungry at the end of the day but we will not allow the children to charge to their account until 5:00 p.m. each day.

MEDICATION:

Medication will only be given to children with a signed parental consent form listing a date, type, name, time, and dosage. All medication must be in the original container, have a valid expiration date, and be labeled with the child’s name. Staff cannot dispense medications in dosages that exceed the recommendations stated on the medication container. The Health Department does not allow a child with a fever of 101 or greater, diarrhea, vomiting, rashes, or sore throat to attend the After School Care Program. If your child displays any of these symptoms, a parent or guardian will be notified immediately.

PROCEDURE FOR INJURY:

The LRAC will contact the parents/guardians of any child that is injured while in the care of the LRAC. If the injury is serious in nature, unless the LRAC is instructed differently by the parents, we will call for an ambulance.

STAFF:

The LRAC hires only qualified staff over the age of eighteen to work in the After School Care Program. A background check is required on all employees who work with this program. All staff members are required to be certified in child/adult CPR.

DHS REQUIREMENTS:

The LRAC After School Care Program is licensed by the Arkansas Department of Human Services (DHS). It is a requirement of DHS that any suspected signs of child abuse be reported to the Child Protection Agency. If an employee suspects any child abuse he/she is required to file a report and call the child abuse hotline. The proper authorities will then intervene and conduct an investigation. Our licensing also stipulates that any staff member or child enrolled in the LRAC After School Care Program may be subject to an interview by DHS officials.

THANK YOU:

We appreciate the opportunity to work with your children in the LRAC After School Care Program. We believe the program is best served when the parent, child, and LRAC staff work together to provide the best experience possible. Please let us know if you have any questions in regards to the operation of the LRAC After School Care Program. Thank you for your time.

Sincerely,

JOMECIA SUMMERVILLE

After School Care Director ________________________

(501)225-3601 ext.283

*SWIM TEAM CHOICE*

The Laser swim team is a year round USA Swimming competitive team and uses a “progressive” program of instruction to develop the child physically, mentally, and emotionally. The emphasis in the early stages of participation will be placed on developing technique, skills and a love for the sport. The primary goal is the same for all levels: Preparing swimmers to perform their best as athletes and to achieve a foundation for a healthy lifestyle. Coaches will evaluate athletes and place them according to their skills that will best benefit them.

*Team Levels*

Stars Ages: 5-10
100% Instructional
This level is for swimmers that have completed Int.II in our Swim Academy. The Stars is the entry level for the team. They will continue to develop the four strokes and will teach the fundamentals necessary for competitive swimming. They will meet twice a week for 30 min. each time.
Requirements: Swimmers will have had instruction in all four strokes and be able to swim a length of the pool freestyle, 1/2 a length in other strokes and tread water for one minute.

LITES AGES: 7-12

100% Instructional

This level is designed to introduce young swimmers to the sport of swimming while allowing maximum opportunity to participate in other activities. These swimmers will focus on learning the fundamentals of four competitive strokes, streamlining, starts and turns.

Requirements: Swimmers will have had instruction in all four strokes and be able to swim a length of the pool freestyle and tread water for one minute. Swimmer must be confident in the water.

SILVERS AGES: 8-14

70% Instructional 30%Training

This level is designed to provide a sound foundation in the proper technique of all four competitive strokes, starts, and turns. Training is introduced to the swimmer at this level. Summer League swimmers often find this is a good level to be introduced to USA competitive swimming.

Requirements: This group is for the swimmer who has had instruction in all four strokes and can swim one length of the pool in each of the four competitive strokes.

*There is an additional charge for this program. However, a 35% discount is applied for all After School Care participants.

*Register for this on the After School Care registration form.

*Contact Tasha Stratton, 225-3600 for details.

*TENNIS CHOICE*

The LRAC offers a year round program involving fundamental instruction and drills encompassing all phases of the game. Coaches will evaluate athletes and place them according to their skills that will best benefit them.

TENNIS BEGINNERS:

This class is designed for basic fundamental strokes: forehand, backhand, serve and volley. Players will also work on proper footwork. Games to help their concentration skills will also be played

TENNIS INTERMEDIATE:

This class is designed to further a players strokes. Students will also learn the basics of the game including scoring and playing. Drills to improve their game are also introduced.

TENNIS ADVANCED:

Players who have their basic strokes down and are able to compete ina Novice Tennis Tournament.

*There is an additional charge for this program. However, a 35% discount is applied for all After School Care participants.

*Register for this program on the After School Care registration form.

*Contact Donnie Wallis, 225-3600 for details.