TOWN OF CUTLER BAY Funded By
Parks & Recreation
Cutler Ridge Park After School Program
Cutler Ridge Park | 10100 SW 200 St., Cutler Bay, FL 33189 | T: (305)233-5472 | F (305) 233-5475
www.cutlerbay-fl.gov | Facebook, Instagram, Twitter: @townofcutlerbay
AFTER SCHOOL PROGRAM CHECKLIST
Please initial next to the number to indicate that youve read and agree to comply with each policy.
1. __________ After School Program Behavior Policy
2. _________ Attendance Policy
3. _________ Authorization for Photography/Video form (Town of Cutler Bay)
4. _________ Authorization for Photography/Video Form
5. _________ Authorization for Release of Information/Town Partners
6. _________ Child Information Form (The Childrens Trust)
7. _________ Child Information Form (Town of Cutler Bay)
8. _________ Client Confidentiality Policy
9. _________ Distracted Adult Flyer
10. ________ Emergency Medical Authorization
11. _________ Flu Brochure
12. ________ Getting to Know Me Form
13. ________ Information on Reporting About Children with Disabilities
14. ________ Know Your Childcare Facility Brochure
15. ________ Late Pick-up Policy
16. ________ Participant Registration Requirements
17. ________ Permission to Swim
18. ________ Policies and Procedures Handbook
19. ________ Statement of Purpose for Collection of Social Security Numbers
Childs Name: _____________________________________________________________________________
Parent/Guardian Name: ___________________________________________________________________
Parent/Guardian Signature: ______________________________________ Date: ___________________
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TOWN OF CUTLER BAY Funded By
Parks & Recreation
Cutler Ridge Park After School Program
Cutler Ridge Park | 10100 SW 200 St., Cutler Bay, FL 33189 | T: (305)233-5472 | F (305) 233-5475
www.cutlerbay-fl.gov | Facebook, Instagram, Twitter: @townofcutlerbay
REGISTRATION FORM
Child’s Last Name ______________________ First Name ______________________ Middle Initial ______
Childs Date of Birth (MM/DD/YYYY)
Childs Gender Male Female
Medical Conditions: ___________________________________________________________________________
Street Address: _______________________________________________________________________________
City: ___________________________________________________________ Zip Code: _____________________
Childs Current School _________________________________________ Childs Current Grade
Parent/Guardian Name: _______________________________________________________________________
Parent/Guardian Email: _______________________________________________________________________
Primary Phone Other Phone
Emergency Contact and Authorized Pick-up
Name _______________________________________ Primary Phone: _________________________________
Other Phone: _________________________________
Name _______________________________________ Primary Phone: _________________________________
Other Phone: _________________________________
Name _______________________________________ Primary Phone: _________________________________
Other Phone: _________________________________
Initial each line below
_______ Your child will not be released to anyone under the age of 18 years old.
_______ A late pick-up fee of $1.00 per minute will be charged for pick up after 6:01 p.m.
_______ Registration fee is $100 per child, per school year (non-refundable)
_______ Monthly fee is $25 per child (September 2020 May 2021)
I give my permission for this information to be submitted to The Children's Trust and The
Department of Juvenile Justice for program monitoring and evaluation purposes. The
Children’s Trust and The Department of Juvenile Justice (DJJ) provide funding for the
program.
Parent/Guardian Signature: ______________________________________ Date: ___________________
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TOWN OF CUTLER BAY Funded By
Parks & Recreation
Cutler Ridge Park After School Program
Cutler Ridge Park | 10100 SW 200 St., Cutler Bay, FL 33189 | T: (305)233-5472 | F (305) 233-5475
www.cutlerbay-fl.gov | Facebook, Instagram, Twitter: @townofcutlerbay
GENERAL AGREEMENT / RELEASE
I, _______________________________________________________________, (print name) do hereby:
1. Assume all risk of possible damage or injury through my child’s participation in Town of
Cutler Bay recreational programs.
2. Agree to compensate the Town of Cutler Bay for any repair and/or replacement costs for
damages to the facility or equipment as a result of my child’s misuse of the equipment.
3. Agree to indemnify and hold harmless the Town of Cutler Bay and/or its departments,
agents or employees from any and all liability, claims, suits, losses, damages including
attorney’s fees at the trial and appellate court level, paralegal fees and investigative costs
for injury to person or property arising out of my child’s participation in the requested
program.
4. Understand and agree to abide by all applicable rules and regulations as set forth by the
Parks and Recreation department. I further understand that my child may be
suspended/expelled from the program and I may forfeit my child’s participation if my
child fails to abide by these rules and regulations or any other reasonable request from
the Town of Cutler Bay staff.
5. Section 402.3125(5), F.S., requires that parents receive a copy of the Child Care Facility
Brochure, “Know Your Child Care Facility”,
6. Section 65C-22.006(3)(c)2., F.A.C., requires that parents are notified in writing of the
disciplinary practices used by the Town of Cutler Bay.
7. I have received the brochure on “Influenza Virus, The Flu, A Guide to Parents”.
Your signature below indicates that the above information is correct and that you have
received and understand the rules and regulations governing this program.
Parent/Guardian Signature: _________________________________________ Date: ___________________
FOR OFFICIAL USE ONLY
Parks & Recreation Official: _____________________________ Title: ________________ Date: ______________
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Page 1 of 2 Revised August 2018
CHILD INFORMATION FORM
Required as of 8/1/2018
Child’s Last Name First Middle Name _________
Child’s Date of Birth (MM/DD/YYYY) Child’s Gender Male Female
Miami-Dade County Public Schools ID # No M-DCPS ID #
Child's current school _______________________________________
Is your child proficient in English? Yes No
Other language(s) spoken in your home Spanish Haitian Creole Other:__________ None
Street Address ____ City Zip Code _
Child's ethnicity Hispanic Haitian Other, please specify:
Child's race (select only one) American Indian or Alaskan Asian Black or African-American
Pacific Islander White Other Multiracial
Child’s current grade
Does child have health insurance? (ex., private insurance, KidCare, Medicaid) Yes No
(If not, we may be able to help you find affordable coverage call 211 or visit
www.thechildrenstrust.org/parents/health-connect/insurance
.)
Child’s primary caregiver (full name) ______________________________________________________________
Primary caregiver email address __________________________________________________________________
Primary Phone Number Is this a cell/mobile phone? Yes No
(Please note that The Children’s Trust may contact you via postal mail, email and/or text to ask about
your satisfaction with these services, and to make you aware of other Trust-funded programs, initiatives
and events you may be interested in.)
We want to get to know your child better so that we can provide the best possible experience in our
programs. Please tell us more about your child…
What are the main ways in which your child communicates? (Mark all that apply)
Speaks and is easily understood
Speaks but is difficult to understand
Uses communication devices like
pictures or a board
Uses gestures or expressions like pointing, pulling,
smiling, frowning or blinking
Uses sign language
Uses sounds that are not words like laughing,
crying or grunting
Page 2 of 2 Revised August 2018
What, if any, help does your child receive at this time? (Mark all that apply)
Behavioral therapy or services
Counseling for emotional concerns
Daily medication (not including vitamins)
Occupational therapy (OT)
Physical therapy (PT)
Special education services in school
Speech/language therapy
None of the above
What conditions does your child have that are expected to last for a year or more? (Mark all that apply)
Autism spectrum disorder
Developmental delay (only if under age 5)
Intellectual/developmental disability (over
age 5)
Hearing impairment or deaf
Learning disability (school age)
Medical condition or illness
Physical disability or impairment
Problems with aggression or temper
Problems with attention and hyperactivity
(ADHD)
Problems with depression or anxiety
Speech or language condition
Visual impairment or blind
None of the above
If you marked “None of the above” on the previous question, please skip the next two questions and
sign below. If you marked any other answer on the question above, please answer the remaining
questions and sign below.
Do any of the conditions marked above make it harder for your child to do things that other
children of the same age can do?
Yes No
To support your child’s successful participation in this program, in what areas might s/he need
extra assistance?
No specific help needed
Holding a crayon/pencil, writing, using scissors or other fine motor tasks
Sports or physical activities like running or other gross motor tasks
Managing feelings and behavior
Academic, learning or reading activities
Adapting activities to take into account a visual or hearing impairment
Using assistive device(s) like a wheelchair, crutches, brace or walker
Personal services like help with feeding, toileting or changing clothes
Other _________________________________________
Please tell us anything else you think it is important for us to know about your child:
______________________________________________________________________________________________
If you are interested in other services funded by The Children’s Trust,
please call 211 or visit www.thechildrenstrust.org
. For special needs resources for your child, visit
www.advocacynetwork.org or www.thechildrenstrust.org/cwd
I give my permission for this information to be submitted to The Children's Trust for program quality and evaluation
purposes. The Children’s Trust provides funding for the program.
PARENT/GUARDIAN SIGNATURE ________________________________________ DATE______________
FOR STAFF USE ONLY (MUST BE COMPLETED)
ORGANIZATION SITE _____________________________________
POPULATION MEMBERSHIP (check all that apply): Dep Syst Delin Syst
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TOWN OF CUTLER BAY Funded By
Parks & Recreation
Cutler Ridge Park After School Program
Cutler Ridge Park | 10100 SW 200 St., Cutler Bay, FL 33189 | T: (305)233-5472 | F (305) 233-5475
www.cutlerbay-fl.gov | Facebook, Instagram, Twitter: @townofcutlerbay
EMERGENCY MEDICAL AUTHORIZATION
The following is the Cutler Ridge Park After School Program Emergency Medical policy and
procedures for addressing emergency medical situations.
The following steps will be taken by park staff in the event of injuries:
Non Life-threatening injuries:
1. Assist or bring the injured child to the park office or first-aid room at the pool.
2. Notify a staff member that is first-aid certified to administer the appropriate first-aid
treatment as necessitated by the injury.
3. Notify parent/guardian and supervisor of incident.
4. Complete accident/incident report.
5. Send copy of incident report for major accident to The Children’s Trust.
Life-threatening injuries:
6. 911 will be called immediately.
7. Find a staff member that is CPR and first-aid certified for “first respondertreatment.
8. Notify parent/guardian (in their absence, notify the first person listed on the child’s
“Emergency Contact and Authorized Pick-Up List”).
9. Notify supervisor.
10. Meet Fire Rescue or Police Officer in the park parking lot and direct them to the injured
child.
11. Complete accident/incident report.
12. Send copy of incident report for major accident to The Children’s Trust.
I, ___________________________________ , th
e parent/guardian of _________________________________
(Print parent/guardian name) (Print child’s name)
do hereby authorize the Town of Cutler Bay to provide for emergency medical treatment as
indicated above for:
_____________________________________________ ____________________________________________
(Print child’s name) (Parent/Guardian Signature)
_____________________________________________
____________________________________________
(Date) (Date)
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TOWN OF CUTLER BAY Funded By
Parks & Recreation
Cutler Ridge Park After School Program
Cutler Ridge Park | 10100 SW 200 St., Cutler Bay, FL 33189 | T: (305)233-5472 | F (305) 233-5475
www.cutlerbay-fl.gov | Facebook, Instagram, Twitter: @townofcutlerbay
AUTHORIZATION FOR PHOTOGRAPHY/VIDEO
I, __________________________________________________________________ , the parent or guardian of
__________________________________________________________________________ hereby authorize
and give consent to service providers and the staff of The Children’s Trust of Miami-Dade
County as follows:
I hereby:
consent and authorize or do not consent and authorize
the staff of The Town of Cutler Bay to take/use still photographs, digital photographs, motion
pictures, television transmission, and/or videotaped recordings (hereinafter “Recordings”) of me,
my children, or my wards for educational, research, documentary, and public relations
purposes.
_____________________________________________ ____________________________________________
(Parent/Guardian Signature) (Signature of Witness)
_____________________________________________ ____________________________________________
(Date) (Date)
Any such Recordings may reveal your identity through the image itself without any
compensation to you, your children or wards.
Any and all Recordings taken of you, your children or wards shall be the sole property of The
Children’s Trust.
With regard to the use of any Recordings taken of you, your children or wards, you hereby
waive any and all present and future claims you may have against The Town of Cutler Bay, their
staff, service providers, employees, agents, affiliates and Board
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3150 SW 3
rd
Avenue, 8
th
Floor ● Miami, FL 33129
305.571.5700 ● Fax: 305.857.9592
www.thechildrenstrust.org
AUTHORIZATION FOR PHOTOGRAPHY/VIDEO
I, __
______________________________________________, the parent or guardian of
_________________________________________, hereby authorize and give consent to the
staff of The Children’s Trust of Miami-Dade County and/or its funded service providers as
follows:
I hereby:
consent and authorize OR do not consent and authorize
the
staff of The Children’s Trust of Miami-Dade County and/or its funded service providers
to take/use still photographs, digital photographs, motion pictures, television
transmissions and/or videotaped recordings (hereinafter “Recordings) of me, my
children or my wards for educational, research, documentary and public relations
purposes.
_______________
________________________ _______________________________________
Signature of Parent or Guardian Signature of Witness
_______________
________________________ _______________________________________
Date Date
Any such Recordings may reveal your identity through the image itself without any
compensation to you, your children or wards.
Any
and all Recordings taken of you, your children or wards shall be the sole property of
The Children’s Trust and its funded service providers.
Wi
th regard to the use of any Recordings taken of you, your children or wards, you hereby
waive any and all present and future claims you may have against The Children’s Trust
of Miami-Dade County and its staff, funded service providers, employees, agents,
affiliates and board members.
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TOWN OF CUTLER BAY Funded By
Parks & Recreation
Cutler Ridge Park After School Program
Cutler Ridge Park | 10100 SW 200 St., Cutler Bay, FL 33189 | T: (305)233-5472 | F (305) 233-5475
www.cutlerbay-fl.gov | Facebook, Instagram, Twitter: @townofcutlerbay
AUTHORIZATION FOR RELEASE OF INFORMATION
Note: The Town of Cutler Bay partners with various agencies in order to provide the highest
quality of service to participants of our Youth Programs. This form allows the Town to
exchange information with our partners that is relevant to the delivery of service such as
contact information and disclosed medical conditions (allergies, physical limitations, differing
learning abilities, etc.). We will not disclose any information without the parent/guardian’s
authorization to release.
I, _____________________________________________ , hereby AUTHORIZE the Town of Cutler Bay to
Release/Exchange information with the following partners associated with the “Cutler Bay
Careers in STEM Summer Camp”: Miami-Dade College School of Continuing Education &
Professional Development (500 College Terrace, B106 Homestead, FL 33030 | Phone: 305-237-
5233); Nature Postings (PO Box 972568, Miami, FL 33197 | Phone: 786-543-8826); Paint with
Faith (1260 NW 196th Terrace, Miami, FL 33169 | Phone: 305-781-0991) and Short Chef (3133 SW
13th Street, Miami, FL 33145 | Phone: 305-761-1452).
CLIENT INFORMATION
_________________________________ __________________ ____________________________________
(First Name) (Middle Initial) (Last Name)
SPECIFIC INFORMATION TO BE RELEASED
Con
tact Information Progress Reports Demographics Other: ___________________
Plea
se DO NOT Share the following information: ______________________________________________
______________________________________________________________________________________________
I understand that the specific information to be released may include, but is not limited to;
history and/or treatment protected under the Privacy Act. I authorize the release of this
information and understand that this authorization expires six months from date of signature,
unless I specify otherwise or revoke it with a written and dated notice prior to the release of this
information.
The above has been fully explained to me and I understand it.
_____________________________________________ ____________________________________________
(Parent/Guardian Signature) (Signature of Witness)
_____________________________________________
____________________________________________
(Date) (Date)
Town of Cutler Bay, Confidential 8/31/2020
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YEN “Getting to Know Me
Name: __________________________________________
D.O.B. _____________________ Date________________
Please tell us about yourself. This form will not be shared with others, please answer it truthfully. Letting
us know your strengths and challenges helps us to better assist you.
1. Which best describes you? (check all that apply)
I would rather read instructions than listen to the
teacher explain them.
I like having someone explain directions aloud.
When I study, I have to take a lot of breaks to get up
and walk around.
I draw a lot of pictures during class.
I remember things better if I write them down.
I study by saying information aloud.
Charts, pictures, and maps help me understand what
I am reading.
I can pay attention better if I have a snack while I
study.
I like to listen to music while I am studying.
I am good at seeing pictures in my mind what I am
studying.
It is easy for me to remember jokes.
I can think better if I tap my foot, play with a pencil
or move a little.
I prefer working by myself.
I prefer working with a friend.
I prefer working in a group of 3 or more.
I find it easy to speak up in class and/or participate in
discussions.
I find it hard to speak up in class and/or participate in
discussions.
I find it easy to read aloud.
I find it hard to read aloud.
I find it easy to control my temper.
I find it hard to control my temper.
It is easier for me to control my temper if I try the
following:
_____________________________________________
_____________________________________________
2. Have you received or are you receiving any of the following? (check all that apply)
Sp
eech/Language therapy
Occupational Therapy
Physical Therapy
Daily Medication (not including vitamins)
Special Education services in school
Counseling
Other:_______________________________________
3. I lea
rn best when I:
4. I do not
like it when I am asked to:
©2016 The Advocacy Network on Disabilities. All Rights reserved.
YEN “Getting to Know Me
Name: __________________________________________
D.O.B. _____________________ Date________________
5. Activities/things that motivate me:
6. Activities I do not like to do:
7. School subjects I am good at:
8. School subjects I find hard:
9. After high school, I want to:
10. Anything else you want us to know about you:
©2016 The Advocacy Network on Disabilities. All Rights reserved.
TOWN OF CUTLER BAY Funded By
Parks & Recreation
Cutler Ridge Park After School Program
Cutler Ridge Park | 10100 SW 200 St., Cutler Bay, FL 33189 | T: (305)233-5472 | F (305) 233-5475
www.cutlerbay-fl.gov | Facebook, Instagram, Twitter: @townofcutlerbay
PARTICIPANT REGISTRATION REQUIREMENTS
1. All participants must have registration forms from The Children’s Trust (TCT), The
Department of Juvenile Justice (DJJ) and the Town of Cutler Bay completed and signed
by a parent/guardian prior to joining the After School Program/Summer Camp. This
program is funded in part by TCT and DJJ. Demographic information collected from the
registration form and other required assessments will be added to TCT and DJJ
information systems. These tracking systems are for information purposes only to
account for youth being supported with grant funding.
2. All of the information required by the Children’s Trust & the Department of Juvenile
Justice must be completed prior to the child participating in any After School/Summer
Program activities.
3. If all information is not provided within one week of the child’s registration, the
parent/guardian will be asked to remove their child from the program until such time as
the required information is made available.
4. Once each participant’s required registration information is complete, the information
will be entered into The Children’s Trust and/or the Department of Juvenile Justice
information tracking system.
5. When a child’s information changes, it is the responsibility of the parent/guardian to
inform the After School/Summer Program staff so that the changes may be made in the
appropriate tracking system(s).
I, _______________________________________ , have reviewed the above stated requirements, and
would like to enroll my child in the Town of Cutler Bay After School and/or Summer Program. I
understand that this program is partially funded by The Children’s Trust and the Department of
Juvenile Justice Prevention Program. I also understand that my child’s demographic
information and assessments required by The Children’s Trust and/or the Department of
Juvenile Justice will be entered into the appropriate funding agency’s information tracking
system, and may be accessed at any time by The Children’s Trust and/or the Department of
Juvenile Justice.
_________________________________ _______________________________ ______________________
(Parent/Guardian’s Signature) (Printed Name of Child) (Date)
TOWN OF CUTLER BAY Funded By
Parks & Recreation
Cutler Ridge Park After School Program
Cutler Ridge Park | 10100 SW 200 St., Cutler Bay, FL 33189 | T: (305)233-5472 | F (305) 233-5475
www.cutlerbay-fl.gov | Facebook, Instagram, Twitter: @townofcutlerbay
SWIMMING PERMISSION FORM
Child’s Name ______________________________________ Birth date: ________________________________
I, _______________________________________ , parent/guardian of _________________________________ ,
(Parent/Guardian’s Name) (Child’s Name)
grant permission for my child to swim at Cutler Ridge Park Pool (10100 SW 200 St Cutler Bay,
FL) on the following date (s) August 31, 2020 June 10, 2021. I understand that certified
lifeguards will be on duty at all times. The program will maintain a minimum staff/child ratio of
1/18 during swimming activities. The program will not be providing additional adults beyond the
required staff/child ratio.
PLEASE CHECK ALL APPLICABLE INFORMATION BELOW
My Child _____________ Is a non-swimmer
_____________ Is a swimmercannot swim in the deep end
_____________ Is a swimmercan swim in the deep end
_____________ Has successfully completed formal swimming lessons
I agree to hold harmless the Town of Cutler Bay, its agents and employees for all incidents
alleging bodily injury or property damage or loss occurring while the person herein described is
a participant in a Town sponsored activity on or off Town premises. I will not hold harmless the
Town of Cutler Bay from any liability arising out of negligence of the Town.
Signature of Parent/Guardian: _____________________________________ Date: _____________________
Signature of Witness: ______________________________________________ Date: _____________________
* A new form must be completed for each new swimming trip that is not routine, and each
time you visit a new swimming location.
July 2020
During the 2009 legislative session, a
new law was passed that requires child
care facilities, family day care homes
and large family child care homes
provide parents with information
detailing the causes, symptoms, and
transmission of the influenza virus
(the flu) every year during August and
September.
My signature below verifies receipt of the
brochure on
Influenza Virus, The Flu, A
Guide to Parents:
Name: ________________________________
Child’s Name: ________________________
Date Received: _______________________
Signature: ____________________________
Please complete and return this portion of
the brochure to your child care provider, in
order for them to maintain it in their records.
What should I do if my child
gets sick?
Consult your doctor and make sure your child gets
plenty of rest and drinks a lot of fluids. Never give
aspirin or medicine that has aspirin in it to children
or teenagers who may have the flu.
CALL OR TAKE YOUR CHILD TO A
DOCTOR RIGHT AWAY IF YOUR CHILD:
Has a high fever or fever that lasts a long time
Has trouble breathing or breathes fast
Has skin that looks blue
Is not drinking enough
Seems confused, will not wake up, does not
want to be held, or has seizures (uncontrolled
shaking)
Gets better but then worse again
Has other conditions (like heart or lung
disease, diabetes) that get worse
What can I do to prevent the
spread of germs?
The main way that the flu spreads is in respiratory
droplets from coughing and sneezing. This can
happen when droplets from a cough or sneeze of an
infected person are propelled through the air and
infect someone nearby. Though much less frequent,
the flu may also spread through indirect contact with
contaminated hands and articles soiled with nose and
throat secretions. To prevent the spread of germs:
Wash hands often with soap
and water.
Cover mouth/nose during
coughs and sneezes. If
you don’t have a tissue,
cough or sneeze into your
upper sleeve, not your
hands.
Limit contact with people
who show signs of illness.
Keep hands away from the
face. Germs are often
spread when a person
touches something that is
contaminated with germs
and then touches his or
her eyes, nose, or mouth.
When should my child
stay home from child care?
A person may be contagious and able to spread
the virus from 1 day before showing symptoms
to up to 5 days after getting sick. The time frame
could be longer in children and in people who don’t
ght disease well (people with weakened immune
systems). When sick, your child should stay at home
to rest and to avoid giving the flu to other children and
should not return to child care or other group setting
until his or her temperature has been normal and has
been sign and symptom free for a period of 24 hours.
For additional helpful information about the dangers of the flu and how to protect
your child, visit:
http://www.cdc.gov/u/ or http://www.immunizeorida.org/
How can I protect my child
from the flu?
A u vaccine is the best way to protect against
the flu. Because the flu virus changes year
to year, annual vaccination against the u is
recommended. The CDC recommends that all
children from the ages of 6 months up to their
19th birthday receive a u vaccine every fall or
winter (children receiving a vaccine for the rst
time require two doses). You also can protect
your child by receiving a u vaccine yourself.
I N F L U E N Z A V I R U S
I N F L U E N Z A V I R U S
“The Flu”
A Guide
for Parents
For additional information, please visit
www.myorida.com/childcare or contact your
local licensing ofce below:
This brochure was created by the Department of Children and
Families in consultation with the Department of Health.
CF/PI 175-70, June 2009
What is the influenza (flu) virus?
Inuenza (“the u”) is caused by a virus which
infects the nose, throat, and lungs. According to
the US Center for Disease Control and Prevention
(CDC), the u is more dangerous than the common
cold for children. Unlike the common cold, the
flu can cause severe illness and life threatening
complications in many people. Children under 5 who
have the u commonly need medical care. Severe u
complications are most common in children younger
than 2 years old. Flu season can begin as early as
October and last as late as May.
How can I tell if my child has a cold,
or the flu?
Most people with the u feel tired and have fever,
headache, dry cough, sore throat, runny or stuffy
nose, and sore muscles. Some people, especially
children, may also have stomach problems and
diarrhea. Because the flu and colds have similar
symptoms, it can be difcult to tell the difference
between them based on symptoms alone. In
general, the u is worse than the common cold,
and symptoms such as fever, body aches, extreme
tiredness, and dry cough are more common and
intense. People with colds are more likely to have a
runny or stuffy nose. Colds generally do not result
in serious health problems, such as pneumonia,
bacterial infections, or hospitalizations.
TOWN OF CUTLER BAY Funded By
Parks & Recreation
Cutler Ridge Park After School Program
Cutler Ridge Park | 10100 SW 200 St., Cutler Bay, FL 33189 | T: (305)233-5472 | F (305) 233-5475
www.cutlerbay-fl.gov | Facebook, Instagram, Twitter: @townofcutlerbay
BEHAVIOR POLICY
RULES (for participants):
1. Keep your hands and feet to yourself. No fighting or bullying. Do not touch other people
or their belongings.
2. No stealing.
3. No lying
4. No cursing, swearing or name calling.
5. No cheating.
6. No running inside.
7. No yelling inside.
8. Wait your turn in the game room.
9. No eating or drinking inside unless you have permission.
10. If someone is bothering you tell a counselor.
11. If you need help with something (homework, game) ask a counselor.
12. Treat people the way you want to be treated.
13. Ask for permission to go to the bathroom or get water.
14. No cell phones during homework time.
WARNINGS:
1. Ask the child to stop. Explain to him/her what they are doing wrong.
2. Speak to the child in private. Explain to him/her what they are doing wrong.
CONSEQUENCES:
1. Timeout-Place child in timeout. Explain to him/her what they did wrong.
2. Bring child to a Supervisor.
3. Talk to parent.
4. If behavior problem continues child will be suspended from the program for three days.
5. If behavior problem continues child will be suspended from the program for one week.
6. If behavior problem continues after one week suspension, Child will be expelled from the
program.
7. In extreme cases such as fighting or if a child is uncontrollable bring them to a
supervisor immediately, a call to the parent will be made and a three day suspension will
be given to the child.
8. Children shall not be subjected to discipline which is severe, humiliating, or frightening.
9. Discipline shall not be associated with food, rest, or toileting.
10. Spanking or any other form of physical punishment is prohibited.
11. Children may not be denied active play as a consequence of misbehavior.
TOWN OF CUTLER BAY Funded By
Parks & Recreation
Cutler Ridge Park After School Program
Cutler Ridge Park | 10100 SW 200 St., Cutler Bay, FL 33189 | T: (305)233-5472 | F (305) 233-5475
www.cutlerbay-fl.gov | Facebook, Instagram, Twitter: @townofcutlerbay
ATTENDANCE POLICY
Town of Cutler Bay, Cutler Ridge Park has established an attendance requirement for the
After School Program. Each participant must follow the attendance policy which mandates
that children attend at least 85 percent of the days that the After School Program is
available, or a minimum of four days per week. If you know in advance that your child will
be absent on any given day, please notify the park office (by phone at 305-233-5472 or by
fax at 305-233-5457), so that unnecessary time is not spent searching for your child.
In addition, it is important that once a child arrives at the park he/she is able to devote at
least two hours per day to program activities such as homework, reading, fitness, social skill
building and more. Please do not use the After School Program as a short-term
“babysitting” service or alternative to picking your child up at school. If, in the sole opinion
of the After School Program staff, your child is not spending adequate time on program
activities, your child may be asked to leave the program in order to make room for a child
who is in greater need of the services being offered by the program.
It is very important that all parents follow the attendance policy, so that each child may
receive the full benefits that the After School Program has to offer.
TOWN OF CUTLER BAY Funded By
Parks & Recreation
Cutler Ridge Park After School Program
Cutler Ridge Park | 10100 SW 200 St., Cutler Bay, FL 33189 | T: (305)233-5472 | F (305) 233-5475
www.cutlerbay-fl.gov | Facebook, Instagram, Twitter: @townofcutlerbay
CLIENT CONFIDENTIALITY POLICY
The Town of Cutler Bay’s records, including all information gathered in conjunction with
the operation of the After School Program at Cutler Ridge Park, are governed by the State
of Florida’s “Public Records Law,” Chapter 119 of the Florida Statutes. A copy of Chapter 119 is
available in the Parks and Recreation Department office (10100 SW 200 Street, Cutler Bay,
FL 3189) and in the Town Clerk’s office in Town Hall (10720 Caribbean Blvd., Suite 105, Cutler
Bay, FL 33189).
Section 119.071 (5) (c) specifically provides for the exemption of disclosure of certain
information as follows:
Any information that would identify or help to locate a child who
participates in government-sponsored recreation programs or
camps or the parents or guardians of such child, including, but not
limited to, the name, home address, telephone number, social
security number, or photograph of the child; the names and
locations of schools attended by such child; and the names, home
addresses, and social security numbers of parents or guardians of
such child is exempt from s. 119.07(1) and s. 24(a), Art. I of the State
Constitution. Information made exempt pursuant to this paragraph
may be disclosed by court order upon a showing of good cause. This
exemption applies to records held before, on, or after the effective
date of this exemption.
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TOWN OF CUTLER BAY Funded By
Parks & Recreation
Cutler Ridge Park After School Program
Cutler Ridge Park | 10100 SW 200 St., Cutler Bay, FL 33189 | T: (305)233-5472 | F (305) 233-5475
www.cutlerbay-fl.gov | Facebook, Instagram, Twitter: @townofcutlerbay
LATE PICK-UP POLICY
1. The After School Program ends at 6:00pm Monday through Friday. There is a late fee
of $1 per minute after 6:01pm.
2. Your child will not be left unattended. A staff member will stay until your child is
picked up.
3. If you know you are going to be late, please call the park at (305) 233-5472 and let the
staff know.
4. It is the parent’s responsibility to synchronize their watches with the Recreation
Center’s clock.
5. When a child is not picked up by 6:00 pm, Park staff will attempt to contact the
child’s parents to determine their estimated time of arrival.
A. In the event that a parent cannot be contacted, Park staff will attempt to
contact the first person indicated on the “Emergency Contact and Authorized
Pick-Up” list on the child’s registration form to pick up the child.
B. Additional calls will be made to those listed on the “Emergency Contact and
Authorized Pick-Up” list until someone is contacted who can pick up the child.
C. If no one is able to pick up the child by 6:30 pm, a call will be placed to the
Cutler Bay Police Department for assistance in making sure the child is
escorted home safely.
6. Chronic lateness will result in your child's expulsion from the program.
1/31/2008
STATEMENT OF PURPOSE FOR COLLECTION OF SOCIAL SECURITY
NUMBERS FROM PARTICIPANTS IN PROGRAMS FUNDED BY THE
CHILDREN’S TRUST
Florida Law requires The Children’s Trust of Miami-Dade to state in writing the purposes for
which it collects social security numbers to provide a copy of that statement of purpose to
individuals from whom it collects social security numbers. Since this program is funded in whole
or in part by The Children’s Trust, this agency may share with the Children’s Trust the social
security number of an individual child or youth who participates in the program of service. This
document signifies notice to you that the social security number of the program participant may
be provided to The Children’s Trust.
The Children’s Trust of Miami-Dade collects the social security numbers of child participants of
funded programs and services for the following purposes:
To research, track and measure the impact of The Children’s Trust’s funded programs and
services so that these programs and services may be maintained and improved in the future
(individual identifying information will not be disclosed).
To identify and march individuals and data within and among various systems and other
agencies for research purposes.
The Children’s Trust does not collect social security numbers for adult participants.
The Children’s Trust of Miami Dade
3150 SW 3 Avenue (Coral Way)
Miami, Florida 33129
305-571-5700
www.thechildrenstrust.org
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Updated 06/16
INFORMATION ON REPORTING ABOUT CHILDREN WITH DISABILITIES
DEFINITION
The Children's Trust Board of Directors defines children with disabilities as:
Children who currently have a physical, emotional, developmental, behavioral, or chronic medical
condition or delay. These children experience impairment in their sensory, cognitive, motor, emotional, or
behavioral functioning, which requires support, ongoing intervention, or accommodation provided by others
in order to participate in an age-appropriate fashion in education, social activity, or physical activity in an
appropriate environment.
INFORMATION TO BE COLLECTED AND REPORTED
The Child Information Form posted on The Trust website is intended to assist providers in collecting
meaningful information about how to better serve children with disabilities in all its funded programs. This
includes information about a child’s primary method of communication, as well as specialized supports and
services the child is receiving and/or needs to fully and meaningfully participate in the program. This
information is reported in The Trust’s electronic reporting system along with other demographics. See page 3
of this document for detailed guidance on how to report the information.
CONDITIONS
The Children’s Trust uses the following categories to track different conditions experienced by children with
disabilities. When entering information into The Trust electronic reporting system, if you indicate that a child
has a condition expected to last for a year or more, you must also choose at least one of the following. A
child may have more than one condition; please indicate all that apply.
Physical Disability or Impairment: Conditions that substantially limit one or more basic physical activity,
such as walking, climbing stairs, reaching, lifting, or carrying (for example cerebral palsy).
Medical Condition or Illness: An ongoing health condition that affects a child’s ability to participate in
at least one program activity. Examples include seizure disorders, asthma, diabetes, sickle cell anemia,
cystic fibrosis, cancer, and HIV/AIDS. Children with chronic medical conditions may be ill or well at any
given time, but they are always living with the condition.
Hearing Impairment or Deaf: A full or partial decrease in the ability to detect or understand sounds
(sometimes referred to as deaf or hard-of-hearing).
Visual Impairment or Blind: Limited or lack of ability to see visual images (sometimes referred to as blind
or legally blind).
Speech or Language Condition: Children with speech/language impairments experience difficulties
that persist beyond early childhood in at least one of the following areas: speech or language
processing, speech or language production, and language use.
Autism Spectrum Disorders (ASD): A general term widely used to refer to Autism, Asperger’s Syndrome,
and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), which are typified, in
varying degrees, by difficulties with social interaction, verbal and nonverbal communication, and
repetitive behaviors or interests.
Developmental Delay (applies only to children through age 5): Refers to a child whose development
lags significantly behind established typical ranges for his or her age in areas that include
speech/communication, self-help, cognitive, physical, and/or social/emotional development.
Updated 06/16
Learning disability (if school-age): This may include learning disabilities, which involve a discrepancy
between achievement and intellectual ability in one or more of the following areas: oral expression,
listening comprehension, written expression, basic reading skills, reading comprehension, mathematical
calculation, and mathematical reasoning.
Problems with Attention or Hyperactivity (ADHD/ADD): Attention Deficit Hyperactivity Disorder is
characterized by an individual having difficulty focusing on a task and maintaining concentration,
being overly active and/or having difficulty with impulse control.
Problems with Depression or Anxiety: Depression refers to a condition characterized by feelings of
sadness, despair, and discouragement. Anxiety is characterized by nervousness, fear, apprehension,
and worrying.
Problems with Aggression or Temper: Aggression is a form of behavior designed to hurt someone else,
either emotionally or physically. It is often accompanied by quick or intense feelings of anger.
Intellectual/Developmental Disability (applies only to children over age 5): Refers to limitations both in
intellectual functioning and the ability to independently conduct activities of daily living.
OTHER PRIORITY POPULATIONS
While The Children’s Trust is focused on supporting all children in our community, one of our guiding
principles specifies that we target early intervention and prevention services to our most vulnerable
children, families and neighborhoods. In addition to children with disabilities and special health and
mental health care needs, some other vulnerable populations include children of migrant parents and
children involved in the dependency and/or delinquency systems.
DEFINITIONS
Children involved in the dependency system: Children involved with DCF, Our Kids, full case
management agencies, dependency and/or family courts.
Children involved in the delinquency system: Children involved with the Department of Juvenile
Justice (DJJ), Juvenile Services Department, and/or diversion/Civil Citation programs.
Know Your
Child Care
Facility
MyFLFamilies.com/ChildCare
CF/PI 175-24, 03/2014
This brochure was created by the
Florida Department of Children and Families,
Ofce of Child Care Regulation and Background Screening
pursuant to s. 402.3125(5), F.S.,
To report suspected or actual cases of
child abuse or neglect, please call the
Florida Abuse Hotline at 1-800-962-2873.
This child care facility is licensed
accordingto the minimum licensure
standards included in
section 402.305, Florida Statutes
(F.S.), and Chapter 65C-22, Florida
Administrative Code (F.A.C.).
License Number: ___________
License Issued on __/__/__
License Expires on __/__/__
For more information regarding
the compliance history of this child care
provider, please visit:
MyFLFamilies.com/childcare
Office of Child Care Regulation
and Background Screening
Office of Child Care Regulation
and Background Screening
More
information
and free
resources:
MyFLFamilies.com/ChildCare
A parent’s role in quality child care is vital:
Inquire about the qualications and
experience of child care staff, as well
as staff turnover.
Know the facility’s policies and
procedures.
Communicate directly with caregivers.
Visit and observe the facility.
Participate in special activities,
meetings, and conferences.
Talk to your child about their daily
experiences in child care.
Arrange alternate care for their child
when they are sick.
Familiarize yourself with the child care
standards used to license the child
care facility.
Parent’s Role
C11MD2768
06 01 2020
12 01 2020
Quality Caregivers
Are friendly and eager to care for children.
Accept family cultural and ethnic differences.
Are warm, understanding, encouraging, and
responsive to each child’s individual needs.
Use a pleasant tone of voice and freqently hold,
cuddle, and talk to the children.
Help children manage their behavior in a positive,
constructive, and non-threatening manner.
Allow children to play alone or in small groups.
Are attentive to and interact with the children.
Provide stimulating, interesting, and educational
activities.
Demonstrate knowledge of social and emotional
needs and developmental tasks for all children.
Communicate with parents.
Quality Environments
Are clean, safe, inviting, comfortable, child-friendly.
Provide easy access to age-appropriate toys.
Display children’s activities and creations.
Provide a safe and secure environment that fosters
the growing independence of all children.
Quality Child Care
Quality child care offers healthy, social, and
educational experiences under qualied supervision
in a safe, nurturing, and stimulating environment.
Children in these settings participate in daily,
age-appropriate activities that help develop essential
skills, build independence and instill self-respect.
When evaluating the quality of a child care setting,
the following indicators should be considered:
Quality Activities
Are children initiated and teacher facilitated.
Include social interchanges with all children.
Are expressive including play, painting, drawing,
story telling, music, dancing, and other varied
activities.
Include exercise and coordination development.
Include free play and organized activities.
Include opportunities for all children to read, be
creative, explore, and problem-solve.
Every licensed child care facility must meet
the minimum state child care licensing standards
pursuant to s. 402.305, F.S., and ch.
65C-22, F.A.C., which include, but are not limited
to, the following:
Valid license posted for parents to see.
All staff appropriately screened.
Maintain appropriate transportation vehicles
(if transportation is provided).
Provide parents with written disciplinary practices
used by the facility.
Provide access to the facility during normal hours
of operation.
Maintain minimum staff-to-child ratios:
Physical Environment
Maintain sufcient usable indoor oor space
for playing, working, and napping.
Provide space that is clean and free of litter
and other hazards.
Maintain sufcient lighting and inside
temperatures.
Equipt with age and developmentally
appropriate toys.
Provide appropriate bathroom facilities and
other furnishings.
Provide isolation area for children who
become ill.
Practice proper hand washing, toileting,
and diapering activities.
Health Related Requirements
Emergency procedures that include:
Posting Florida Abuse Hotline number
along with other emergency numbers.
Staff trained in rst aid and Infant/Child
CPR on the premises at all times.
Fully stocked rst aid kit.
A working re extinguisher and
documented monthly re drills with
children and staff.
Medication and hazardous materials are
inaccessible and out of children’s reach.
Training Requirements
40-hour introductory child care training.
10-hour in-service training annually.
0.5 continuing education unit of approved
training or 5 clock hours of training in
early literacy and language development.
Director Credential for all facility directors.
General Requirements
Age of Child Child: Teacher Ratio
Infant
1 year old
2 year old
3 year old
4 year old
5 year old and up
4:1
6:1
11:1
15:1
20:1
25:1
Food and Nutrition
Post a meal and snack menu that pro-
vides daily nutritional needs of the chil-
dren (if meals are provided).
Record Keeping
Maintain accurate records that include:
Children’s health exam/immunization
record.
Medication records.
Enrollment information.
Personnel records.
Daily attendance.
Accidents and incidents.
Parental permission for eld trips and
administration of medications.
Getting In; Getting Out...
Developed by:
PREVENTION UNIT
Oce of Family and
Community Services
Out:
Check the Back Seat
• Injust
10 minutes
,acar’stemperaturecanincreaseby19°
• Beforegettingoutofyourcar,checkthebackseat...
Dont forget
your chilD!
•
never
leaveyourchildaloneinacarand
call 911 if you see any
chilD lockeD in a car!
• Placesomethinginthebackseatthatyouwillneedat
work,school,orhome(yourlaptop;yourlunch).
Getting In; Getting Out...
Developed by:
PREVENTION UNIT
Oce of Family and
Community Services
In:
Check Behind The Car
•
Before getting in the car anD starting the engine,
walkaroundthecarand
check for kiDs, toys, anD pets!
• Makesurethereis
nothing unDer or BehinD your car
thatcould
attractayoungchild.
•
pick up toys, Bikes, chalk or any type of
equipment
aroundthedrivewaysothattheseitems
don’tenticekidstoplay.