Fill - Free fillable KIDS W.O.R.L.D. 2020-21 EXTRAORDINARY SKIES. UNCOMMON GROUND. (City of Sierra Vista) PDF form

EXTRAORDINARY SKIES. UNCOMMON GROUND.

2020-21

KID’S W.O.R.L.D.

Available to children in grades K - 6

Program begins when school ends and lasts until

5:30 

$45 per week

Program sites are Bella Vista Elementary, Huachuca

Mountain Elementary, Town & Country Elementary

Completed registration forms should be emailed to

KidsWORLD@SierraVistaAZ.gov. Sta will contact you for

payment. Program begins September 14.

Carmichael and Village Meadows

students will be bused to Bella Vista

Pueblo Del Sol students will be

bused to Town & Country

Registration forms are available

online, just search “KW Registration

Form”

For more information:

OSCAR YRUN COMMUNITY

CENTER (OYCC)

3020 E Tacoma St

(520) 458-7922

Monday - Friday 8:00AM - 5:00PM

For more information:

KidsWORLD@SierraVistaAZ.gov

EXTRAORDINARY SKIES. UNCOMMON GROUND.

2020-21 KID’S W.O.R.L.D. REGISTRATION FORM

Kid’s W.O.R.L.D. Parent Information Sheet

NOTICE: The conditions surrounding the COVID-19 pandemic are continually evolving, and Kid’s W.O.R.L.D.’s

plan and safety protocols will be constantly evaluated to adapt to the continuing trends of the COVID-19

virus, guided by local, state, and national authorities

SCREENING – All children will be screened upon arrival to the program. They CANNOT attend the

program if they have a fever above 99.9 and/or a dry cough. Children MUST be fever free (without

medication) for AT LEAST 24 hours.

MASK POLICY - Masks are mandatory for all children, parents/guardians, and staff while at the Kid’s

W.O.R.L.D. program.

EXPOSURE ACKNOWLEDGEMENT - The risk to have direct or indirect contact with individuals who have

been exposed to and/or diagnosed with one or more communicable diseases, including but not limited

to COVID-19 or other medical conditions, diseases, or maladies, and/or any mutation or variation thereof

does exist and it is impossible to eliminate the risk that your child could become infected through contact

with or close proximity to an individual with a communicable disease.

PICKUP DUE TO ILLNESS – Immediate pick up is required for children with a fever above 99.9, a dry

cough, or any other illness for safety concerns. Children MUST be fever free (without medication) for AT

LEAST 24 hours to return to the program.

FEE PAYMENT – Weekly participation fees are due by 1:00 P.M. the first day of attendance that week.

When payment is not received by 1:00 p.m., a $10 late fee will apply. Payments are not accepted at the

program site. No exceptions. I understand weekly attendance fees can be paid online, via credit card or

over the phone at the OYCC during business hours.

REFUNDS/CREDITS - The weekly fee applies to any number of days attended Monday-Friday. To receive

a credit or refund for participation fees paid in advance (for the current week or beyond), notification

must be sent in writing to KidsWORLD@SierraVistaAZ.gov no later than 1:00

pm Monday of that week. No

refunds or credits will be given for absences, sickness, or days otherwise missed during the current week

of participation (including suspensions). A 15% administrative fee will be charged on any refunds.

COVID-19 REFUND POLICY - Household credits will be issued in the event of program closure due to

direct exposure.

LATE PICK UP FEES – The program ends at 5:30

pm late pick ups will be charged $10/child for every 10

minutes (5:31 -5:40 pm = $10, 5:41 -5:50 pm = $20, etc.) Multiple late pick ups may result in a suspension or

removal from the program. If a Before School Program is offered, no drop offs will be allowed prior to

6:40

am.

Pickup will be contactless. Participants must be picked up by someone on the registration form. An ID is

required when signing out a child. We cannot physically / otherwise restrain participants who choose to

leave the program of their own volition.

BEHAVIOR MANAGEMENT – We promote a “hands off” approach, so participants MUST be able to

respond to verbal direction from staff. Emphasis is placed on each child taking responsibility for their

own actions. Participants do not have the right to endanger or interrupt the activity of other children.

If your child is having trouble with another participant or needs assistance, they should notify a staff

member. Behavioral problems will be approached as deemed appropriate:

Verbal Warning/Redirection

Time Out/Loss of Privileges Short/Long-Term Suspension

Extreme behaviors that put a child, or those around them in danger or harms way, may accelerate

this process. These include, but are not limited to:

Leaving the Program Inappropriately

Throwing Objects Physical Attacks

Inappropriate Language Disrespect to Staff

EXTRAORDINARY SKIES. UNCOMMON GROUND.

2020-21 KID’S W.O.R.L.D. REGISTRATION FORM

Kid’s W.O.R.L.D. Parent Information Sheet (continued)

EMERGENCY CARE - In the event I cannot be reached in an emergency, I hereby give my permission to

employees of Sierra Vista Leisure Services to secure medical care for my child as deemed necessary. I

understand 9-1-1 can be used for urgent medical care.

PHOTOS - The City of Sierra may take photos of participants enrolled in our programs or activities. These

photos are for department use /promotion or may be used in future promotional materials. As a public

program, participants may also be exposed to outside sources/media.

LIABILITY WAIVER - As a participant in the above activity, I recognize that there are certain risks of

physical injury and I agree to assume the full risk of any injuries, including death, damages or loss which

my child may sustain as a result of participating in any and all activities connected with or associated

with such programs. I agree to waive and relinquish all claims I may have as a result of participating in

the program against the U.S. Government or City of Sierra Vista, their officers, agents, servants, and

employees. I do hereby release and discharge the U.S. Government, City of Sierra Vista and their officers,

agents, servants, and employees from any and all claims from injuries, including death, damage or loss

which I may have or which may occur to me on account of my participation in the program. I do further

agree to indemnify and hold harmless the U.S. Government, City of Sierra Vista and their officers, agents,

servants, and employees from any and all claims resulting from injuries, including death, and losses

sustained by me and arising out of, connected with, or in any way associated with the activities of the

program.

Online Payment Instructions

First Time Online Users

1. You will need to register for the Kid’s W.O.R.L.D. program before you can make online

payments.

2. Once you have registered, you will get your Household ID. It is located in the top right

corner of your receipt. The default password is your zip code. Once you have your login

information, follow the instructions for “Registered Users” below.

After logging in for the first time, you may change your login information.

Registered Users

1. Go to the city’s website (www.SierraVistaAZ.gov).

2. Click on the top bar where it says “I want to:”

3. Click “Pay Online” then the pop out will give you the option to choose your child’s school/

site.

4. Scroll to “Activity Search Results” and “add to cart” the program site and activity dates by

clicking on the shopping cart.

5. You’ll be prompted to login using your ID/user name and password (see below).

6. Select the family member you wish to register and click the “add to cart” icon.

7. Repeat for additional weeks/family members, then proceed to check out.

8. An email with your receipt will be sent to you.

IMPORTANT: If you do not receive an email with your receipt, then the payment has not

been processed. Please give us a call if you do not receive a receipt.

My household ID #/User Name is

My password is

EXTRAORDINARY SKIES. UNCOMMON GROUND.

2020-21 KID’S W.O.R.L.D. REGISTRATION FORM

Kid’s W.O.R.L.D. is a group-recreation focused program. All participants must be able to feed & toilet themselves,

follow verbal directions, and interact appropriately in a group environment. If a child has a disability that requires

an ADA accommodation, please contact the OYCC to receive a Request for Accommodation packet and submit

prior to enrollment. If a request has already been granted for KW 2020-21, another one is not necessary.

This packet must be filled out completely and turned in prior to enrollment & attending the program.

CHILD:

Grade: School: Birth date: Sex(M/F):

Address: City: Zip Code:

FATHER/GUARDIAN E-mail:

Employer: Wk. Ph#: Cell /Hm. Ph#:

MOTHER/GUARDIAN: E-mail:

Employer: Wk. Ph#: Cell/Hm. Ph#:

HEALTH INFORMATION (Please initial all below):

YES: I understand my child must be able to toilet them self (includes identify need, proper use, dress self, no

pull-ups, etc)

NO / YES: Are there any health issues (food allergies, etc) affecting your child?

If so, please provide details:

NO / YES: Does your child have an ADA disability requiring an accommodation? If so, attach completed

Request for Accomodation packet.

NO / YES: Is your child on any medication? If so, please list:

MEDICATIONS - Meds are not allowed on site, except for Rescue Inhalers & EPI-pens. These must be left with

staff in the prescription box.

EMERGENCY CONTACTS – List (2) or more LOCAL individuals BESIDES Parents/Guardians listed above.

We attempt to contact the parent(s) first. The following may also be contacted (or) remove my child from the

program.

NAME – As it appears on ID

(Do not re-list parent/guardian above)

RELATIONSHIP HOME PHONE/

CELL

WORK PHONE

The following person, or persons, may not remove my child from the program: (Copy of custody or court papers

MUST be provided for any name given for us to enforce):

EXTRAORDINARY SKIES. UNCOMMON GROUND.

2020-21 KID’S W.O.R.L.D. REGISTRATION FORM

Kid’s W.O.R.L.D. Terms & Conditions

NOTICE: The conditions surrounding the COVID-19 pandemic are continually evolving, and Kid’s W.O.R.L.D.’s

plan and safety protocols will be constantly evaluated to adapt to the continuing trends of the COVID-19

virus, guided by local, state, and national authorities

Initial ALL Below:

: SCREENING* – All children will be screened upon arrival to the program. They CANNOT attend

the program if they have a fever above 99.9 and/or a dry cough. Children MUST be fever free (without

medication) for AT LEAST 24 hours.*Pickup will be contactless.

: MASK POLICY - Masks are mandatory for all children, parents/guardians, and staff while at the

Kid’s W.O.R.L.D. program.

: EXPOSURE ACKNOWLEDGEMENT - The risk to have direct or indirect contact with individuals

who have been exposed to and/or diagnosed with one or more communicable diseases, including but not

limited to COVID-19 or other medical conditions, diseases, or maladies, and/or any mutation or variation

thereof does exist, and it is impossible to eliminate the risk that your child could become infected through

contact with or close proximity to an individual with a communicable disease.

: PICKUP DUE TO ILLNESS – Immediate pick up is required for children with a fever above 99.9, a

dry cough, or any other illness for safety concerns. Children MUST be fever free (without medication) for

AT LEAST 24 hours to return to the program.

: FEE PAYMENT – Weekly participation fees are due by 1:00 P.M. the first day of attendance that

week. When payment is not received by 1:00 p.m., a $10 late fee will apply. Payments are not accepted at

the program site. No exceptions. I understand weekly attendance fees can be paid online, via credit card

or over the phone at the OYCC during business hours.

: REFUNDS/CREDITS - The weekly fee applies to any number of days attended Monday-Friday.

To receive a credit or refund for participation fees paid in advance (for the current week or beyond),

notification must be sent in writing to KidsWORLD@SierraVistaAZ.gov no later than 1:00

pm Monday of

that week. No refunds or credits will be given for absences, sickness, or days otherwise missed during

the current week of participation (including suspensions). A 15% administrative fee will be charged on any

refunds.

: COVID-19 REFUND POLICY - Household credits will be issued in the event of program closure due

to direct exposure.

: LATE PICK UP FEES – The program ends at 5:30 pm late pick ups will be charged $10/child for

every 10 minutes (5:31 -5:40 pm = $10, 5:41 -5:50 pm = $20, etc.) Multiple late pick ups may result in a

suspension or removal from the program. If a Before School Program is offered, no drop offs will be

allowed prior to 6:40

am.

: SIGN IN/OUT - Daily attendance is tracked for program purposes. Children will be signed in/out

daily. Pickup will be contactless. Participants must be picked up by someone on the registration form.

An ID is required when signing out a child. We cannot physically / otherwise restrain participants who

choose to leave the program of their own volition.

: BEHAVIOR MANAGEMENT – We promote a “hands off” approach, so participants MUST be able

to respond to verbal direction from staff. Emphasis is placed on each child taking responsibility for their

own actions. Participants do not have the right to endanger or interrupt the activity of other children.

If your child is having trouble with another participant or needs assistance, they should notify a staff

member. Behavioral problems will be approached as deemed appropriate:

Verbal Warning/Redirection

Time Out/Loss of Privileges Short/Long-Term Suspension

Extreme behaviors that put a child, or those around them in danger or harms way, may accelerate this

process. These include, but are not limited to:

Leaving the Program Inappropriately

Throwing Objects Physical Attacks

Inappropriate Language Disrespect to Staff

EXTRAORDINARY SKIES. UNCOMMON GROUND.

2020-21 KID’S W.O.R.L.D. REGISTRATION FORM

Kid’s W.O.R.L.D. Terms & Conditions (continued)

: EMERGENCY CARE - In the event I cannot be reached in an emergency, I hereby give my

permission to employees of Sierra Vista Leisure Services to secure medical care for my child as deemed

necessary. I understand 9-1-1 can be used for urgent medical care.

: PHOTOS - The City of Sierra may take photos of participants enrolled in our programs or

activities. These photos are for department use /promotion or may be used in future promotional

materials. As a public program, participants may also be exposed to outside sources/media.

: LIABILITY WAIVER - As a participant in the above activity, I recognize that there are certain risks

of physical injury and I agree to assume the full risk of any injuries, including death, damages or loss which