CAFE Drop-Off Form 2014-2015
Parent Name ______________________________________
Address__________________________________________
Email Address _______________________________________________________________
Phone numbers where parent can be reached during CAFE hours ______________________
____________________________________________________________________________
Alternate person’s name ________________________________________________________
Alternate person’s phone number ________________________________________________
Student Name_____________________________________ Age _____
Medical Information ___________________________________________________________
Designated CAFE Adult responsible for your child ___________________________________
Drop-Off Policy
1. Students ages 14 and up in paid high school level classes may be dropped off or drive themselves. Parents must fill out a drop-off form with contact information at the beginning of the semester, and must be accessible at the given phone numbers during co-op hours. If discipline issues arise, the co-op may require a parent to be on the premises during class hours.
2. Students in paid junior high level classes (ages 11-13) may be dropped off, but must be responsible to a designated adult on the premises. Parents must fill out a drop-off form with contact information at the beginning of the semester, and must be accessible at the given numbers during co-op hours. If discipline issues arise, the co-op may require a parent to be on the premises during class hours.
3. There is a $50 drop off fee per family per semester in addition to the family registration fee.
4. Drop-off families will still have cleaning assignments and family responsibilities.
I understand and have read the Drop-Off Policy.
Initials
Waiver of Liability
In consideration of the opportunity afforded my family’s participation in CAFE, I hereby voluntarily fully waive any rights, actions or causes of action resulting from personal injury or death to any member of my family or damage to property, sustained in connection with participation in with CAFE activities and agree to hold CAFE and ECC, its board members, and affiliates, harmless from and against any and all claims, liabilities, rights or causes of action arising out of or as a result of with any injuries, or damages that occur as a result of my family’s participation in CAFE activities. I AGREE NOT TO SUE CAFE and ECC, ITS BOARD MEMBERS, OR AFFILIATES, in connection with any injuries, or damages that occur as a result of my family’s participation in CAFE activities.
Parent Signature _____________________________________________
Print Parent’s Name __________________________________________
Executed this ___________ day of ___________________, 2014.
CAFE Drop-Off Form and Liability Waiver 2014-2015
CAFE Policies and Liability Waiver 2014-2015
Parent Responsibilities
1. If you are running late, please call the Coordinator or someone who would be on site to let them know when you will be arriving.
2. Please let the Coordinator know if someone other yourself will be bringing your children or visiting.
3. Be alert and aware of activities and happenings in and around the building at all times. We are all traffic controllers, hall monitors and building security!
4. Parents are expected to remain on the premises while children are participating in classes. If a child is not in class during any given hour, he/she must be in the designated study hall area or in the immediate vicinity of his/her parent. Children should not be wandering the halls. If you leave for any reason, you must designate another parent to be responsible for your children, record that information on the sign out sheet and inform your children who is responsible for them.
5. Students may be outside with a parents' permission and supervision. Children should play in the side parking lot only, and parents should use extreme caution when driving on church property.
I understand and have read the Parent Responsibilities.
Initials
Student Responsibilities
1. Be on time to class and come prepared.
2. Walk in the hallways, respect the church property, and be kind and respectful to others.
3. Honor teachers and other adults by addressing them with formal titles (ie. Mr./Mrs.), and responding appropriately to teachers' directives.
4. Complete all class requirements and cooperate with teachers at all times.
5. Stay current with assignments and take responsibility for making up missed material due to an absence. A pattern of excessive absences or late/missed assignments may result in notification by the teacher to the parent and/or co-op leadership, or even dismissal from the class with no refund.
6. No gum is allowed.
7. No cell phones, other electronic games/equipment, or personal items such as trading cards, toys, headphones, etc. should be brought to class unless approved by the teacher. Each teacher has the right to confiscate any distracting item until the end of class or returned to a parent.
I understand and have read the Student Responsibilities.
Initials
Discipline Policy
Every student is expected to participate in class activities, to honor teachers and other adults, and to respect their fellow students. If a child is disrupting a class session and does not respond to verbal redirection, he/she will be removed from the class and escorted to the parent for the duration of the class period.
If the child's behavior continues to be a disruption, co-op leadership will work with the teacher and the parent to resolve the situation. However, the co-op reserves the right to dismiss the child from the class for the rest of the term. The child will be expected to remain with the parent during that class period for the remaining weeks.
We are guests of Evangelical Community Church, and thus any willful destruction of church property will not be tolerated. Failure to respect the building or property may result in co-op discipline and/or dismissal. Please report any accidental damage immediately.
I understand and have read the Discipline Policy..
Initials
Waiver of Liability
In consideration of the opportunity afforded my family’s participation in CAFE, I hereby voluntarily fully waive any rights, actions or causes of action resulting from personal injury or death to any member of my family or damage to property, sustained in connection with participation in with CAFE activities and agree to hold CAFE and Evangelical Community Church (ECC), its board members, and affiliates, harmless from and against any and all claims, liabilities, rights or causes of action arising out of or as a result of with any injuries, or damages that occur as a result of my family’s participation in CAFE activities. I AGREE NOT TO SUE CAFE and ECC, ITS BOARD MEMBERS, OR AFFILIATES, in connection with any injuries, or damages that occur as a result of my family’s participation in CAFE activities.
Parent Signature _____________________________________________
Print Parent’s Name __________________________________________
Executed this ___________ day of ___________________, 2014.
CAFE Policy Form and Liability Waiver 2014-2015