Child's Name
*
First Name
Last Name
Child's Grade
*
K
1st
2nd
3rd
4th
5th
6th
7th
8th
Date of Birth
*
MM
DD
YYYY
Second Child's Name
First Name
Last Name
Child's Grade
K
1st
2nd
3rd
4th
5th
6th
7th
8th
Date of Birth
MM
DD
YYYY
Parent Name
*
First Name
Last Name
Parent Email
*
Parent Phone Number
*
(###)
###
####
Parent 2 Name
First Name
Last Name
Parent 2 Email
Parent 2 Phone Number
(###)
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Child Lives With
*
Both Parents
Dad
Mom
Guardian
Child's Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Address of Parent or Guardian (if different from Child's)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact
*
Must be someone other than parents.
First Name
Last Name
Emergency Contact Phone
*
(###)
###
####
Emergency Contact's Address
*
Please list Emergency Contact's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
I give consent for Southlake Tutoring Academy to secure any and all necessary emergency medical care for my child.
*
Yes
No
I give my consent for my child to be transported and supervised by Southlake Tutoring Academy employees:
*
Please check all that apply.
List any special needs that your child may have, such as environmental allergies, food intolerances, existing illness, previous serious illness, injuries and hospitalizations during the past 12 past months, any medication prescribed for long term continuous use, and any other information which caregivers should be aware.
My child attends the following school:
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Name of school.
School's Phone Number
*
(###)
###
####
My child has permission to:
*
Check all that apply.
Southlake Tutoring Academy Operational Manual. Please read the following manual and acknowledge that you read it.
*
Daily Schedule:
3:15pm – 3:30pm (Arrival & Snack time)
3:30pm – 4:30pm (Foreign Language Classes for Chinese/Spanish)
4:30pm – 5:30pm (Homework helps & Enrichment Program)
5:30pm – 6:30pm (STA Activities & Dismissal)
Snacks: STA will NOT provide snacks. Please pack a snack for the student daily.
To ensure a safe environment for all students and staff participating in STA 2022 Fall academic programs, we will strictly follow CDC and Texas State Child Care licensing Minimum Standards for Child Care Center Operations to screen those entering our facility.
We will send home any employee or child who has any of the following signs or symptoms of possible COVID-19:
- Cough
- Shortness of breath or difficulty breathing
- Sore throat
- Chills
- Loss of taste or smell
- Diarrhea
- Muscle pain
- Headache
- Feeling feverish or a measured temperature greater than or equal to 100.0 degrees Fahrenheit
-Repeated shaking with chills
- Known close contact with a person who is lab-confirmed to have COVID-19
--Recommend all new hires and existing employees to take a COVID test and bring in a negative test result prior to coming to work. (up to employee’s discretion)
Modified children drop off/pick up procedure:
Morning Drop-off: No parents are allowed into the building. Only enrolled students are allowed into the building to ensure limited access. Parents will call the number on the pick up sign and one of our employees will go outside to escort kids inside.
Daily pick up will be through the gym door for after school students and through the front door for academic help students. Parents are not allowed to enter the building. Our staff will bring the camper outside upon parent arrival. We will check them out
We will ensure at least 30 mins of outdoor recess time for those who are staying whole day.
Late Pick-Up
We close promptly at 6pm daily.
For all children not picked up by the end of the program, regular or extended hours, the following late policy will be in effect:
First 5 minutes: Grace Period
Each 5 minutes thereafter: $5.00 per child
The late fee is in place to compensate staff members for their time. If you know you will be late, please attempt to make alternate pick-up arrangements.
STA should be notified if you foresee late arrival, as it is often stressful for a child when parents are late.
NOTE: When a child is not picked up in emergency situations including, but not limited to, inclement weather or natural disasters, we will follow the above “late pick-up” policy listed above starting 45 minutes from when the parent has been informed of the need for students to be picked-up.
Holidays/School Closing
STA Afterschool program observes the same holidays as the CISD school calendar. However, we will offer day
camps with minimum enrollment of 4 kids per day with additional charges.
Inclement Weather Policy
In case of inclement weather conditions, STA will follow the CISD’s decisions of opening/closing.
Children at Risk
Parents who arrive at STA in an incapacitated condition (i.e. alcohol, drugs) present a risk to their child. The staff in charge will advise the parent of their options regarding the transportation of their child to his/her home. Some options that may be exercised are:
Call another person on the child’s emergency contact list
Call the other parent
Call a taxi
Call a nearby neighbor / friend
If a reasonable conclusion cannot be reached, the parent will be advised that either Child Protective
Services or the Police will be called.
TRANSPORTATION
STA will ensure students are transported safely, we will count the students on and off the vehicles and provide booster seats for children who will require them.
BABY-SITTING
Employees of STA are prohibited from babysitting for families with children NOT enrolled in STA Program.
COMMUNICATION
We will send email notifications of any special events/scheduling changes to the parent emails on file or via Remind.
CONDUCT
Our Code of Conduct states that STA is committed to providing a safe and welcoming environment for all of our members and guests. To ensure safety and comfort for all, we ask individuals to act appropriately while they are in our facility or participating in an STA program. We expect persons using STA to behave in a mature and responsible way and to respect the rights and dignity of others.
Our code of conduct does not permit language or action that can hurt or frighten another person or that falls below a generally accepted standard of conduct. Specifically this includes:
♣ Angry or vulgar language including swearing, name calling, and shouting;
♣ Physical contact with another person in an angry or threatening way;
♣ Any demonstration of sexual activity or sexual contact with another person;
♣ Harassment or intimidation with words, gestures, body language or other menacing behavior;
♣ Behavior which intends to or results in the theft or destruction of property;
♣ Carrying or concealing any weapons or devices that may be used as weapons.
Members are responsible for their own personal comfort and safety and should ask any person whose behavior threatens their personal comfort to refrain. Staff are trained and expected to respond to any reported violation of our code of conduct. Please do not hesitate to notify a staff member if you need assistance. We want to help! STA Management will investigate all reported incidents. Dismissal from a program or termination of STA Membership privileges may result from any violation of the code of conduct. No refunds will be given.
Please note that STA Staffs are not required to have specific vaccines
DISABILITIES
In order for STA to provide the best afterschool experience for your child, we ask that prior to registration, you consult with the STA director regarding any special needs of your child. Due to the fact that there are some medical treatments and procedures that legally STA staff is not trained nor qualified to perform, children will be enrolled on an individual basis. We will make every attempt to serve all children.
MEDICATION
The Medication must be given as stated on the label directions or as amended in writing by the child’s health-care professional and must be in the original container labeled with the child’s name and the date brought to the operation. The medication will not be administered after its expiration date. STA must record the full name of the Child to whom the medication was given, the name of the medication, date, time, and amount of the medication given, and full name of the employee administering the medication. We will keep all records for at least three months after administering
DISCIPLINE POLICY (Please See Attached Discipline Standard Form)
If your child needs to be disciplined, acceptable measures may include: stern verbal warnings, time-out from activity, and removal from activity and placed with staff away from group, suspension from STA.
Behavioral guidance is intended to promote your child’s physical, intellectual, emotional, and social well being and growth. Staff shall interact with the child and one another to provide needed help, comfort, support and:
o Respect personal privacy
o Respect differences in cultural, ethnic, and family backgrounds
o Encourage decision making abilities
o Promote ways of getting along
o Encourage independence and self-direction
o Use consistency in applying expectations
Behavioral guidance will be constructive in nature, age and stage appropriate, and will be intended to redirect children to appropriate behavior and resolve conflicts. Parents will be notified when persistent behavioral problems are identified and will include any disciplinary steps taken in response.
EXPECTATIONS
Good behavior will be encouraged in a positive manner. Before the first day of starting with STA, you and your child are required to read through and sign the “Parent Handbook” to confirm the receipt of the rules and policies, found in your registration packet. This way you will both be aware of the rules and consequences. The staff will work cooperatively with parents, keeping them informed of behavior problems and methods used to teach and guide them toward socially acceptable behavior. Behavior problems that cannot be resolved cooperatively will result in your child’s dismissal from STA Program. Certain abusive behaviors will result in immediate dismissal.
If your child has been receiving assistance in behavior management during the school year, it is imperative that this information be shared with the STA staff. This will enable us to work more effectively and productively with your child.
Emergency Preparedness Plan
It is our first responsibility to move the children to a safe area known to all employees, parents, and volunteers
When we evacuate children will line up in a line and walk out of the building. If children have limited mobility or otherwise need assistance, a caregiver will assist them out. If we must leave the property, we will go to the Duff’s famous wings at 2787 E. Southlake Blvd. Southlake, TX 76092.
In the event of a lockdown, we will gather the children and move them to the computer room.
When we evacuate or relocate, we will conduct a face count to ensure all children are present. We will use a staff member cell phone to contact local authorities, parents and licensing. When we evacuate or relocate, we will take following items with us:
1) Parent and emergency contact numbers
2) Authorization for emergency care
3) Sign-in record
If you need to contact us during an emergency, please call 214-566-3421
We will provide food, water and quiet activities until the lockdown or emergency is lifted or children have been release to their parents. When you arrive at our offsite shelter, a staff member will greet you at the door and send your child out to you. We will not release children during a lockdown. Normal release procedures will resume when the lockdown is lifted.
ENROLLMENT, WITHDRAWAL & PAYMENT POLICIES
There are three payment options:
1) Pay the whole semester (early bird receives 5% off)
2) Make payment in 4 installments of equal amount (payment has to be made via auto draft)
3) Enrichment classes will be billed or drafted on the 1st of each month
Please fill out the Auto-Draft Authorization Form at the front desk. All returned checks will incur a $20 processing fee. Any credit card draft payments returned with non-sufficient funds will incur a $20 processing fee.
Any cancellation of the Auto-Draft Authorization needs to be made in writing at least two week in advance to info@southlaketutoringacademy.com , otherwise, your account will be charged automatically without notice.
All withdrawals and/or refund requests must be made in writing at least 2 weeks in advance
∙ All deposits and prepaid tuitions are non-refundable, unless the program is cancelled by STA.
∙ Registration cancellations must be made 2 weeks in advance.
∙ Cancellations less than two weeks in advance will be charged a 20% processing charge in addition to the non-refundable deposit.
All cancellations must be submitted in writing.
NO child will be accepted into the program unless the balance has been paid in full each week
NO child will be able to register without all the required paperwork filled out and submitted to STA.
STA reserves the right to remove a child from any program due to behavioral or other concerns. In the event that this may occur there will be no refund given. Every attempt will be made to work with children and their families through conferences and direct communication.
∙ Talk to your child about the importance of telling you if someone does or says something that makes them feel uncomfortable. Emphasize that adults should not ask them to keep secrets from you.
∙ Explain to your child that s/he has a basic right to privacy and that no one should touch them inappropriately or compel them to touch someone else inappropriately.
∙ Instruct your child to always remain part of the group. Stress safety in numbers.
∙ Be concerned if your child suddenly becomes withdrawn or balks at attending certain activities or being around a particular person. Gently seek to find out why.
∙ Report any actions by STA staff or volunteers that you deem to be inappropriate
If you have questions or concerns, please feel free to address them with the STA Director at: 682-477-4089
We look forward to a happy and safe school year with your child!
Parents have the right to review a copy of our inspection report which is posted on the wall by the sign in table. If they would like to see the minimum standard, they may go to the DFPS website at www.dfps.state.tx.us
You may contact the licensing office at 817-321-8604
Address: 1501 Circle Drive, Fort Worth, TX 76119
I have read Southlake Tutoring Academy After School Manual
I have NOT read the Southlake Tutoring Academy After School
By writing my name below I acknowledge that all the information above is correct to the best of my knowledge.
*
First Name
Last Name
Today's Date
*
MM
DD
YYYY
Were you referred to us by a current student or family enrolled in our After School Program?
Yes
No
If you were referred, please let us know by who.
How will you be paying for this semester's tuition?
*
Pay entire semester tuition at once (5% off through bank draft!)
Monthly installments (auto draft credit card monthly on Sawyer down below)
