03Fees EC 5 17 18 - il02218195.schoolwires.net · ☐ Millburn Middle School • 640 Freedom Way...
Transcript of 03Fees EC 5 17 18 - il02218195.schoolwires.net · ☐ Millburn Middle School • 640 Freedom Way...
Millburn School District 24
2017-‐18 Reg i s t ra t ion Fees One form required for each student.
GRADES Early Childhood through 5 STUDENT NAME GRADE Last First
Materials and Program Support Fees Fee Received BEFORE 4:00 PM on 6/02/17
O R
Fee Received AFTER 4:00 PM on 6/02/17
Returning Students in Grades 1, 2, 3, 4, 5 $175.00 $225.00
Returning Students in Early Childhood $125.00 $175.00
TOTAL
Two ways to pay:
☐ CHECK PAYABLE TO MILLBURN DISTRICT 24
☐ CHECK HERE IF USING REVTRAK and ATTACH PRINTED RECEIPT For Office Use Only
CASH $ CHECK# CHECK AMT$ Check applies to more than one in family? YES PAID BY REVTRAK – Confirmation # Name on check if different from student Date Received Processed by
To pay the lower cos t on the l i st be low , reg is te r on or befo re 4 :00 p .m. on
Fr iday, JUNE 2 , 2017
$
Millburn School District 24
2017-‐18 Reg i s t ra t ion Fees One form required for each student.
GRADES 6 -‐ 8 STUDENT NAME GRADE Last First
Two ways to pay:
☐ CHECK PAYABLE TO MILLBURN DISTRICT 24
☐ CHECK HERE IF USING REVTRAK and ATTACH PRINTED RECEIPT For Office Use Only
Materials and Program Support Fees √ Items you are
purchasing
Fee Received BEFORE
4:00 PM on 6/02/17
OR
Fee Received AFTER
4:00 PM on 6/02/17
Grade 6 (includes gym uniform of shorts and shirt)
$195.00 $245.00
Grade 7 $195.00 $245.00
Grade 8 $195.00 $245.00
Additional PE Shirt (6-‐8) Optional Purchase $ 5.00 $ 5.00
Additional PE Shorts (6-‐8) Optional Purchase $ 8.00 $ 8.00
TOTAL
CASH $ CHECK# CHECK AMT $ Check applies to more than one in family? PAID BY REVTRAK – Confirmation # Name on check if different from student Date Received Processed by
To pay the lower cos t on the l i st be low , reg is te r on or befo re 4 :00 p .m. on Fr iday,
JUNE 2 , 2017
$
Millburn School District 24 2017-‐18 Activities and Fees These are the ACTIVITIES that are available for the 2017-‐18 school year. At the appropriate time/season, the coach/sponsor will have forms available for students to take home and have signed by a parent. All the below activities cost $150.00 each. Fees are due when the form is returned. For an additional fee, for eligible students, an Activity Bus is available upon completion of the Activity Bus Registration form available on the website.
These are the CLUBS that may be available for the 2017-‐18 school year. The sponsor will send home a form to be signed by a parent. All clubs are $50.00 each. Fees are due when the form is returned. For an additional fee, for eligible students, an Activity Bus is available upon completion of the Activity Bus Registration form available on the website. Please note: not all activities are available at both schools. Note: In-‐house clubs should not be confused with groups who rent space from the district and offer similar programs to our students. In-‐house clubs are supervised by district teachers.
CHESS CLUB GAME CLUB ART CLUB MATH CLUB STUDENT SERVICE CLUB NEWSPAPER YEARBOOK CREATIVE WRITING ECOLOGY CLUB
MILLBURN MIDDLE SCHOOL JAZZ BAND THEATER (Grades 4-‐8) DANCE TEAM CHEERLEADING SCHOLASTIC BOWL BASKETBALL CROSS COUNTRY (Grades 5-‐8) WRESTLING (Grades 5-‐8) SOCCER TRACK
MILLBURN ELEMENTARY SCHOOL BAND CHOIR THEATER (Grades 4-‐8) CROSS COUNTRY (Grades 5-‐8) WRESTLING (Grades 5-‐8)
2017-‐18 Act iv i ty Bus Fee ❏ My child should be included on the Bus Roster for the sport/activity in which he or she is participating.
Note to Middle School Parents: If your child is not eligible for regular bus service, then bus service for activities or clubs is also not available. STUDENT NAME_____________________________________________________ GRADE _________
Activity Full Year Option Only
Sport/Activity* Seasonal Cost
Any Activity held outside the school day
1 day a week
$80.00
All seasonal sports
$80.00
Any Activity held outside the school day
2 days a week
$120.00
NOTE: if your child participates in three or more sports/or activities, the cost for busing for the year will not
exceed $200.00.
Any Activity held outside the school day
3 days a week
$150.00
Any Activity held outside the school day
4 or 5 days a week
$200.00
Homework Hut – 2 days a week
$120.00
How to Pay? • A check made payable to “Millburn School District 24” • RevTrak (online payment system) Include a copy of the receipt with this form.
For Office Use Only CASH $ CHECK# REVTRAK Name of check if different from student
Check applies to more than one in family? YES Date Received Processed by
Millburn CCSD #24 exists to create a culture of learning that inspires and empowers students to enrich our community.
Millburn Community Consolidated School District 24 Yearly iPad Accident Protection Plan
Millburn School District 24 is providing and administering an accident protection plan for students and parents as part of our iPad Learning Initiative. Enrollment in this plan is required for students who wish to take their iPad home. Students who are not enrolled in the plan will check their iPad in and out of the classroom each day. This plan covers “accidental damage” to the device and is designed to limit a family’s financial responsibility for any damage as described in the coverage section below. In addition each device is covered under a manufacturer's warranty that covers the normal operation of the device to ensure that it is functioning properly.
Program Rate/Coverage ● $30 Non-refundable Annual Premium ● Limit of Liability: $400
Effective Coverage/Expiration Date ● Effective Date: Based on the receipt of signed
agreement. ● Expiration Date: Last day of school for the current
school year or date of last day of attendance if transferring out of the district.
Coverage (Subject to Deductible Plan Below)
● Accidental Damage: Pays for accidental damage caused by liquid spills, drops, or any other unintentional event.
● Theft: Pays for loss or damage of the iPad due to theft. The claim requires a police report to be filed.
● Fire: Pays for loss or damage of the iPad due to fire. The claim must be accompanied by an official fire report from the investigating authority.
● Electrical Surge: Pays for damage to the iPad due to an electrical surge.
● Natural Disasters: Pays for the loss or damage of the iPad caused by natural disasters.
Exclusions ● Dishonest, Fraudulent, Intentional, Neglect or
Criminal Acts: Will not pay if damage or loss occurs in conjunction with dishonest, fraudulent, intentional, negligent or criminal act. The student/parent will be responsible for the full amount of the repair/replacement.
● Consumables: Parent will pay 50% of consumables including but not limited to the case ($60-$100), the charger ($29), and software.
● Cosmetic Damage: that does not affect the functionality of the device. This includes but is not limited to scratches, dents, and broken plastic ports/parts or port covers.
● “Jail-breaking” or otherwise voiding the manufacturer’s warranty by altering the software.
● Millburn D24 is not liable for any loss, damage (including incidental, consequential, or punitive damages) or expense caused directly or indirectly by the equipment.
Annual Deductible Per Claim If a student loses an iPad more than once, take home privileges
will be revoked Deductible per Occurrence
$50
Damage/Repair or
Lost/Stolen
If a student is unenrolled from Millburn District 24 for any reason, this accidental protection plan agreement becomes null and void on that date. There are no refunds once this agreement becomes active on the date the iPad is issued. The iPad must be returned on the last day of student attendance.
PLEASE COMPLETE THE INFORMATION ON THE NEXT PAGE AND RETURN THE FORMS TO SCHOOL WITH PAYMENT TO YOUR CHILD’S SCHOOL OFFICE.
Parentspaythepricebelowreflecting50%ofthepriceshownforeachitem.______RuggedCap-$2.50
______RuggedCradle&Cap-$30
______RuggedFrame-$12.50
______RuggedCover–$12.50
______RuggedKeyboard–$24.50
______LighteningCable–$9.50
______12WPowerAdapter-$9.50
______CompleteCase-$49.50
Appl icat ion for Fac i l i t ies Use – 2017-18 MILLBURN C. C . SCHOOL DISTRICT 24 • www.mi l lburn24.net
Updated 02/22/2016
☐ M i l lburn E lementary Schoo l •18550 M i l lburn Road • Wadswor th , IL 60083 • PH 847-356-8331•FAX 847-356-9722 ☐ M i l lburn M idd le Schoo l • 640 Freedom Way • L indenhurst , IL 60046 • PH 847-245-1600 •FAX 847-265-8198 FAC IL IT IES CHARGES District 24 is charging rental fees in an attempt to cover the costs incurred for overtime, custodial, supplies, and utilities as
approved by the Millburn Board of Education.
CATEGORY CHARGES NOTE: PAYMENT IS DUE IN ADVANCE OF THE SCHEDULED EVENT Custod ia l Fee District Sponsored, PTO and Foundation
Waived Waived
Charitable and Non-Profit (requires proof of tax-exempt status) ➤ $5 per classroom; for 2 or more classrooms - $10 each ➤ $50 for gym ➤ $50 for cafeteria
$37 per hour*
Colleges and Universities
$750 per course $37 per hour*
Commercial
Whichever is greater: 15% of gross revenue realized through location OR $15 per classroom/$75 per gym or cafeteria. Whichever is greater, for daily, exclusive school-year use: the rental charge will be a minimum of $4250 per classroom or 20% of gross revenue. If anticipating using % of revenue, a $50 refundable deposit is required with application. A check for the full amount of charges or the $50.00 deposit as listed, is due with this application. Checks are made payable to “Millburn District 24.”
$37 per hour*
Field Use $20 per field** *This additional fee will be charged when a custodian needs to be scheduled during non-working hours (including clean up)
**Lindenhurst Park District is exempt. Contact Person: Email Mailing Address, City, State, Zip Phone GROUP INFORMATION Name of Requesting Group: (Scout groups must include troop/den number and grade level) Check one: ❐ D is t r ic t Organ izat ion ❐ Commerc ia l ❐ Non-Pro f i t ❐ Co l leges and Un ivers i t ies Purpose and Nature of Activity (briefly) Anticipated Number of Participants: Activity will be open for ❐ General Public ❐ Group Members Only ❐ Restricted to: DATE and T IME REQUESTED Dates will only be approved when school is in session.
FAC IL IT IES REQUESTED OTHER NEEDS
❐ East Gym (does NOT inc lude Stage) ❐ C lassroom ❐ Tab les ❐ B leachers
❐ West Gym ❐ Soccer F ie ld (see be low for f ie ld ass ignment a t E lem Sch)
❐Cha i rs
❐Other ❐ Ca fe ter ia (does NOT inc lude K i tchen) ❐ O ther
CERTIF ICATE o f L IABIL ITY A Certificate of Liability Insurance with Millburn School District 24 listed as an additional insured on a primary - noncontributory basis, in the following amounts is needed: • General liability- $1,000,000 per occurrence /$3,000,000 general aggregate. • Auto liability: $1,000,000 per occurrence. • Workers Compensation- $1,000,000/$1,000,000/ $1,000,000
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Check one: ☐ Single Meeting Date ☐ Series of Meetings Date(s) Requested: Day of Week: Start time of activity: AM or PM End time of activity: AM or PM
All non-school related groups must supply adequate supervision to ensure proper care and use of school facilities. The non-school related group is responsible to the Board for the use and care of the school facility. All adult supervisors must have cell phones with them at all times. Sufficient, competent adult supervision must be provided and the adult supervisor must ensure that no minor is left alone after the activity. Only assigned classrooms, the dafeteria, auditorium, gymnasium, and assigned athletic fields, along with needed hallways and parking areas, are avilable for community use. Entering any room or ara not in use by the group is prohibited. The adult supervisor will vacate the facility at the scheduled end time. Use of the school facility is not permitted past the agreed end time. No tables, bleachers, furniture or equipment may be moved without prior approval from the Building Principal. Signs, displays, or materials may not be attached, nailed, or otherwise affixed to walls.
_______Initial here to agree to above statements. All non-school related groups must agree to: • Indemnify and hold harmless the District and its agents and employees for and from any and all loss including attorneys’ fees, damages, expense, and liability arising out of its use of school property. • Pay any damages to school facilities, furniture, or equipment arising out of its use of school property whether such damage was accidental or deliberate. The cost of damages will be based on the repair or replacement cost, the choice of which is at the School Board’s discretion. • Supply proof of insurance naming MILLBURN SCHOOL DISTRICT 24 as an additional insured and verifying that the group maintains adequate insurance coverage against personal injury and/or property loss: Insurance provider name and contact number_________________________________________________________________________________________
_______Initial here to agree to above statements. If the request involves a physical fitness facility, the non-school related group must:
• Designate at lease one adult supervisor who agrees to be an emergency responder. All emergency responders are encouraged to be trained in CPR and AED use. • Be given a copy of the District’s plan for responding to medical emergencies to each designated emergency responder. • Require that 9-1-1 be called for medical emergencies and whenever an AED is used. • Ensure that each designated emergency responder knows the location of first aid equipment and any AED. • Ensure that only trained AED users operate an AED, unless the circumstances do not allow time for a trained AED user to arrive. • Arrange for at least one emergency responder to have a tour of the facility before the activity. • Ensure that if an AED is used, the Superintendent is informed and all appropriate forms are completed.
_______Initial here to agree to above statements.
➨ If charitable or non-profit organization, proof of tax-exempt status is attached. I certify that I am authorized to act for the above-named organization. I understand that: (1) the granting of this request does not constitute recognition of my organization as a school-related group or activity, and (2) my organization may not represent itself or any of its activities as school-related.
I agree to: (1) abide by the conditions stated in this application, and (2) adhere to all Board policies and administrative procedures applicable to this use of the school’s facility.
Applicant name (please print) Telephone number
Address Email address
✎ Applicant signature Date
M i l lburn E lementary School SOCCER FIELD ASSIGNMENT ❐ A Northwest Field ❐ B Northeast Field
❐ C Center-west Field
❐ D Center-east Field
❐ E South Field
For Office Use Facilities Use ❐APPROVED ❐ DENIED O ther Needs ❐ APPROVED ❐ DENIED ✎ Principal Signature _____________________________________________ Date____________________ Dates NOT included with this application
Room Assignment
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