2013 Summer Program

2013 SUMMER PROGRAM

Creative Minds International Public Charter School is happy to offer a summer school program filled with a wide variety of fun learning opportunities that support students’ social-emotional and academic goals. In addition, the program will offer students the following activities: field trips, music, dance, yoga, and sports in addition to other enrichment opportunities. Explore, create and have fun with us this summer!

Schedule July 8th to August 2nd (4 weeks), 9:00 a.m. to 2:00 p.m. at our school building (3224 16th Street NW). If interested, you can enroll for all 4 weeks by filling out the attached registration form. Weekly registration will not be available.

• Students can be dropped off beginning at 9:00 a.m.• Breakfast will be served between 9:00 a.m. and 9:30 a.m.• You can choose to enroll your child in the lunch program (by

checking this option on the registration form).• Late pick up will be charged at a rate of $2/min past 2:00 p.m.• Activities will begin at 9:30 a.m.

Cost English Language Learners (ELL) and Extended School Year (ESY) students are required to participate and will therefore not be charged.

Students eligible for free or reduced meal plans: $50.00

All other students: $400 (with lunch: $495)

These fees will allow us to provide our students with various field trips and other enrichment activities throughout all 4 weeks of the program.

3224 16th Street NW Washington, DC 20010 • 202.588.0370www.creativemindspcs.org

LIMITED SPACES PLEASE REGISTER EARLY!

2013 SUMMER PROGRAM

Registration Form July 8th to August 2nd (4 weeks) 9:00 a.m.— 2:00 p.m.

Student Information

Name ____________________________________________________________________ M ☐ F ☐

Birthdate & Year in School _________________________________________________

Qualifies for National School Lunch Program? Y or N

Qualifies for Extended School Year or is English Language Learner student? Y or N

Do you want lunch provided daily ($95/4weeks)? Y or N Medical History(i.e. allergies, physical limitation(s) & special considerations) ____________________________________________________________________________________________________________________________________________________________________________________________________________

Emergency Contact Information

Name _____________________________________________________________________

Address ___________________________________________________________________

Parent/Guardian 1 Work Phone _______________________ Cell/Other Phone _______________________

Parent/Guardian 2 Work Phone _______________________ Cell/Other Phone _______________________

Email Address _____________________________________________________________________

Doctor’s Contact Information

____________________________________________________________________________________________________________________________________________________________________________________________________________


Please attach your payment (check or money order) with this registration form to reserve your child’s space by February 28, 2013

Reimbursements for withdrawing from the summer program are as follows:• Full reimbursements before June 1st

Please Turn Over

Acknowledgement of Liability - Field Trips

My child has permission to participate in activities/field trips as part of the Creative Minds International Public Charter School (CMIPCS) summer program. I understand that the necessary safety precautions will be taken for supervision during these activities/field trips using DC public transport/rented transportation or walking.

Liability and Medical Waiver

The parent/legal guardian agrees to hold harmless CMIPCS, all CMIPCS personnel, and the owners of any properties in CMIPCS made available for summer school activities, from any claims, damages, losses and/or expenses arising out of participation in summer school activities and to assume all liability for any and all personal injury, bodily injury, illness or property damage that occurs as a result of participation in such summer school activities. The parent/legal guardian also warrants that participation in this summer school is voluntary and that the student and the parent/legal guardian understand the inherent risks involved in summer school activities, and the student agrees to all rules and policies mandated by summer school personnel.

The students’ parent/legal guardian warrants that the student is physically fit and able to participate in summer school activities, and consents to any employee, agent, or other personnel affiliated with the CMIPCS summer school personnel, to seek medical attention and treatment or other measures deemed necessary or advisable in the discretion or judgment of CMIPCS personnel for the above-named student in the event of an accident, sudden illness, or other condition that occurs while the above-named summer is in the care or under the supervision of CMIPCS personnel.

In case of an emergency, the school has my permission, to take my child to the emergency room at the nearest hospital, if I cannot be reached. The hospital and its medical staff have my authorization to provide treatment that a physician deems necessary for the well being of my child. I recognize that CMIPCS does not provide medical insurance for my child and my child is physically able to participate in the activities listed above.

The parent/legal guardian signing this form releases CMIPCS, and all CMIPCS personnel from and of any liability for such decisions or actions in seeking medical care, and agrees to pay all the costs and fees for the medical care or treatment authorized under this emergency medical authorization.

____________________________________________________________Parent or Guardian’s Name (please print)

____________________________________________________________________________________Parent or Guardian’s Signature Date

PLEASE RETURN THIS COMPLETED FORM TO CMIPCS ADMIN For more information, please contact Sebastien at 202.588.0370 or [email protected].


OFFICE USE ONLY DATE: ____________ TOTAL: ____________ CHECK:

NOW Available with AFTER CARE Option Until 5 p.m.

We’re happy to offer a summer school program filled with a wide variety of fun learning opportunities that support students’ social-

emotional and academic goals. The program will also offer students the following activities: field trips, music, dance, yoga,

and sports in addition to other enrichment opportunities.

Explore, create and have fun with us this summer!

Monday, July 8 – Friday, August 2 9 a.m.-2 p.m. / After Care Option Until 5 p.m.

Limited Registration Contact

Sebastien [email protected]

2013SUMMER

PROGRAM

2013 Summer Program

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Transcript of 2013 Summer Program